Discussion Question

In not less than 200 words discuss:

Mr. Roland Jones, a patient of Dr. Reed Simon, has a history of mental illness. Mr. Jones is taking Depakote®, a medication for bipolar patients, but was hospitalized because he has been having increased symptoms of hallucinations and convulsions. Mr. Jones has no known family in the local area, and insists on going home because he is “afraid of these nurses.” Dr. Simon refused to release the patient, so Mr. Jones sneaked out of the hospital. He was found approximately 3 hours later near the side of the road (approximately 2 miles from the hospital) and was non-responsive.

Please discuss the following:

What responsibilities and liabilities does the hospital have? Dr. Simon? Any other healthcare professionals involved?
What options did the facility have in terms of ensuring Mr. Jones wasn’t able to physically leave the facility?
Should a medical facility have the ability, under the law, to keep a person against their will?
If so, what criteria should be used? Who decides whether patients fit these criteria?
Now, that Mr. Jones has been found, please discuss how you as the administrator of this facility will respond to this incident and what measures will be put in place to avoid such an undesirable outcome.
On two different paragraph with no less than 100 words give your personal opinion to Brenda Newcomb and Crystal Moore

Crystal Moore

Referring back to chapter 3, mentally ill and incompetent patients by law must have emergency medical treatment provided to them and it is the hospitals responsibility to be prepared to handle such patients for their safety as well as the safety of others (Showalter, 2017). Mr. Jones was clearly incapable of making decisions for himself based off his mental condition and daily medication use. Dr. Simon should have immediately initiated a plan to make the patient high risk for elopement and put the patient on constant monitoring.

Under the EMTALA law, patients that present such behavior problems require an appropriate medical screening so that they get the care they need and all precautions are taken to keep the patient safe (Showalter, 2017). As a result of the patient not being properly attained, the entire medical staff involved with Mr. Jones’ care should be held liable for the circumstances that unfolded.

The facility should have protected Mr. Jones by providing him with a constant observer/sitter once he displayed signs of increased mental illness. Hospitals provide sitters, observers and companions to individuals in need of constantly monitoring. Some facilities also offer rooms installed with cameras and speakers so that the individual is monitored remotely and redirected by voice through the speaker when necessary. The nurse should have inquired about constant observation and the physician should have written orders to have the patient monitored for safety.

Yes, medical facilities have the right to keep a patient against their will if they are deemed mentally incompetent, unsafe, or are a danger to themselves or others. Therefore the decision is made with the knowledge and expertise of the medical staff. The family can also recommend constant monitoring if they believe that the patient is in danger or pose a threat to themselves. In this case, the patient unfortunately had no family to advocate on his behalf.

As an administrator I would call into question the nurse, charge nurse, nurse assistant and physician who were assigned to Mr. Jones. I would review all charting and documentation looking specifically for nursing/physician notes regarding the patients assessment. The patient presented to the facility with increased hallucinations (note: Depakote has many side-effects including increased ammonia levels which can cause disorientation, confusion and difficulty thinking), a history of bi-polar disorder which automatically made him mentally unstable upon his initial triage assessment (NAMI, 2016). There should have been standard protocols put into place to keep the patient from eloping such as a colored gown, room/door signage, all staff alert, etc. After the physician assessed the patient, constant monitoring should have been ordered until completion of a psychiatric evaluation. Since these steps were not followed, I would speak with the staff and explain the importance of following immediate protocols whenever there is a patient who could potentially put themselves in danger. A refresher course for the entire staff would be implemented and there will be a mandatory educational staff sign-off on appropriate patient safety measures. I would personally give the nursing staff involved with Mr. Jones verbal warnings for not following protocols and inevitably placing the patient in harms way. I do not think that termination or written reprimand for this isolated incident would be my first approach, unless I noticed a pattern of negligence from the nurse or assistant.

References:

NAMI. (2016, January). Retrieved February 21, 2020, from https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Types-of-Medication/Valproate-(Depakote)

Showalter, J.S. (2017). The Law of Healthcare Administration (8th ed.). Chicago, IL: Health Administration Press.

Brenda Newcomb

Dr. Simon and the staff has the responsibility and the liability under the common law, that do not require the duty to serve or admit everyone who may be present. In other words, people have no common law duty in aiding another person. However, the common law does not impose a duty on a hospital in treating emergency patients. An option the facility had of ensuring that Mr. Jones was not able physically to leave the facility was a policy in detail that covered the situation. The policy should have included documentation of Dr. Simon’s advice given to the patient and their signature on a form that released the facility from liability. The form should have stated that the patient had knowledge of the reasons medically, for recommending staying and should have been advised not to leave the facility. It should have been recommended that leaving was solely on the patient’s own and refusing to stay was the patient’s will and his violation. The facility had the ability to restrain Mr. Jones because of his unsound mind of mental illness, from leaving the facility if his leaving endangered his health and life and the lives of other people (Showalter, 2017).

As the administrator of the facility, I would call a meeting to order with all staff

that were involved, including Dr. Simon. A review will take place of all documentation of treatments and charting. I would remind the staff and doctor that the protocol of standards was not followed, and they should have restrained Jones from leaving the facility, by keeping watch on him or other means. From the nature of the incident, I would have to educate meetings monthly, on patients’ safety at the facility and the protocols that follow (Showalter, 2017).

Showalter, J.S. (2017). The Law of Healthcare Administration (8th ed.). Chicago, IL: Health Administration Press.