INITIAL COMMENTS
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This report is a result of an on-site complaint investigation conducted on October 25, 2012 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site complaint investigation, PA Care LLC d/b/a Miners Medical was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility. The following deficiencies were identified during this investigation.
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Plan of Correction
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715.11 LICENSURE Confidentiality of patient records
A narcotic treatment program shall physically secure and maintain the confidentiality of all patient records in accordance with 42 CFR 2.22 (relating to notice to patients of Federal confidentiality requirements) and § 709.28 (relating to confidentiality).
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Observations
Based on the review of patient records, the facility failed to maintain confidentiality in one of seven patient records, # 5.
The findings include:
Seven patient records were reviewed. The facility failed to maintain confidentiality in its interaction regarding a patient.
Patient # 5 was admitted on June 23, 2011, and involuntarily discharged on September 17, 2012. The facility documented a note dated September 14, 2012, stating the counselor was approached by an employee of a neighboring store. The employee referred to a patient and her behavior in the store. The documentation in the patient's record revealed that counselor acted on the information provided by the store employee and spoke directly following this conversation with the patient in the parking lot in front of the store. This action was not in compliance with maintaining a patient's confidentiality as the counselor did not document any attempt to explain that the facility was unable to verify that the individual was a patient of the facility.
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Plan of Correction
The facility failed to comply with 42 CFR 2.22 and regulation 709.28 relating to confidentiality. On December 6, 2012 the facility director will provide an in-house training on confidentiality, HIPPA, and regulation 709.28 to insure that the privacy of all patients are protected. It is the responsibility of the clinical supervisor to insure that compliance with all confidentiality regulation is maintained. Individual supervision will be utilized to evaluate compliance in this area. The Facility Director will also monitor patient interaction and provide continuing education to employees when needed. |
715.15(b) LICENSURE Medication dosage
(b) The narcotic treatment physician shall determine the proper dosage level for a patient, except as otherwise provided in this section. If the narcotic treatment physician determining the initial dose is not the narcotic treatment physician who conducted the patient examination, the narcotic treatment physician shall consult with the narcotic treatment physician who performed the examination before determining the patient 's initial dose and schedule.
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Observations
Based on the review of patient records and incident reports, the facility failed to document the physician determined the dosage in five of seven patient records.
The findings include:
Seven patient records were reviewed. Patient records failed to contain documentation of the narcotic treatment physician determining dose, # 1, 2, 5, 6 and 7.
Patient # 1 was admitted to treatment on September 16, 2011, and involuntarily discharged on May 3, 2012. The facility documented a case consult on March 19, 2012, for 90 day review of a contract from January 9, 2012. The recommendation was for a higher level of care. The check off boxes for attendees remained blank. The patient was immediately discharged per an incident report signed by two clinicians and the facility director. The documentation did not include consult with the narcotic treatment physician.
Patient # 2 was admitted on July 27, 2010, and involuntarily discharged on May 9, 2012. The patient was involuntarily discharged for positive urine drug screens, not meeting monthly treatment hours, and disrespect of staff. A case consultation on April 26, 2012, signed off by multiple clinical staff stated the patient was to complete an administrative detox and then transfer to Suboxone program. The documentation did not include consult with the narcotic treatment physician.
Patient # 5 was admitted on June 23, 2011, and involuntarily discharged on September 17, 2012. The patient was involuntarily discharged for alleged theft from the store next door. The documentation included contact with the facility director by the counselor. The patient met with two counselors and a nurse. The documentation did not include consult with the narcotic treatment physician.
Patient # 6 was admitted on December 1, 2011, and involuntarily discharged on September 28, 2012. The patient was involuntarily discharged for continued use of illicit substances, not obtaining a methadone friendly physician and using intimidation tactics. The patient was immediately discharged. The documentation did not include consult with the narcotic treatment physician.
Patient # 7 was involuntarily discharged on May 3, 2012. The patient was involuntarily terminated for alleged illegal distribution per an incident review. The patient was immediately discharged without offer of detoxification. The documentation did not include consult with the narcotic treatment physician.
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Plan of Correction
The facility failed to demonstrate via documentation in the clinical record that the narcotic treatment physician participated in the treatment team meetings, case consultations, and/or discussions regarding detoxification of patients and was solely responsible for determining the dosage and dosing schedule of all patients. The facility will complete case consultations during treatment team meetings begining 11/29/12 which the physician attends and participates and modify the case consultation form to include the signature of the physician. The facility director and Senior Counselor will provide education to the staff on the importance of documenting the physicians dosing and detoxification decisions in the progress note as well as case conference. The facility director and/or clinical supervisor will review all case consultations to insure that the physician's participation is documented via her signature. |
715.21(1)(i-iv) LICENSURE Patient termination
A narcotic treatment program shall develop and implement policies and procedures regarding involuntary terminations. Involuntary terminations shall be initiated only when all other efforts to retain the patient in the program have failed.
(1) A narcotic treatment program may involuntarily terminate a patient from the narcotic treatment program if it deems that the termination would be in the best interests of the health or safety of the patient and others, or the program finds any of the following conditions to exist:
(i) The patient has committed or threatened to commit acts of physical violence in or around the narcotic treatment program premises.
(ii) The patient possessed a controlled substance without a prescription or sold or distributed a controlled substance, in or around the narcotic treatment program premises.
(iii) The patient has been absent from the narcotic treatment program for 3 consecutive days or longer without cause.
(iv) The patient has failed to follow treatment plan objectives.
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Observations
Based on the review of patient records and incident reports, the facility failed to restrict the reasons for involuntary termination to those reasons allowed by regulation in six of seven patient records.
The findings include:
Seven patient records were reviewed. All patient records were reviewed for involuntary discharge. The facility failed to document all efforts to retain the patient in the program prior to initiating an involuntary termination. Patient records contained documentation of the patient being discharged for reasons other than those listed by regulation, # 1, 2, 3, 5, 6 and 7.
Patient # 1 was admitted to treatment on September 16, 2011, and involuntarily discharged on May 3, 2012. The patient was involuntarily terminated for alleged illegal distribution per an incident review. The facility failed to document confirmation of the activity.
Patient # 2 was admitted on July 27, 2010, and involuntarily discharged on May 9, 2012. The patient was involuntarily discharged for positive urine drug screens, not meeting monthly treatment hours, and disrespect of staff. These are not reasons that a patient can be involuntarily terminated according to this regulation.
Patient # 3 was admitted on July 15, 2011, and involuntarily discharged on July 5, 2012. The patient was involuntarily discharged for continued use of illicit substances, missed dosing and missed clinical sessions. These are not reasons that a patient can be involuntarily terminated according to this regulation.
Patient # 5 was admitted on June 23, 2011, and involuntarily discharged on September 17, 2012. The patient was involuntarily discharged for alleged theft from the store next door. This is not one of the reasons that a patient can be involuntarily terminated according to this regulation.
Patient # 6 was admitted on December 1, 2011, and involuntarily discharged on September 28, 2012. The patient was involuntarily discharged for continued use of illicit substances, not obtaining a methadone friendly physician and using intimidation tactics. These are not reasons that a patient can be involuntarily terminated according to this regulation.
Patient # 7 was involuntarily discharged on May 3, 2012. The patient was involuntarily terminated for alleged illegal distribution per an incident review. The facility failed to document confirmation of the activity.
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Plan of Correction
The facility failed to comply with regulation 715.21. The facility director and senior counselor will provide a comprehensive training to all counselors on December 13, 2012 regarding compliance with involuntary termination guidelines, necessary documentation, engagement techniques, and appropriate treatment interventions. Specific direction and oversight to insure compliance will be provided by the facility director and senior counselor via ongoing clinical supervision. |
709.33(a) LICENSURE Notification of Termination
709.33. Notification of termination.
(a) Project staff shall notify the client, in writing, of a decision to involuntarily terminate the client's treatment at the project. The notice shall include the reason for termination.
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Observations
Based on the review of patient records and incident reports, the facility failed to inform the patient, in writing, of a decision to involuntarily terminate the patient's treatment in four of six patient records.
The findings include:
Seven patient records were reviewed. All patient records were reviewed for involuntary discharge. Of these records, six records required written notification to the patient informing him/her of the decision to terminate the patient's treatment. The facility failed to document notification to the patient in patient records # 1, 5, 6 and 7.
Patient # 1 was admitted to treatment on September 16, 2011, and involuntarily discharged on May 3, 2012. The patient was involuntarily terminated with no written notification of the decision to terminate.
Patient # 5 was admitted on June 23, 2011, and involuntarily discharged on September 17, 2012. The patient was involuntarily terminated with no written notification of the decision to terminate.
Patient # 6 was admitted on December 1, 2011, and involuntarily discharged on September 28, 2012. The patient was involuntarily terminated with no written notification of the decision to terminate.
Patient # 7 was involuntarily discharged on May 3, 2012. The patient was involuntarily terminated with no written notification of the decision to terminate.
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Plan of Correction
The facility failed to comply with regulation 709.33, notification of termination. The facility director and clinical supervisor will provide a staff training on December 6th regarding the policy and procedure to provide all patients with written documentation of a decision to involuntarily terminate a patient's treatment. Training will include a review of the Involuntary Termination Form and the need to provide referrals to other providers upon discharge. The facility director and clinical supervisor will provide direct oversight on all involuntary terminations to insure that patients receive the appropriate written notice and referrals. |
709.33(b) LICENSURE Notification of Termination
709.33. Notification of termination.
(b) The client shall have an opportunity to request reconsideration of a decision terminating treatment.
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Observations
Based on the review of patient records and incident reports, the facility failed to provide the patient an opportunity to request reconsideration in four of six patient records.
The findings include:
Seven patient records were reviewed. All patient records were reviewed for involuntary discharge. Of these records, six records required providing the patient an opportunity to request reconsideration of the decision to terminate the patient's treatment. The facility failed to document providing the patient an opportunity to request reconsideration in patient records # 1, 5, 6 and 7.
Patient # 1 was admitted to treatment on September 16, 2011, and involuntarily discharged on May 3, 2012. The patient was not provided an opportunity to request reconsideration of the involuntarily termination.
Patient # 5 was admitted on June 23, 2011, and involuntarily discharged on September 17, 2012. The patient was not provided an opportunity to request reconsideration of the involuntarily termination.
Patient # 6 was admitted on December 1, 2011, and involuntarily discharged on September 28, 2012. The patient was not provided an opportunity to request reconsideration of the involuntarily termination.
Patient # 7 was involuntarily discharged on May 3, 2012. The patient was not provided an opportunity to request reconsideration of the involuntarily termination.
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Plan of Correction
The facility failed to comply with regulation 709.33 providing the client with an opportunity to request reconsideration of a decision to terminate treatment. The facility director and/or clinical supervisor will provide training to all staff on the Notice of Treatment Termination form on December 12th which provides the client an opportunity to write an appeal and request a meeting with the facility director, clinical supervisor, and medical doctor. The training will also include focus on documentation to include keeping a copy of the client's appeal letter in their record. The facility director and clinical supervisor will provide oversight on all Notice of Treatment Termination forms that are being presented to clients to insure adherence to regulation 709.33. |