Hospital faulted over drug restraint

By Marshall Allen

Saturday, May 15, 2010 | 2:01 a.m.

Staff at the state’s Rawson-Neal Psychiatric Hospital failed to document and disclose the use of drugs to subdue out-of-control patients in each of 10 randomly selected cases, an investigation revealed Friday.

In two of the cases, the facility’s records did not justify the drug use, investigators found.

The hospital has been under scrutiny since a patient died April 4 while she was supposed to be on one-to-one observation. A state investigation revealed in late April that staff failed to properly monitor the woman. Her cause of death had not been determined.

Friday’s findings hinge on the definition of “chemical restraint.” Nevada law defines it as administering drugs for the exclusive purpose of controlling aggressive behavior. That’s what happened in the 10 cases at Rawson-Neal, according to the Nevada State Health Division’s health care quality and compliance bureau, which licenses and investigated the facility.

Harold Cook, administrator of Nevada’s Mental Health and Developmental Services Division, which runs the 212-bed hospital near Oakey and Jones boulevards, said the facility does not use chemical restraints. In each of the cases identified, he said, patients were being treated with drugs that addressed the psychological disorders that led to the behavior problems. Cook said he will appeal the findings.

The investigation faulted the facility for failing to complete the “denial of rights” reports when restraints are used — reports that, according to Cook, were not necessary because drugs were not used as chemical restraints.

Marla McDade Williams, Health Division deputy administrator, said the problems boil down to a failure to protect the rights of patients, who deserve to know and have a record of the treatment they receive.

A hearing officer will need to resolve the dispute, Williams said. Rawson-Neal faces a potential $800 fine for the violations.

Meanwhile, a family member of the patient who died April 4 provided more information to the Sun about the incident. The relative, who did not want to be identified so she could protect her family’s privacy, said the patient was a 53-year-old nurse from San Francisco who had been visiting Las Vegas on business. The woman had a schizophrenic episode that caused her to be combative and violent, and was admitted to Rawson-Neal a week before she was discovered dead, the relative said. The family was in constant contact with a social worker about her care, the relative said.

The patient had no known medical problems, although she was morbidly obese, about 400 pounds, the family member said.

The hospital’s medical director notified the family of the death, but no one knew that the patient had not been observed on a one-to-one basis until they read about it in the Sun weeks after the death.

“I’m just baffled about why any of this was allowed to happen,” the relative said.