Buffalo Hospital

“PATIENT RIGHTS: INFORMED CONSENT CFR(s): 482.13(b)(2) The patient or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care. The patient’s rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate. This Standard is not met as evidenced by: 33925 Based on interview and document review, the hospital failed to ensure an established patient power-of-attorney (POA) was updated and afforded a chance to accept or refuse treatment with neuroleptic medication before it was provided on a non-emergent basis for 1 of 10 patients (P2) reviewed who was started on haloperidol (an anti-psychotic medication) while in the hospital. Findings include: On 6/3/26 at 2:59 p.m., P2’s family member (FM)-E was interviewed and stated they were P2’s healthcare POA. P2 had been admitted to the hospital in January 2026 after having a fall, and FM-E voiced several concerns about the care P2 received while admitted. The concerns included P2 being started on haloperidol without them (FM-E) ever being told of it or giving any consent to the medication. FM-E stated P2 had a history of myasthenia gravis (a chronic autoimmune neuromuscular disorder) and using haloperidol could cause those symptoms to be exacerbated and worsen, which was concerning. FM-E stated they learned P2 had been started on the medication after reading their “MyChart” and noticed the medication listed. They then called the hospital and demanded P2 being taken off the medication. FM-E reiterated nobody from the hospital had ever contacted them about it prior to the medication being started which was “illegal and unethical.” FM-E stated that P2 experienced some increased troubles with swallowing after the medication was given for several days, which FM-E attributed to the haloperidol medication. P2’s hospital record identified P2 admitted on 1/3/26 after a fall outside the home on ice with a head injury. The record identified, “Some concern from patient, son and neighbors about her safety at home.” P2’s Psychiatry Consult, dated 1/8/26 at 12:17 p.m., identified P2 was seen for a tele-health consultation by medical doctor (MD)-B for evaluation of paranoia and agitation. The medical record was reviewed, and information was gathered from the patient, registered nurse (RN), and attending physician, however, the note also recorded, “Called [FM-E] but no response.” P2 denied suicidal ideation or past attempts and wanted to get home to attend to her clothes still in the washing machine. The note recorded, “Staff reports she is confuse [sic] and forgetful however no episode of agitation requiring prn [as needed] meds.” P2’s past medical history was outlined and P2 was listed as low risk for imminent self-harm. The section labeled, “Assessment,” identified P2 admitted to chronic depression and being forgetful but there was “ ... No gross agitation or paranoia.” FM-E was identified as P2’s POA but did not regularly speak with P2. A series of orders were written that included haloperidol 0.5 mg at 6:00 p.m. along with dictation reading, “Benefits and risk of neuroleptic medication was NOT discussed with patient or [FM-E] which is POA ... Will follow up.” P2’s Other Orders, undated, identified a subsection labeled, “Medications,” which listed every medication order for P2. This identified MD-B’s order for haloperidol 0.5 milligram (mg) with a frequency listed, “Routine daily afternoon.” The order was placed on 1/8/26 at 2:45 p.m. P2’s Medication Administrations, dated 1/8/26, identified the medications given to P2 on that date. This included haloperidol 0.5 mg at 8:38 p.m. and was signed by RN-C. P2’s medical record lacked evidence P2’s POA had ever been reached or consented to the medication being given prior to it being administered to P2 on 1/8/26. There was no evidence the risks or benefits of the medication had been reviewed or explained to either P2 or FM-E to afford them a chance to consent or refuse the medication despite it being given on a non-emergent basis approximately six (6) hours after being ordered. When interviewed on 6/4/26 at 1:41 p.m., RN-A explained that if a patient was not their own person, then a call should be placed to the emergency contact to obtain permission before administering a newly ordered psychotropic medication. RN-A stated it was not uncommon to see haloperidol being given on the unit especially when a patient is confused, agitated or unable to be directed with care. RN-A reiterated they would call the emergency contact for a confused patient prior to giving the medication unless it was being given for an emergency situation; then the medication would be given and the contact called afterwards with an update. However, RN-A stated this was more a verbal process and that there was no signed consent form to be completed nor did the hospital direct anything be charted to demonstrate this happened. When interviewed on 6/5/26 at 10:29 a.m., RN-C stated the provider was responsible for discussing the risks and benefits of newly ordered medications with a patient or their POA. RN-C reiterated, “As a nurse, we wouldn’t get consent and that would be up to the prescriber.” RN-C stated there was nothing charted by nursing to show if this was done or pending. RN-C stated if someone had a POA, it would also be flagged in the medical record. RN-C recalled working with P2 and stated P2 was “pretty behavioral” at times and upset with “lots of ranting.” RN-C stated they could not recall specifics around the 1/8/26 administration of haloperidol, including if they contacted FM-E about it or not. On 6/5/26 at 10:29 a.m., MD-B was interviewed and verified they had reviewed P2’s medical record. P2 admitted on 1/3/26 after having a fall on ice and had multiple episodes of being confused and agitated which is why the psychiatry consult had been placed. MD-B stated 1/8/26 was the first encounter they had with P2 and recalled her being paranoid and not wanting to talk much. P2 had scored a 14/30 on her SLUMS (screening tool to evaluate cognitive impairment) which showed “some memory issues.” MD-B stated they started the haloperidol on 1/8/26 at “a tiny dose” to help reduce P2’s paranoia. MD-B verified they knew FM-E was the POA for P2 and they were unable to reach them to consult about the medication until the following day, on 1/9/26, when FM-E then did allow the medication to be given. MD-B added, “I knew [FM-E] was POA, that’s why I called [FM-E].” MD-B stated P2 was not able to understand the medication on 1/8/26 due to her condition, and as a result would not have been able to make informed decisions about it then. MD-B stated they acted in the best interest of the patient by ordering the haloperidol on 1/8/26 as P2 was paranoid and “my job is to treat the patient.” MD-B stated that, in hindsight, they likely should have contacted their supervisor when they had been unable to reach FM-B and discussed how to proceed, however, reiterated they acted in good faith to treat P2 as her paranoia seemed “so acute” at the time. On 6/5/26 at 12:02 p.m., a group interview was held with the medical-surgical nurse manager (RN)-G and risk manager (RM)-A. The campus had a consent for psychoactive medication policy in place; however, it was not applicable to the medical-surgical unit but more for the inpatient mental health units. RM-A stated obtaining consent would then fall to more “general operations” and decision-making with the POA if such authority had been activated. RN-G stated any discussion for a risk versus benefit or consent would be the providers responsibility, adding that nurses do the medication basics aloud when given (i.e., this is for your anxiety). RM-A stated with P2, the provider felt the medication was needed on a more “emergent basis” and ordered it accordingly. RM-A then reviewed the time frames of when the order was placed to when it was given, and acknowledged it was several hours between them, adding, “The time doesn’t seem to match that scenario [emergency].” RN-G stated if psychotropic medications were ordered, then “usually before” they were given the consent should be obtained. A Patient Rights and Responsibilities policy, dated 3/2025, identified all employees and contracted staff would respect each patient’s rights and comply with the Minnesota Patients’ Bill oof Rights and Medicare Conditions of Participation. The policy identified patients have the right to accept or refuse medical care, treatments and procedures adding, “A substitute decision maker has the right to accept or decline medical care, treatment or procedures on behalf of a patient who lacks decision-making capacity.””