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Allegations of Patient Assault

Introduction

Date of Last Review 08/01/2012

Date of Last Review 9/2/11
SME:
Patient Relations Manager

Each patient's safety is a great concern to the staff at UTHCPC. Staff members are responsible for helping to provide a safe environment.

Maintaining safe environment

UTHCPC employees perform frequent environmental checks along with checks every 30 minutes to help maintain a safe environment at UTHCPC.

Immunity
Anyone reporting in good faith is exempt from civil and criminal liability and is protected from retaliation in the workplace.

Purpose:
To describe guidelines and requirements for maintaining safety, legality and confidentiality in various types of situations involving an allegation or suspicion of assault, abuse, and/or inappropriate sexual contact between patients.

Statement of Policies:

The immediate health and safety of patients and staff are always of uppermost priority.

HCPC staff will strive at all times to maintain, and promptly reconcile any and all conflicts surrounding the following which are ranked accordingly:

1. Patient Safety
2. Appropriate notification of Law Enforcement
3. Confidentiality.

In the event of irreconcilable conflict between two priorities, the higher ranked priority should prevail until the conflict is resolved.

Patient and staff rights and staff duties regarding the reporting of crimes remain intact in the psychiatric hospital setting. Patients, upon request, must be allowed to freely report alleged crimes, including assault or abuse, to appropriate Law Enforcement Authorities. HCPC staff who may have a reasonable belief that criminal behavior has occurred, must make an immediate report to UTPD dispatch (713-792-2890) within five (5) minutes of their discovery of the event. The report to UTPD shall include the name of the victim(s) involved as well as their location.

Any patient or staff member making a report in good faith will not be subjected to retaliatory or disciplinary actions.

Definitions:

Allegation: A statement indicating a belief that an impropriety has occurred.

Allegation of Patient Abuse: Any reasonable grounds for believing that improper contact between a patient and a staff or between a patient and another patient has occurred or may have occurred.

Allegation of Patient Assault: Any reasonable grounds for believing that an activity involving inappropriate contact with a patient has occurred, or may have occurred, including:
Any statement, allegation or evidence that activity was not consensual, or
Any indication that a patient lacked capacity to give meaningful consent to participate in the activity in question

Crime: A public offense committed or omitted in violation of a law forbidding or commanding it, for which the law provides certain annexations following conviction.

Suspicion: A reasonable belief that an impropriety may have occurred.

Processes:

A. Inappropriate Contact Between Patients and Possible Assualt

Note: Patients with known history of sexually inappropriate behavior should be placed on sexual acting out precautions at the time when the precarious or inappropriate behavior is identified.

1. Any staff with information indicating or suspecting inappropriate contact between patients should immediately:
Make face to face assessments of patients for physical and/or emotional issues
Take necessary actions to restore & maintain safety (separate and/or isolate patients)
Notify nursing supervisor or charge nurse, noting time, place and circumstances of event. Staff shall immediately call UTPD dispatch 713-792-2890 (within 5 minutes) if it is determined that circumstances involve an allegation or suspicion of assault or abuse, including situations involving patients whose capacity to engage in consensual contact maybe questionable. If Assault or Abuse is indicated, also refer the corresponding section below.
Secure the immediate area by limiting access and/or securing relevant items or any personal clothing which may have bearing on the incident in question.
Forward a completed Patient Care Variance Report, the completed UTHCPC Patient Relations Patient Injury/Incident Report A/N/E form, and all collected written statements to Patient Relations.

 

2. If no allegation or no suspicion of assault or abuse are involved the following actions shall be taken promptly:
The Charge Nurse or RN in Charge will

Interview each patient involved with statements gathered on occurrence reports from all involved parties (including staff where indicated)
Give consideration to increasing the monitoring of patients
Give consideration to moving the patient to another unit
Initiate the Patient Relations Patient Injury/Incident Form and notify Patient Relations during Mon-Fri 8AM -5PM with a copy of this form. After hours, the Nursing Supervisor will ensure that the Patient Relations Injury/Incident Report form is completed and delivered to the Patient Relations office.
Send a copy of the Patient Care Variance Report to Patient Relations
Notify the House Officer (MD) who will examine patient and make recommendations in the Patient Relations Injury/Incident Report, patient’s record and refer to patient’s Social Worker where indicated.
Offer the patient a pregnancy test and/or GYN consult as appropriate

B. Allegation or Suspicion of Sexual Assault/Abuse

Upon receipt of information indicating that a sexual assault or sexual abuse to a patient may have occurred including cases where such actions may have occurred without the patient’s consent or the occurrence may be considered nonconsensual due to patient’s incapacity to give meaningful consent, staff shall, in addition to steps indicated in Section A (1) above, also:

Advise patient not to shower, urinate, defecate, eat or drink until arrival of police
Interview any witnesses and documents patient’s emotional state, physical appearance and behavior, and note time/place/circumstances of incident
Accompany police in patient interview as appropriate
Follow UTPD orders for rape exam, and UTPD and HCPC staff (same gender) will escort patient to Ben Taub ER
Provide UTPD with potential evidence upon request (i.e., stained clothing, bed sheets, any other physical items) in return for detailed receipt
By order of the House Officer (M.D.) coordinate transfer of patient to Ben Taub for rape exam
By follow-up of the patient’s Social Worker, notify the patient’s family/guardian
By physician’s order, refer patient to patient’s Social Worker to provide follow-up to patient(s) as recommended.

Note: If a patient desires to file charges, police who respond to the call, will provide direction to the patient about this process.

Allegation or Suspicion of Staff Abuse:

If a review of circumstances, including statements provided by patients or staff, involves an indication that inappropriate contact or assault between a patient and a staff member has occurred or may have occurred, a referral to Patient Relations for an internal Abuse/Neglect/Exploitation investigation to be initiated.

HIPAA and Patient Confidentiality
Confidentiality of patient information is to be maintained to the greatest extent possible without compromising safety. Patient facilitation during the Police response is encouraged. Release of the patient record continues to require the written consent(s) of patients involved. HCPC patients receiving “rape kit” follow-up retain their patient record confidentiality rights.

 

Related standard

The Joint Commission: Ethics, Rights, and Responsibilities,

Texas Administrative Code

 

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Harris County Psychiatric Center University of Texas Health Science Center