Rex official resigns after scathing federal report
Posted May 14, 2015
Raleigh, N.C. — A Rex Hospital official has resigned after a federal investigation exposed communication and policy lapses in how a psychiatric patient was treated in the facility’s emergency department.
Sherry Whitt, the department's director, resigned this week, hospital officials said.
“She said that following recent events, her stepping down would help ensure the long-term stability of the Rex ED, and allow nurses and other co-workers to focus on their mission of providing excellent care to all patients,” the hospital said in a statement.
Rex was cited by federal officials for a “lack of coordination and communication” between nursing and security staff while caring for a “psychiatric patient with known violent behavior” in its emergency department in January. Investigators also said the patient should not have been continuously restrained and that security officers should not have used Tasers to subdue the patient. Federal investigators have since approved the hospital's changes.
James Gibbs, the Rex nurse who contacted the U.S. Department of Health and Human Services, said little was done after he met with the hospital’s ethics committee “regarding the involvement of administration in altering printed policies without oversight or review” and filing a complaint with state officials.
Rex officials said staff followed the hospital's policies and procedures, but Gibbs said they did so under pressure.
“My coworkers identified that there was a problem in the policies being implemented, but were intimidated by the director of emergency services Ms. Whitt and the director of security,” Gibbs said in a statement. “The problem is not with nursing ... the problem is with 'whisper policy' creation from the director. It is true that the staff upheld these policies of keeping the patient in restraints ‘at all times’ but it was through intimidation and fear of punishment that these staff members acted.”
Violent patient exposes ‘catastrophic’ problems
In a 281-page report, nurses and administrators told federal officials how William Scott Gibbs, 24, was treated in Rex’s emergency department.
William Gibbs, who is unrelated to James Gibbs, was brought to Rex by ambulance from a mental health crisis center one day after being released from prison for assaulting a relative. He was involuntarily committed to Rex for “being too violent as he was verbally aggressive to staff members,” the report said.
During his 17-day stay, William Gibbs was stunned twice by a Taser – the first after he punched two security officers – and was restrained the entire time.
Chris Main, the hospital's director of protective services, told investigators the second Taser use was “a direct result of communication breakdown” and that policies were not followed.
Main's employment status at the hospital has not changed since the report, Rex officials said.
William Gibbs has a history of assault, including pending charges for attacking a Rocky Mount police officer in March and convictions for assaulting an emergency room worker at Nash General Hospital and a probation officer in 2014. He also had two assault convictions in 2013.
William Gibbs faced a Wake County judge on Thursday, charged with simple assault for attacking a Rex security officer during his stay.
His family, who were in the courtroom, did not want to talk on-camera but said he has not received the help he needs due to being in and out of hospitals and jails.
Rex staff told investigators there were multiple communication breakdowns, incomplete policies and that they were not ready for such a violent patient, according to the report. The hospital was cited for failing “to assure a safe patient environment” by allowing non-law enforcement personnel to use Tasers to subdue psychiatric patients, failing “to discontinue restraints at the earliest possible time” and not placing a patient known for violent behavior into the custody of law enforcement to be taken to a psychiatric hospital.
“The hospital’s leadership failed to provide oversight and have systems in place to ensure the protection and promotion of patients’ rights, failed to have an organized nursing service and failed to provide emergency services to meet the patient's needs,” the report said.
Whitt, the former emergency department director, told federal investigators that “staff were not managing the patient well” and that “the nurses and security were not working together.” She described the ordeal as a “catastrophic communication failure.”
A larger societal problem
Rex was placed in “immediate jeopardy” due to the report, meaning it could lose federal Medicaid reimbursements if issues were not addressed. Hospital officials said the facility is now in compliance.
In addition, Rex officials said they instituted additional training for staff and updated policies “to reflect the increasing number of behavioral health patients coming to our ED.” They described the incident with William Gibbs as an “extreme situation.”
“Rex executives have been meeting frequently with our emergency department co-workers to listen to their concerns and to reiterate that they have done nothing wrong,” the hospital said. “Rex ED co-workers followed the hospital’s existing policies and procedures and provided the best care possible, while trying to protect the patient and themselves.”
The incident also points to a larger societal problem – William Gibbs spent more than two weeks at Rex because there are not enough state mental health beds, hospital officials said.
“Hospital EDs are not the best places to help behavioral health patients get well,” they said. “It is incredibly challenging for a community hospital to provide care for violent patients with acute mental health needs. We recognize, however, that community hospitals are often stopovers until a patient can be moved to a more appropriate facility with specialized care.”
James Gibbs, the nurse, is confident in Rex’s efforts to address the patient care issues he brought to federal officials.
“I am confident in (Chief Nursing Officer Joel Ray’s) and (Chief Medical Officer Dr. Linda Butler’s) ability to rectify this problem and restore confidence in our hospital, and most importantly, in my more than capable and skilled coworkers,” he said.