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Based on, reviews of, facility's diversion data, medical records, facility policies and procedures, Probate Court, Order to Apprehend, Chief Medical Officer, and interviews the facility failed to provide an appropriate medical screening examination that was within the capability of the hospital ' s emergency department to determine whether or an emergency medical condition exists for one (1) of twenty one (21) patients who presented to the emergency room for treatment (#21). Refer to findings at Tag A-2406.


Based on reviews of medicals records, policies and procedures, and staff interviews the facility failed to provide within their capabilities of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilize the medical condition for 1 (#21) of 21 patient who presented to the emergency room for treatment. Refer to findings at Tag 2407.

Based on reviews of medical records Probate Court, Order to Apprehend, policies and procedures and staff interviews the facility failed to provide an appropriate transfer by failing to provide medical treatment within its capacity that minimized the risks of to an individual's health for 1 (#21) of sampled patients who presented to the emergency department for treatment. Refer to findings at Tag 2409.

Based on review of Medical Staff and Appended Rules and Regulations, the facility failed to maintain a medical and other records related to individuals transferred to or from the hospital for one (#21) of twenty sampled (21) patients who presented to the emergency room for treatment.
Findings include:
Review of the of the Medical Staff and Appended Rules and Regulations, dated 12/16/10 revealed that an attending medical staff member would be responsible for the preparation of a complete and legible medical record of each patient and that an appropriate medical record would be kept for every patient receiving emergency services and incorporated in the patient's hospital record, if such exist. The record would include adequate patient information; information concerning the time of the patient's arrival, means of arrival, and by whom transported; pertinent history of the injury or illness, including details relative to first aid or emergency care given the patient prior to his arrival at the Hospital; description of significant clinical, laboratory and or radiologic findings; diagnosis; treatment given; condition of the patient on discharge or transfer; and final disposition, including instructions given to the patient and/or his family, relative to necessary follow-up care.
The facility failed to ensure that the Medical Staff and Appended Rules and Regulations were followed as evidence by failing to create a medical record for patient #21 on 6/8/2015 when he/she presented to the Emergency Department.

Based on reviews of Emergency Central Log, and policy and procedure, the facility failed to assure that patients who presented to the emergency room were logged into the Emergency Central Log for 1 (#21) of 21 sampled patients.
Findings include:
Review of the ED census log failed to reveal evidence that patient #21 had been logged, registered, triaged, and/or appropriate discharge/transfer to another facility.
Review of the facility's Georgia Central Log Policy, effective May 1989, last reviewed 07/10/2012, revealed the facility would maintain a central Log containing information on each individual who comes on the hospital campus requesting assistance or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he/she left before a medical screening examination (MSE) could be performed whether he or she refused treatment, or whether he or she was transferred or discharged. The facility failed to ensure that their policy and procedure was followed as evidenced failing to maintain a central log on patient #21 on 6/8/2015 who presented to the emergency department seeking medical assistance.








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Based on, reviews of, facility's diversion data, medical records, facility policies and procedures, Probate Court, Order to Apprehend, Chief Medical Officer, and interviews the facility failed to provide an appropriate medical screening examination that was within the capability of the hospital ' s emergency department to determine whether or an emergency medical condition exists for one (1) of twenty one (21) patients who presented to the emergency room for treatment (#21).
Findings include:
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Review of facility policy titled, EMTALA, effective date January 1990, last review date 7/10/2012 revealed: A) all individuals or representative presenting on the facility grounds and requesting an examination or treatment would receive a medical screening examination (MSE) . . . within the capability of the hospital's emergency department, including ancillary services routinely available to the Dedicated Emergency Department (DED) to determine whether or not an Emergency Medical Condition (EMC) exists.
Review of a letter which was dated 1/21/14 from the Chief Medical Officer to all ED staff concerning diversion and EMTALA requirements, directed that the facility must receive and accept all unstable patients, . . ., regardless of diversion status.
The probate paperwork for patient #21 was reviewed. The " ORDER TO APPREHEND " dated June 8, 2015 revealed in part, TO ANY PEACE OFFICER OF SAID COUNTY You are commanded to take into custody Patient #21 ...a MENTALLY ILL person requiring involuntary treatment who presents a substantial risk of imminent harm to himself/herself or others as manifested by either recent overt acts or recent expressed threats of violence which present a probability of physical injury to himself/herself or to other persons ...You shall deliver ...forwith to, EASTSIDE MEDICAL CENTER, SNELLVILLE, GA. ...for an examination as prescribed by law. "
The medical record from the Hospital (Hospital B) where patient #21 was taken for an appropriate MSE was reviewed. Review of the Emergency Department Chart form from Hospital B revealed that Patient #21 presented to the ED on 6/8/2015 at 6:57 p.m. The Chief Complaint was listed as " Suicidal Thoughts. " The patients triage (A process of sorting people based on their need for immediate medical treatment) level was listed as "Emergent." Further review revealed in part, "Pt (patient ) brought in by Sheriff ' s department deferred by Eastside, " Review of the Nursing Consultation Notes dated 6/8/2015 at 7:09 p.m., revealed in part," PROBATE PPWK (paper work) STATES PT (patient) HAS SEVERE MOOD DISORDER AND IS THREATENING TO KILL SELF AND FAMILY ...Pt (patient) medicated per TO (telephone order) per MN(Name). Security at bedside with Sheriff 's officers securing pt. with restraints. Pt screaming and spitting ...Security remains at bedside. Restraints remain in place. Pt calming down. Bloodwork drawn and sent. Pt straight cath'd (catheter) for urine (19:34(7:34 p.m.). The Emergency Room Report dated 6/8/2015 was reviewed. Documentation by the physician revealed in part, " CHIEF COMPLAINT: Psychiatric Breakdown, HISTORY OF PRESENT ILLNESS: This is a 23- year old ...known with history of schizophrenia (A very serious and chronic mental illness in which someone cannot think, behave normally and often experience delusions). EMS (emergency medical services) was called to the scene by police ...having a breakdown at home, screaming, and yelling, threatening family with sharp knives, presents here restrained...REVIEW OF SYSTEMS: Otherwise negative. . .PHYSICAL EXAMINATION: Vital signs are grossly within normal limits ... In general frail looking ...screaming and yelling and attacking staff ...Neurologic ...awake, alert, combative, but no lateralizing findings. Psychiatric: Appears to be having an acute schizophrenic break. EMERGENCY DEPARTMENT COURSE: Given Geodon, Ativan and Benadryl IM (intra-muscular). After achieving anesthesia control, labs have been obtained and are grossly normal. At this time, mental health consult is pending ...CLINICAL IMPRESSION: Suicidal thoughts. DISPOSITION: The patient is transferred to (Name of Facility) in stable condition and has been accepted by (name of Physician).
Review of the facility's diversion data revealed the facility was on psychiatric diversion on 6/8/15 (3:31 p.m. until 11:45 p.m.) when patient #21 presented to Eastside Medical Center.
The facility failed to ensure that their policy and procedures were followed as evidenced by failing to ensure that on 6/8/2015 when patient #21 presented on the facility grounds and a request was made (court ordered) requesting an examination within the capability of the hospital's emergency department, including ancillary services routinely available to the dedicated emergency department to determine whether or not an emergency medical condition existed.
Interview with the Chief Nursing Officer (CNO) on 7/21/15 at 9:15 AM revealed that on the specified day, the facility was on diversion and the technician needed to get direction from the charge nurse on how to proceed. In the overcrowded rapid pace of the Emergency Room population, and, attempting to find the patient a bed, there was a misconception that the patient was being refused care. The CNO continued explaining that the Charge nurse was working on changing the patient acuity around to accommodate the patient, but, the sheriff department personnel was adamant that the responsibility of the officer was to bring the patient to the facility and drop the patient off, without regard or consideration in allowing the hospital to make preparations for the patient. He/she continued on stating that law enforcement personnel decided to take the patient to another facility for treatment. The CNO explained that the hospital had been trying to work with the sheriff's department in making sure there is a clear understanding on how the hospital and law enforcement can work together to better serve and care for patients brought to the hospital in their custody. The CNO reported he/she believed it was not that the hospital did not want to treat the patient, but that the law enforcement did not want to wait for staff to get the patient situated in a safe setting so that all patients and staff would be free from danger. The officer was at the facility for less than twenty (20) minutes before contacting his/her supervisor and taking the patient to another hospital. The CNO stated that he/she didn't believe law enforcement clearly understood the complexity of this type of situation and the time it may take for the nursing staff to take over the responsibility of the patient. The CNO explained that he/she had investigated an incident related to an EMTALA violation, and the hospital had completed a plan of correction that included additional staff training. The key concern was that the technician, who was the first hospital staff person to come into contact with the sheriff department's female officer, had not clearly communicated the facility's obligation to provide treatment to the patient.
Interview with a ED License Practical Nurse (LPN) on 7/21/15 at 10:00 AM in the board room revealed the ED had been on psychiatric diversion only. The LPN explained an Emergency Medical Treatment and Labor Act (EMTALA) meant that all patients coming to the facility or anywhere on the property and requesting to be seen would be given a MSE. The LPN verbalized an EMTALA training was conducted yearly for the nursing staff (registered nurses, LPN's, technicians and the registrar). The LPN stated the triage area staff personal had requested that he/she go to the triage area because there was a Sheriff Department officer with a patient. The LPN reported that on arrival to the triage area, he/she found two sheriffs with a patient. The LPN explained the charge nurse was already looking for a place to put the patient, and had called him/her because the LPN was involved with the sheriff department and court system, and could better represent/communicate with the officers on the facility's behalf. The LPN had asked the female officer for his/her supervisor' name while they were in the hallway in front of triage waiting room. The LPN stated after talking with the female officer, he/she called the officer's supervisor. He/she continued explaining that while he/she was still on the phone, the officers left the hospital with the patient. The LPN spoke to the technician who approached him/her and obtained the 1013 (involuntary hold for person who has been assessed as a danger to self or others) from the officer. The LPN stated he/she was unable to resolve the care of the patient because the officers had left the area. The LPN was not able confirm if the patient had been given a Medical Screening Examination.
Interview with the ED Charge Nurse on 7/21/15 at 10:50 a.m. in the board room, revealed that he/she was called to the front triage area by the technician reporting there was a psychiatric patient with law enforcement. The charge nurse explained he/she talked to the female law enforcement officer and asked if they knew that the facility was on diversion, and they were backed up in the ED, but would get a bed when he/she could. The charge nurse stated that the female officer did not respond to him/her. The charge nurse went back to locate a bed and was told by another staff member the sheriff officers were gone. The charge nurse reported he/she saw the patient and thought he/she was in handcuffs standing near the water fountain with the male law enforcement officer. The charge nurse explained after readjusting the acuity and looking for a bed he/she then went back out front to see if what the technician had reported was accurate, and that the patient and sheriff officers were gone. The charge nurse stated the facility had EMTALA training annually, on-line, and that is how he/she and the staff learned about the facility expectations. The charge nurse explained all patients have to be seen and screened and cannot be turned away, if the facility was on diversion all the patients are still seen. The charge nurse asked the technician what happened to the patient and the technician stated the officers did not want to wait and went to another acute care hospital. The charge nurse was not able confirm if the patient was given a Medical Screening Examination. The charge nurse explained the facility does not have a call center whereby calls are called into a designated call center, however the hospital request that ambulances and law enforcement who are bringing patients in, call into the ER prior to coming. In this case, no call came in prior to the patient arriving to the facility.
Interview with the ED technician on 7/21/15 at 1:50 p.m. in the board room, revealed the technician had been unclear in his/her understanding of the hospital ' s EMTALA policies. The patient presented to the ED triage area by automobile with two (2) officers from the Sheriff's department. The technician explained the patient was upset about being in handcuffs and being brought to the facility. The patient was in a nightgown, crying and upset, and, could not speak English. The technician related that he/she informed the sheriff that the facility was on diversion and that they might need to take the patient somewhere else. The technician reported the female officer handed him/her an envelope, explaining that he/she had an order to deliver the patient to this facility. The technician stated he/she informed the officer that he/she needed to consult with the charge nurse because he/she knew the facility was on diversion at the time. The female officer then stated "okay, you won't take the patient?" The technician corrected the officer, stating, I didn't say we won't take the patient but I need to find out where we can put the patient. The officer then said it was his/her job to deliver the patient, and that was the end of their responsibility. The male officer remained with the patient, off to the side. The technician stated that while the female officer was on her phone, he/she had contacted the charge nurse by phone for further direction. The technician continued explaining that he/she wanted to get the patient out of the waiting room due to the lack of privacy. The technician explained that the charge nurse had indicated that he/she was actively looking for a bed for the patient, and asked the technician if there was any beds in the front, to which the technician responded " no ". The charge nurse asked for a minute to make some changes to accommodate the patient. The female officer finished his/her call and stated he/she had talked with his/her supervising sergeant and was instructed to take the patient to another acute care hospital. The technician stated the female officer placed the patient into their car and drove away. After the patient had left, the technician had called the charge nurse, informing him/her that the officers had been directed by their supervisor to take the patient to another facility, and they had done so. The technician explained the facility required ER staff to have EMTALA training once a year, and, from time to time diversion activities are discussed during staff meetings.

Interview with the Chief Nursing Officer (CNO) on 7/21/15 at 9:15 AM revealed that on the specified day, the facility was on diversion and the technician needed to get direction from the charge nurse on how to proceed. In the overcrowded rapid pace of the Emergency Room population, and, attempting to find the patient a bed, there was a misconception that the patient was being refused care. The CNO continued explaining that the Charge nurse was working on changing the patient acuity around to accommodate the patient, but, the sheriff department personnel was adamant that the responsibility of the officer was to bring the patient to the facility and drop the patient off, without regard or consideration in allowing the hospital to make preparations for the patient. He/she continued on stating that law enforcement personnel decided to take the patient to another facility for treatment. The CNO explained that the hospital had been trying to work with the sheriff's department in making sure there is a clear understanding on how the hospital and law enforcement can work together to better serve and care for patients brought to the hospital in their custody. The CNO reported he/she believed it was not that the hospital did not want to treat the patient, but that the law enforcement did not want to wait for staff to get the patient situated in a safe setting so that all patients and staff would be free from danger. The officer was at the facility for less than twenty (20) minutes before contacting his/her supervisor and taking the patient to another hospital. The CNO stated that he/she didn't believe law enforcement clearly understood the complexity of this type of situation and the time it may take for the nursing staff to take over the responsibility of the patient. The CNO explained that he/she had investigated an incident related to an EMTALA violation, and the hospital had completed a plan of correction that included additional staff training.
Interview with an ED License Practical Nurse (LPN) on 7/21/15 at 10:00 AM in the board room revealed the ED had been on psychiatric diversion only. The LPN explained an Emergency Medical Treatment and Labor Act (EMTALA) meant that all patients coming to the facility or anywhere on the property and requesting to be seen would be given a MSE. The LPN verbalized an EMTALA training was conducted yearly for the nursing staff (registered nurses, LPN's, technicians and the registrar). The LPN stated the triage area staff personal had requested that he/she go to the triage area because there was a Sheriff Department officer with a patient. The LPN reported that on arrival to the triage area, he/she found two sheriffs with a patient. The LPN explained the charge nurse was already looking for a place to put the patient, and had called him/her because the LPN was involved with the sheriff department and court system, and could better represent/communicate with the officers on the facility's behalf. The LPN had asked the female officer for his/her supervisor' name while they were in the hallway in front of triage waiting room. The LPN stated after talking with the female officer, he/she called the officer's supervisor. He/she continued explaining that while he/she was still on the phone, the officers left the hospital with the patient. The LPN spoke to the technician who approached him/her and obtained the 1013 (involuntary hold for person who has been assessed as a danger to self or others) from the officer. The LPN stated he/she was unable to resolve the care of the patient because the officers had left the area. The LPN was not able confirm if the patient had been given a Medical Screening Examination..
Interview with the ED Charge Nurse on 7/21/15 at 10:50 a.m. in the board room, revealed that he/she was called to the front triage area by the technician reporting there was a psychiatric patient with law enforcement. The charge nurse explained he/she talked to the female law enforcement officer and asked if they knew that the facility was on diversion, and they were backed up in the ED, but would get a bed when he/she could. The charge nurse stated that the female officer did not respond to him/her. The charge nurse went back to locate a bed and was told by another staff member the sheriff officers were gone. The charge nurse reported he/she saw the patient and thought he/she was in handcuffs standing near the water fountain with the male law enforcement officer. The charge nurse explained after readjusting the acuity and looking for a bed he/she then went back out front to see if what the technician had reported was accurate, and that the patient and sheriff officers were gone. The charge nurse stated the facility had EMTALA training annually, on-line, and that is how he/she and the staff learned about the facility expectations. The charge nurse explained all patients have to be seen and screened and cannot be turned away, if the facility was on diversion all the patients are still seen. The charge nurse asked the technician what happened to the patient and the technician stated the officers did not want to wait and went to another acute care hospital. The charge nurse was not able confirm if the patient was given a Medical Screening Examination. The charge nurse explained the facility does not have a call center whereby calls are called into a designated call center, however the hospital request that ambulances and law enforcement who are bringing patients in, call into the ER prior to coming. In this case, no call came in prior to the patient arriving to the facility.
Interview with the ED technician on 7/21/15 at 1:50 p.m. in the board room, revealed the technician had been unclear in his/her understanding of the hospital ' s EMTALA policies. The patient presented to the ED triage area by automobile with two (2) officers from the Sheriff's department. The technician explained the patient was upset about being in handcuffs and being brought to the facility. The patient was in a nightgown, crying and upset, and, could not speak English. The technician related that he/she informed the sheriff that the facility was on diversion and that they might need to take the patient somewhere else. The technician reported the female officer handed him/her an envelope, explaining that he/she had an order to deliver the patient to this facility. The technician stated he/she informed the officer that he/she needed to consult with the charge nurse because he/she knew the facility was on diversion at the time. The female officer then stated "okay, you won't take the patient?" The technician corrected the officer, stating, I didn't say we won't take the patient but I need to find out where we can put the patient. The officer then said it was his/her job to deliver the patient, and that was the end of their responsibility. The male officer remained with the patient, off to the side. The technician stated that while the female officer was on her phone, he/she had contacted the charge nurse by phone for further direction. The technician continued explaining that he/she wanted to get the patient out of the waiting room due to the lack of privacy. The technician explained that the charge nurse had indicated that he/she was actively looking for a bed for the patient, and asked the technician if there was any beds in the front, to which the technician responded " no ". The charge nurse asked for a minute to make some changes to accommodate the patient. The female officer finished his/her call and stated he/she had talked with his/her supervising sergeant and was instructed to take the patient to another acute care hospital. The technician stated the female officer placed the patient into their car and drove away. After the patient had left, the technician had called the charge nurse, informing him/her that the officers had been directed by their supervisor to take the patient to another facility, and they had done so. The technician explained the facility required ER staff to have EMTALA training once a year, and, from time to time diversion activities are discussed during staff meetings.

Based on reviews of medicals records, policies and procedures, and staff interviews the facility failed to provide within their capabilities of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilize the medical condition for 1 (#21) of 21 patient who presented to the emergency room for treatment.

Findings include:
Review of facility policy titled, EMTALA, effective date January 1990, last review date 7/10/2012 revealed in part, " A. All individuals or representative presenting on the facility grounds and requesting an examination or treatment would receive . . . stabilizing treatment within the capability of the hospital's emergency department. "

Review of the medial record revealed that patient #21 was 1013 ' d (involuntary hold for persons who have been assessed as a danger to self and others). Review of the Form 1013 CERTIFICATE AUTHORIZING TRANSPORT TO EMERGENCY RECEIVING FACILITY & REPORT of TRANSPORTATION (Mental Health) revealed in part, " This is to certify that I have personally examined Patient #21 on 6?8/2015 at 2012 (8:12 p.m.) which was within the preceding 48 hours of the signing of the certificate, In my opinion this individual appears to be a mentally ill person requiring involuntary treatment in that he/she appears to be mentally ill... AND...B. appears to be so unable to care for his/her own physical health and safety as to create an imminently life-endangering crisis. At the time of my evaluation, the conditions checked below were present. This individual appears to be mentally ill My opinion is based on the following observations very aggressive and threatening ... This individual ...Has ...expressed ...threats towards others ...Has ...expressed threats of violence to self ...For example Suicidal/Homicidal. "


An interview was conducted with the Chief Nursing Officer on 7/21/2015 at 9:15 AM. The Chief Nursing Officer stated that the key concern was that the technician, who was the first hospital staff person to come into contact with the sheriff department's female officer, had not clearly communicated the facility's obligation to provide treatment to the patient.

Interviews were conducted with the ED Licensed Practical Nurse (LPN) at 10:00 AM, and with the ED Charge Nurse at 10: 50 AM in the board room. Both interviews revealed that they were not able to confirm if the patient (#21) had been given treatment.



The facility failed to ensure that their policy and procedures were followed as evidenced by failing to ensure that on 6/8/2015 patient #21 who was 1013 ' d with an identified psychiatric emergency condition received stabilizing treatment that was within the capability of the hospital ' s emergency department.

Based on reviews of medical records Probate Court, Order to Apprehend, policies and procedures and staff interviews the facility failed to provide an appropriate transfer by failing to provide medical treatment within its capacity that minimized the risks of to an individual ' s health for 1 (#21) of sampled patients who presented to the emergency department for treatment.

Findings include:

Review of the facility ' s EMTALA Georgia Medical Screening Examination and Stabilization Policy effective date January 1990, last revised 7/10/12, revealed 1. Stable for transfer. An individual is sufficiently stable to be transferred as an appropriate transfer when, the physician treating the individual in the DED has determined within reasonable clinical confidence no material deterioration of the condition is likely, within reasonable medical probability, to result from, or occur during, the transfer of the individual from a facility, ...or in the case of an individual with a psychiatric or behavioral condition, the individual is protected and prevented from injuring himself of herself or others. C. Stable for discharge. An individual is considered stable for discharge when, within reasonable clinical confidence, it is determined that the individual has reached the point where his or her continued care, including diagnostic work-up and/or treatment, could reasonably be performed as an outpatient or later as an inpatient, provided the individual is given a plan of appropriate follow-up care with the discharge instructions. The EMC (Emergency Medical Condition) that caused the individual to present must be resolved, but the underlying medical condition may persist. For the purpose of discharging an individual with psychiatric of behavioral condition (s), the individual is considered to be a threat to self or to others. "


The probate paperwork for patient #21 was reviewed. The " ORDER TO APPREHEND " dated June 8, 2015 revealed in part, TO ANY PEACE OFFICER OF SAID COUNTY You are commanded to take into custody Patient #21 ...a MENTALLY ILL person requiring involuntary treatment who presents a substantial risk of imminent harm to himself/herself or others as manifested by either recent overt acts or recent expressed threats of violence which present a probability of physical injury to himself/herself or to other persons ...You shall deliver ...forwith to, EASTSIDE MEDICAL CENTER, SNELLVILLE, GA. ...for an examination as prescribed by law. "




Review of the medial record revealed that patient #21 was 1013' d (involuntary hold for persons who have been assessed as a danger to self and others). Review of the Form 1013 CERTIFICATE AUTHORIZING TRANSPORT TO EMERGENCY RECEIVING FACILITY & REPORT of TRANSPORTATION (Mental Health) revealed in part, " This is to certify that I have personally examined Patient #21 on 6?8/2015 at 2012 (8:12 p.m.) which was within the preceding 48 hours of the signing of the certificate, In my opinion this individual appears to be a mentally ill person requiring involuntary treatment in that he/she appears to be mentally ill... AND...B. appears to be so unable to care for his/her own physical health and safety as to create an imminently life-endangering crisis. At the time of my evaluation, the conditions checked below were present. This individual appears to be mentally ill My opinion is based on the following observations very aggressive and threatening ... This individual ...Has ...expressed ...threats towards others ...Has ...expressed threats of violence to self ...For example Suicidal/Homicidal. "



An interview was conducted with an ED LPN on 7/21/2015. The LPN stated that he/she had spoken to the technician who approached him/her and obtained the 1013 (involuntary hold for person who has been assessed as a danger to self or others) from the officer. The LPN stated he/she was unable to resolve the care of the patient (#21) because the officers had left the area. The LPN was not able confirm if the patient had been transferred to another facility for care.
During an interview with the ED Charge Nurse on 7//21/2015 at 10:50 AM, the Charge Nurse was not able to confirm if the patient (#21) was transferred to another facility for care by the hospital.

The facility failed to ensure that their transfer policy and procedure was followed as evidenced by failing to ensure on 6/8/2015 when patient #21 presented to the hospital with law enforcement. Patient #21 a known psychiatric patient, the hospital staff was well aware the patient was determined at risk to harm self and others (IVC hold 1013' d), and was inappropriately discharged/transferred as stated in the hospital ' s policy and procedure