INITIAL COMMENTS
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This report identifies the findings of an on-site complaint investigation conducted on February 27, 28, and March 1, 2007 by staff of the Division of Drug and Alcohol Licensure.
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Plan of Correction
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715.6(a)(3)(i) LICENSURE Physician staffing
(a) A narcotic treatment program shall designate a medical director to assume responsibility for administering all medical services performed by the narcotic treatment program.
(3) The medical director 's responsibilities include the following:
(i) Supervision of narcotic treatment physicians.
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Observations
The facility failed to ensure that the Medical Director fulfilled his responsibility to supervise the narcotic treatment physician. For the period of June 2006 to March 2007, the Medical Director was on site at Health Masters a total of 6.75 hours: 3.75 hours in October 2006 and 3 hours in December 2006. The Medical Director cannot perform the responsibilities of Medical Director, including the supervision of the narcotic treatment physician, if not on site. The narcotic treatment physician has less than one year of experience in using methadone for the treatment of narcotic addiction.
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Plan of Correction
STATEMENT: PLAN OF CORRECTION: Simmon L. Wilcox has resigned as Medical Director effective upon Dr. Patricia M. Bonitatibus executing an employment contract. The employment contract defines her responsibilities and the time she will be spending on site. Her time added to our CRNP's hours exceed the required time on site. Dr. Pat has in excess of 1 year experience. We will forward under separate cover her qualifications.
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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
The facility failed to maintain the confidentiality of a meeting with two patients. Specifically, on Monday, February 12, 2007, patients number 1 and 2 returned to Health Masters for a follow-up meeting with the narcotic treatment physician. The follow-up meeting with the physician, both patients, one patient's mother and the facility director occurred in the hallway at Health Masters with disregard to the sensitive nature of the issues being discussed or the patients' right to confidentiality. As reported by patient #1, the narcotic treatment physician began yelling at the patients because they failed to follow the physician's directive. The facility director supported the allegations of patient #1 in regard to the lack of sensitivity to the situation on the part of the narcotic physician, as well as the physician's lack of emotional control when "screaming" at the two patients that they did not follow her directive.
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Plan of Correction
PLAN OF CORRECTION: The entire staff including Dr. Pat have been instructed to give the patient at all times the freedom of choice which includes the right to make decisions as to the selection of those entities providing medical help. Periodically the staff and Dr. Pat will be reminded by facility director and governing body of the patients' freedoms.
Facility Director will review Health Masters Policy 715.11 pertaining to confidentiality of patients with staff at weekly meetings on a quarterly basis. Staff will sign an acknowlegement form that policy was reviewed and that each staff member will adhere to the policy.
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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
The facility failed to adhere to the specific conditions set forth in the regulations concerning when a patient may be involuntarily detoxed from methadone, a life sustaining medication. The narcotic treatment physician ordered an involuntary discharge and methadone detoxification for patient number 1 and 2 for not following the physician's specific directive. Instead of going to the hospital designated by the narcotic treatment physician, patients number 1 and 2 went to a hospital of the patients' choice. They were able to verify treatment at the hospital. According to patient #1, on Monday, February 12, 2007, the narcotic treatment physician began yelling at them because they failed to follow the physician's specific directive. The physician then stated she would be placing both patients on a ten day methadone detoxification protocol since they did not go to the hospital designated by the narcotic treatment physician.
The physician did not make an attempt to retain these patients and violated this regulation when she ordered an involuntary detoxification for these patients.
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Plan of Correction
PLAN OF CORRECTION: The following involuntary patient termination standing operating procedure shall be followed. An interdisciplinary team made up of the Facility Director, the Medical Director, Counselor, and dosing nurse shall meet to review the factual circumstances to determine whether all efforts have been made to correct the situation and whether the facts fall into one of the 4 termination categories. In the event a termination shall be ordered it shall follow the regulations.
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715.28(c)(1-5) LICENSURE Unusual incidents
(c) A narcotic treatment program shall file a written Unusual Incident Report with the Department within 48 hours following an unusual incident including the following:
(1) Complaints of patient abuse (physical, verbal, sexual and emotional).
(2) Death or serious injury due to trauma, suicide, medication error or unusual circumstances.
(3) Significant disruption of services due to a disaster such as a fire, storm, flood or other occurrence.
(4) Incidents with potential for negative community reaction or which the facility director believes may lead to community concern.
(5) Drug related hospitalization of a patient.
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Observations
The facility failed to file the required incident report. On February 12, 2007, the narcotic treatment physician was observed by the facility director verbally screaming at and threatening patients number 1 and 2. The required incident report regarding the verbal abuse was never filed with the Division as required.
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Plan of Correction
PLAN OF CORRECTION: The subject of filing "Unusual Incident Report" shall be reviewed and emphasized at the next weekly meeting of staff. Periodically, the subject of Incident Reporting will be reviewed with the entire staff.
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