Florida the rules are different here Chapter XXVII

Are we a third world country? Because a Miami-Dade hospital has been called a health threat by the state of Florida.

Condemning the hospital for putting binding restraints on elderly and mentally disabled patients, state regulators have ordered Aventura Hospital to stop admitting nonemergency patients.

One patient died after being placed in physical restraints on the hands and legs and given several medications that could serve as chemical restraints, although a state report didn't conclude those actions led to the patient's death.

Still, after finding problems with five patients placed in restraints, the Agency for Healthcare Administration declared the facility presented ''an immediate threat to public health and safety'' and took the highly unusual move of closing it to all admissions except those entering through the emergency room.

Hospital spokeswoman Luz Urbáez Weinberg said the Aventura facility is working with investigators to resolve the issues and hoped the ban would be lifted quickly.

Federal officials are getting involved after being notified by the state. Spokeswoman Sharon Fisher said the Center for Medicare & Medicaid Services is in the process of looking into the situation at Aventura.

Alan Levine, secretary of the Agency for Healthcare Administration, said, ``It's very rare that the agency will take such an aggressive action. It's only when there is a potential danger to the safety, health or well being of patients.''

Incredible. Here are some of those patients and what happened to them.

• On March 28, a mentally disabled patient who had an ulcer caused by a leg cast was admitted to the hospital. The man became agitated and was restrained at the ankles and wrists. He was prescribed several drugs.

One of the drugs, an anti-seizure medication called Klonopin, was supposed to be given twice daily, at 3 and 9 p.m.

At 7 p.m. April 2, a ''sitter'' was assigned to constantly monitor the patient, who was still restrained. At 8:30 p.m., a doctor ordered a drug be given to the patient to treat congestion. There is no evidence the drug was given.

That night, the patient missed the 9 p.m. dose of Klonopin, but was given a dose at 10:30 and another at 11:59. No explanation was given for the extra dose.

The patient died at 3:30 a.m. April 3.

• On May 4, an 81-year-old man with a urinary tract infection and possible pneumonia was admitted. His condition deteriorated, and a feeding tube was inserted into his stomach. On May 14, a doctor ordered the patient be restrained as needed. Federal regulations prohibit ordering restraint as needed -- the order must be written for a specific circumstance. A nurse ordered that the patient be restrained at the wrists. On May 25, 11 days after the restraint order, he was placed on a ventilator and still restrained.

State investigators concluded there was nothing in the man's records to demonstrate whether he was properly monitored while in restraints, nor was there anything that showed ``any behavior or other basis which would justify the use of restraints.''

• Three patients, ages 61, 78 and 90, were described as ''unresponsive'' and ''flat on his/her back in the bed.'' For all three, physicians issued daily orders to keep the patients restrained.

Investigators found nothing in the patients' records to show that they were monitored for the effects of long-term restraint or cared for to prevent the problems that can arise from long-term restraint. There was also no evidence in the records of ''any behavior or other basis which would justify the use of restraints,'' or ''any indication of the continued necessity of restraints,'' according to the state's report.

If you want more details, here is a PDF with details of the suit brought by the State of Florida.

All of this led to the State of Florida prohibiting Adventura hospital from admitting non-emergency patients. That ban was a short one, it has already been removed.

I'm disgusted by this whole story, partly due to having formerly worked in the healthcare field. Restraints are seldom used, usually if a patient is violent or incoherent, and then we try only using them as a last resort. Adventura if the reports are to be believed, used restraints without proper reason. Also it appears these patients were left alone in their restraints. What kind of health care people work at this place?

Ok I believe most people at the hospital were professionals at their work. Maybe even some of them reported what was going on to the state. Some had to have known what was happening, and said nothing. They are as bad in my opinion as the doctors who ordered unnecessary restraints.

Missing records are damning in themselves. I worked in x-ray, which is far different than working as a nurse, but the record keeping one does is immense. In an average day I did as much record keeping as I did time with patients. You almost have to wonder if Adventura deliberately fudged their records or destroyed them.

All I say is I hope the State of Florida keeps a close eye on this hospital.

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