HospitalInspections.org

Based on record reviews and interviews, the hospital failed to meet the requirement of §489.24 as evidenced by:
Failing to ensure for the appropriate transfer of psychiatric patients (evaluated to be a danger to self and/or others and placed on a Physician's Emergency Certificate) who were in need of acute inpatient psychiatric services of which the sending hospital was unable to provide at the time of transfer. This was evidenced by the hospital's failure to ensure 10 (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10) of 10 PEC'D psychiatric patients were transferred from the sending hospital to the receiving hospital by individuals who were appropriately trained to provide for safe and effective transport of a patient in need of acute inpatient psychiatric services. The hospital allowed Company A to transport these patients using a single driver whose training included CPR and classroom CPI, but Company A's S5VPO reported all drivers are still No Hands On with patients during transport. (see findings tag A-2409).

Based on record review and interview, the hospital failed to ensure for the appropriate transfer of psychiatric patients (evaluated to be a danger to self and/or others and placed on a Physician's Emergency Certificate) who were in need of acute inpatient psychiatric services of which the sending hospital was unable to provide at the time of transfer. This was evidenced by the hospital's failure to ensure 10 (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10) of 10 PEC'D psychiatric patients were transferred from the sending hospital to the receiving hospital by individuals who were appropriately trained to provide for safe and effective transport of a patient in need of acute inpatient psychiatric services. The hospital allowed Company A to transport these patients using a single driver whose training included CPR and classroom CPI, but Company A's S5VPO reported all drivers are still No Hands On with patients during transport.

Findings:

Review of the hospital policy titled Transfer To Another Facility, revised 12/2016 revealed in part: Transfer Of Patient Without Emergency Medical Condition: The patient being transferred will be provided with the appropriate medical care, including qualified personnel and appropriate equipment, throughout the transfer process.

Review of the hospital contract with Company A dated 07/26/16 revealed in part:
A. Company A agrees to provide secure one-way transportation for Physician Emergency Certificate (PEC) patients of the hospital to any psychiatric and/or chemical dependency treatment facility within the state of Louisiana. Company A requires that patients must be physically fit for travel ...
E. Company A will only transport one patient per delivery. Company A will not transport violent, bedridden patients. Nor will Company A transport patients with medical equipment or medical apparatus (such as IV's or heart monitors).
F. Company A agrees to transport the patients of the hospital in a safe and timely manner. Company A agrees to provide vehicles equipped with video equipment (for monitoring and observation of patients) and tracking devices. Additionally each vehicle shall be equipped with a cage/separator between the driver and the back seat passenger for safety purposes. The driver will assist the patient into the back of the vehicle and assist the patient out of the vehicle. The driver will assure that the patient is properly secured in a seat belt.
G. In the event of an emergency during transport, such as illness, Company A will notify the treating physician and hospital. Company A staff will not and shall not be held responsible to administer first aid.
H. Company A is not responsible for the medical care of the patients, nor will Company A seek services other than for emergency care as warranted during transport.

Review of the hospital's policy for transfer required that the patient being transferred will be provided with the appropriate medical care, including qualified personnel and appropriate equipment, throughout the transfer process. However, review of the hospital's contract with transport Company A revealed Company A staff will not and shall not be held responsible to administer first aid; and Company A is not responsible for the medical care of the patients, nor will Company A seek services other than for emergency care as warranted during transport.

Patient #1
Review of the medical record for patient #1 revealed a 14 year old male with no prior psychiatric history brought to the ED by police for threats to kill abusive father on 02/06/17. Patient was placed on a PEC and then CEC with homicidal, unwilling, dangerous to others and gravely disabled. Patient #1 requires inpatient psychiatric admission and treatment for preservation of safety, treatment of mood and anxiety and r/o psychotic disorders and not suitable for discharge to home at present. Patient #1 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 179 miles.

Patient #2
Review of the medical record for patient #2 revealed a 23 year old female with history of Psychosis, brought to the ED by family threatening to commit suicide and kill others. Patient was placed on a PEC and then CEC with suicidal, homicidal, danger to self and others. Patient #2 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 79 miles.

Patient #3
Review of the medical record for patient #3 revealed a 16 year old male with history of Depression and presents to the ED with plan to overdose on medication, and suicide ideation. Patient #3 was placed on a PEC with suicidal, danger to self, and gravely disabled. Patient #3 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 179 miles.

Patient #4
Review of the medical record for patient #4 revealed a 21 year old female with history of suicide attempts and presents to the ED with overdose on medication, and suicide ideation. Patient #4 was placed on a PEC with suicidal, danger to self, and gravely disabled. Patient #4 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 49 miles.

Patient #5
Review of the medical record for patient #5 revealed a 12 year old female with history of Depression and presents to the ED with plan to commit suicide. Patient #5 was placed on a PEC with suicidal, danger to self, and unwilling. Patient #5 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 189 miles.

Patient #6
Review of the medical record for patient #6 revealed a 34 year old female with history of Depression and suicidal ideation and presents to the ED with plan to commit suicide. Patient #6 was placed on a PEC with suicidal, danger to self, and gravely disabled. Patient #6 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 81 miles.

Patient #7
Review of the medical record for patient #7 revealed a 14 year old female and presents to the ED with plan to commit suicide. Patient #7 was placed on a PEC with suicidal, danger to self, and unwilling. Patient #7 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 176 miles.

Patient #8
Review of the medical record for patient #8 revealed a 52 year old male with history of Mental Illness and presents to the ED by police with hallucinations and paranoia. Patient #8 was placed on a PEC with suicidal, danger to self, and unwilling. Patient #5 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 67 miles.

Patient #9
Review of the medical record for patient #9 revealed a 65 year old female with history of Mental Illness and Substance Abuse and presents to the ED with suicide ideation. Patient #9 was placed on a PEC with suicidal, danger to self, and unwilling. Patient #9 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 80 miles.

Patient #10
Review of the medical record for patient #10 revealed a 33 year old male with history of Schizophrenia and Psychosis and presents to the ED with paranoia. Patient #10 was placed on a PEC with danger to self, gravely disabled, and unwilling. Patient #10 was transferred to another facility for inpatient treatment, via Company A. The travel distance to the receiving facility was 169 miles.

Interview on 02/08/17 at 2:10 p.m., S2ED/Director stated that when an individual presents to the ED with psychiatric issues, a full work up is done to include blood work and x-ray's if required. He reported psychiatric patients are placed in the observation room directly across from the nurse's station. He reported all ligature hazards are removed from the room, and a staff member will remain in the room with the patient at all times. He reported psychiatric patients are placed on 1 to 1 observation while in the ED. The ED has Tele Psych available and has access to a Psychiatrist to do evaluations and determine the course of treatment for the patient, whether to stabilize and discharge or transfer to a higher care facility. The hospital has a contract with Company A for transport of psych patients. When placement is found for the patient and it's determined the patient will be transferred Company A is notified and usually there is only one driver. The patients are escorted from the ED and placed in the back of the vehicle. There is a cage that separates the patient from the driver and the door handles are deactivated so the patient cannot open the door. S2ED/Director stated he was not sure of the exact verbiage of the contract but knew that Company A would only transport stable non-medical Psych patients. They would not transport any patients with aggressive behaviors or agitated, the transport staff were strictly no hands on. S2ED/Director further stated that if there was a problem that occurred during transport the drivers would take the patient to the closest ED hospital.

Interview on 02/09/17 at 10:30 a.m., S3RN confirmed that the ED uses Company A transport for psychiatric patients. The patients are accompanied by ED staff to the vehicle which is usually a Crown Victoria and placed in the back of the vehicle. S3RN indicated there is always one driver and a camera and a GPS system in the vehicle. There are bars between the driver and the patient and the rear doors are unable to be opened from the inside. The drivers do not touch the patients. S3RN indicated that if there is an emergency in route then Company A transport will bring the patient to the nearest ED or call 911. S3RN reported that the hospital uses Company A for all psychiatric patient transports and that she was not aware of any problems with transported patients.

Interview on 02/09/17 at 10:45 a.m., S4Physician stated that Company A was used to transport all of the hospital's psychiatric patients. S4Physician reported that he felt the service was very professional and he was unaware of any problems. He further indicated that he was aware that the staff did not provide any hands on care to the patient during transport. In an emergency situation the drivers are to go to the nearest ED or call 911. S4Physician reported there had been issues in the past with the ambulance service taking too long to provide transport for psychiatric patients and the patients would stay in the ED too long before receiving a higher level of care. S4Physician reported the ED would call Ambulance transport if there was any question as to the safety of the patient or if their medical condition required medical intervention.

Interview on 02/09/17 at 11:55 a.m. with S5VPO (Vice President of Operations) for Company A revealed that all drivers have CPR and CPI (classroom) training. S5VPO reported all drivers are still no hands on with patients during transport. S5VPO reported drivers are trained only to help recognize early problems before they escalate. S5VPO further stated that when the patient is placed in the back of the vehicle and secured, the driver will contact the receiving hospital with an estimated time of arrival. S5VPO indicated that once the patient is placed in the vehicle, the trip from the sending hospital to the receiving hospital is non-stop and the driver will only open the door upon arrival to the receiving hospital or in the event of a medical emergency when emercency medical personnel arrive at the vehichles location after calling for assistance through the use of a 911 dispatcher.