HospitalInspections.org

.


20177




26351




30364



Based on interviews and record reviews, the facility failed to follow its Admission Criteria Policy as evidenced by failing to accept appropriate transfers of individuals with emergency psychiatric conditions or document acceptable rationale for refusal of admission for 26 (#F1, #F2, #F3, #F4, #F5, #F6, #F7, #F8, #F9, #F10, #F11, #F12, #F13, #F14, #F15, #F16, #F17, #F18, #F19, #F20, #F21, #F22, #F23, #F24, #F25, and #F26) of 100 patient intake assessment sheets reviewed dated 04/18/12 through 06/09/12.
Findings:

Review of the Policy numbered IN.003, revised 5/1/12, titled "Admission Criteria: Clinical Appropriateness" revealed in part:
...Admission to the hospital will be offered to adult psychiatric patients 18 years of age or older meeting criteria for Axis I-V according to the DSM IV-TR (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision) ...
...The hospital's Psychiatric Program is therapeutically oriented for individuals that are suicidal, homicidal or gravely disabled ...
...The hospital has a duty under ...to accept from a referring hospital any appropriate transfer of an individual who requires the specialized capabilities and facilities available at the hospital that are not available at the Transferring Hospital (i.e., the psychiatric services we provide) if the hospital has the current capacity and capability to treat the individual ...

In a face to face interview on 6/12/12 at 10:20 a.m, Intake Director SF4 indicated when a call for patient placement was taken from an emergency room, an intake coordinator filled out the hospital's document titled "Initial Intake Assessment & Inquiry Information". She stated if the coordinator was not comfortable making the decision about if the patient met the hospital's admission criteria, the physician on call was notified. SF4 also said the supporting documentation about patient information from the emergency rooms was destroyed after 72 hours of refusal of admission. Review of the intake document revealed sections to record patient information which included client data, presenting problem, criteria for admission, and clinical reason client was not admitted.

Patient #F1 A review was made of the document titled "Initial Intake Assessment & Inquiry Information" for Patient #F1. The intake assessment was charted as having been started on 5/1/12 at 4:50 a.m. by intake coordinator SF9. Under the section titled "Presenting Problem", danger to self and others was circled. Also listed as a presenting problem was "hit his stepfather with a bottle", stopped taking his medications, UDS (urine drug screen) neg (negative) for all but THC (marijuana), and ETOH (alcohol level) zero. Further review revealed under the section titled " Criteria For Admission", legally mandated and PEC (Physician's Emergency Certificate) were checked for the patient. The section labeled "Initial Diagnostic Impression" listed Patient #F1 as not medication compliant, violent/ GD (gravely disabled). Under the section titled "Clinical Reason Client Was Not Admitted", the response was written as: Per Psychiatrist SF7 pt (patient) does not have psych (psychiatric problems), needs jail.

Review of the medical record for Patient #F1 revealed he had previously been admitted to the hospital on 3/22/12 under the care of Psychiatrist SF7. His Axis I diagnosis on the Psychiatric Evaluation dated 3/22/2012 by SF7 was listed as psychosis and r/o (rule out) major depression with psychosis, schizophreniform psychosis.

In face to face interview on 6/12/12 at 12:50 p.m. Administrator SF2 reviewed the "Initial Intake Assessment & Inquiry Information" form dated 5/1/12 for Patient F1. She said the patient had been refused admission to the hospital because Psychiatrist SF7 said he needed to be in jail instead. SF2 stated this was, "certainly not an acceptable reason for denial of admission for a patient". SF2 indicated she tried to speak with the previous medical director, Psychiatrist SF6, about inappropriate denials for admissions, but he would not make any changes.

In a face to face interview on 6/12/12 at 12:53 Corporate Relations Representative SF5, reviewed the document dated 5/1/12 for Patient #F1 titled "Initial Intake Assessment & Inquiry Information". SF5 agreed that the psychiatrist statement indicating Patient #F1 needed jail instead of psychiatric treatment was not an acceptable reason for denial of admission.

Patient #F2
Review of the Initial Intake Assessment & Inquiry Information form for Patient #F2, a 20 year old male, which was dated/timed 06/09/12 @1:42pm revealed .... "Presenting Problem (Danger to Self circled) Pt. (Patient) is having SI (suicidal ideation) with the plan to use 12 gauge gun. Drug abuse of marijuana, drinking alcohol, Xanax and Heroin IV". Further review of the form revealed the initial diagnostic impression was MDD (Major Depressive Disorder). The Criteria for Admission was checked next to PEC (Physician's Emergency Certificate). In the section titled "Clinical Reason Client Was not Admitted" revealed ... ... "Per MD S10 acuity is too high. Patient needs a higher level of care". Further review revealed no documented evidence a drug screen was performed and/or reported to the hospital to substantiate the current use of drugs or the current levels.

Review of the hospital's Census for June 9, 0212 submitted by Administrator SF2 revealed a total census of 47 patients out of a total of 60 licensed beds. Further review revealed there were five available male beds (Unit A - 1, Unit B - 2 and Unit C - 2).

In a face to face interview on 06/12/12 at 2:30pm Administrator SF2 indicated the reason for denial was not appropriate.

Patient #F3
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F3, dated 4/21/12, revealed the patient was a 23 year old female. The section labeled, " Presenting Problem (Danger to Self or Others) " included the following information, " Pt (patient) has been having + (positive) anxiety and has been paranoid for years. She stated she feels that she is having a nervous breakdown. She is scared of her ex-husband. " The initial Diagnostic Impression was listed as Bipolar with depression. A criterion for admission was listed as PEC (Physician Emergency Certificate). The Time Start was listed as 12:15 a.m. and the time completed was 7:00 a.m. The clinical reason the client was not admitted was listed as, " Pt placed while waiting on physician to return call. "

Patient #F4
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F4, dated 4/21/12, revealed the patient was a 24 year old female. The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " Danger to self, others, GD (Gravely Disabled) h/o (history of) anxiety, depression, antisocial bx (behavior), HI (homicidal ideation), Brought into ER (Emergency room) by police, aggressive bx toward mother. " The initial Diagnostic Impression was listed as Depression, Anxiety, HI. Criteria for Admission was listed as legally mandated and PEC. The clinical reason the client was not admitted was listed as, " Pt placed while waiting on physician to call. " The Time start was listed as 2:50 a.m. and the time completed was listed as 6:00 a.m.

Patient #F5
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F5, dated 4/21/12, revealed the patient was a 19 year old male. The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " nervous breakdown, SI (suicidal ideation), tried cutting himself, not taking prescribed meds, abusing amphetamines. " The criteria for admission was listed as legally mandated and PEC. The Initial Diagnostic Impression was listed as SI/substance abuse, not med (medically) compliant. The clinical reason the client was not admitted was listed as, " Pt placed while waiting on dr. (doctor). " Handwritten at the bottom of the Initial Intake Assessment and Inquiry Information sheet was, " called/text S6. " The time start was listed as 2:30 a.m. and the time completed was listed as 11:30 a.m.

An interview was conducted with SF4 Intake Director on 6/11/12 at 1:05 p.m. She reported the time started listed on the Initial Intake Assessment and Inquiry Information sheet was the time the referral was received from the referring hospital and the time completed was the time the decision is made to accept the patient or not.

An interview was conducted with SF1 CEO on 6/12/12 at 2:00 p.m. She stated towards the end of the time SF6 and SF7 were working at the hospital, the doctors were not answering their pages or texts on possible admissions to the hospital. She further stated the physicians are the ones that set up the policy and procedure on when to be notified to allow an admission or not to allow an admission to the hospital.

An interview was conducted with SF4 Intake Director on 6/12/12 at 1:30 p.m. She reported the intake staff would first text a message to the physician on call and if the physician didn't answer the text, the intake staff would then call the physician's cell phone. She went on to state they couldn't go to the medical director and file a complaint against the physicians because SF6 was their medical director.

Patient #F6
Review of the "Initial Intake Assessment & Inquiry Information" form for Patient #F6 a 54 year old male, which was dated/timed 06/08/12 @4:55pm revealed .... "Presenting Problem (Danger to Self and Others - both circled) Pt. (Patient) is delusional, HI (homicidal ideation) threatening wife, children and grandchildren to kill them shooting them then burning them in a house, then SI (suicidal ideation) plans to kill himself with a gun or fire, pulled gun on police when they removed him from the house". Further review of the form revealed the initial diagnostic impression was psychosis. The Criteria for Admission was checked next to PEC (Physician's Emergency Certificate). In the section titled "Clinical Reason Client Was not Admitted" revealed ..... " Per MD S10 acuity level of patient is too high, patient a 1:1, unable to accept" .

Review of the hospital's Census for June 8, 0212 submitted by Administrator SF2 revealed a total census of 45 patients out of a total of 60 licensed beds. Further review revealed there were three available male beds (Unit A- 1, Unit B - 1, and Unit C - 1).

In a face to face interview on 06/12/12 at 2:30pm Administrator S2 verified the hospital accepted suicidal/homicidal patients requiring 1:1 observation.

Patient #F7
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F7, dated 5/6/12, revealed the patient was listed as a 49 year old female. The referral source was listed as Hospital " Fa " The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " + (positive) AH (auditory hallucination) brought in by -PD (Police Department), violent bx, disturbing the peace, had to be physically restrained, Bizarre bx, agitated, wandering st (streets), chemically restrained (Haldol, Ativan, Benadryl). " The Criteria for Admission was listed as legally mandated and PEC. The Initial Diagnostic Impression was listed as Manic, Bipolar. The clinical reason the client was not admitted was handwritten as, " Hospital Fa has its own psyc unit-they need to accommodate their own. -Our hospital is near full for. As well as acuity of our hospital too high to accommodate another violent pt. "

An interview was conducted with SF4 Intake Coordinator on 6/12/12 at 1:30 p.m. She stated the handwritten information under clinical reason why the client was not admitted was written by SF7 MD.

Patient #F8
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F8, dated 5/6/12, revealed the patient was listed as a 26 year old male. The referral source was listed as Hospital " Fa " . The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " GD-danger to self. Brought in by police. Found naked, under car. Believes psychiatrists are the antichrist and he is allergic to fat women, minimally cooperative, no eye contact, disorganized thoughts. + THC (marijuana), alcohol ok. " The criteria for admission was listed as legally mandated and PEC. The initial diagnostic impression was listed as " history of bipolar or Schizophrenia, manic. " The handwritten information written under the clinical reason why the client was not admitted was, " Hospital " Fa " has its own psyc unit. They need to be accommodating their own. " The statement was signed by S6MD.

Patient #F9
Review of the "Initial Intake Assessment & Inquiry Information" form for Patient #F9, a 22 year old female, dated/timed 06/02/12 @11:29am revealed .... "Presenting Problem (Danger to Self circled) Pt. (Patient) tried to commit suicide by slitting her wrists with a razor blade". Further review of the form revealed the initial diagnostic impression was Depression and suicide attempt. The Criteria for Admission was checked next to PEC (Physician's Emergency Certificate) and a Recent Suicide Attempt. In the section titled "Clinical Reason Client Was not Admitted" revealed ... ... "Pt. (patient) declined IV drug used". Further review revealed no documented evidence a drug screen was performed and/or reported to the hospital to substantiate the current use of drugs and the current levels. In addition there was no documented evidence any MD from the hospital had been in the decision to decline admission to Patient #F9.

In a face to face interview on 06/12/12 at 2:30pm Director of Intake SF4 indicated all denials were made by the physician. Further she reviewed the intake form and verified there was no documented evidence an MD has been contacted concerning Patient #F4.

Patient #F10
Review of the "Initial Intake Assessment & Inquiry Information" form for Patient #F10, a 25 year old female, which was dated/timed 06/02/12 @12:07pm revealed .... "Presenting Problem: Pt (patient) attempted to hit ER (emergency room) staff members, increased aggression, difficult to re-direct". Further review of the form revealed the initial diagnostic impression was Psychosis NOS/Substance Abuse. The Criteria for Admission was checked next to PEC (Physician's Emergency Certificate). In the section titled "Clinical Reason Client Was not Admitted" revealed ... ... Pt declines IV drug user". Further review revealed no documented evidence drug screening was performed or that the MD was involved in the decision not to accept Patient #F10 for admission.

Review of policy # IN.003 titled "Admission Criteria: Clinical Appropriateness" last revised 05/01/12 and submitted as the one currently in use revealed.... "It is the policy of this hospital to provide treatment for clients with a primary psychiatric diagnosis and secondary diagnosis of substance abuse. The hospital will assess on a case by case basis, with approval from a physician, to determine if a patient can be safely treated for withdrawal from chemical agents at the hospital".

In a face to face interview on 06/12/12 at 2:30pm Administrator SF2 indicated patients with substance abuse are admitted to the facility if substance abuse is the not the primary diagnosis.

Patient #11
Review of the "Initial Intake Assessment & Inquiry Information" form for Patient #F11, a 47 year old male, which was dated/timed 06/05/12 @9:34pm revealed .... "Presenting Problem (Danger to Self circled) Pt. (Patient) having increased depression associated with unable to find a job, homeless, on a binge of drugs, SI (suicidal ideation) no plan, recently released from jail, voices telling him it's over. ETOH (alcohol) = 66. UDS (Urine Drug Screen) positive for cocaine, opiates, THC". Further review of the form revealed the initial diagnostic impression was MDD (major Depressive Disorder) and Polysubstance Abuse. The Criteria for Admission was checked next to PEC (Physician's Emergency Certificate). In the section titled "Clinical Reason Client Was not Admitted" revealed .. ... "Needs detox MD".

Review of policy # IN.003 titled "Admission Criteria: Clinical Appropriateness" last revised 05/01/12 and submitted as the one currently in use revealed .... "It is the policy of this hospital to provide treatment for clients with a primary psychiatric diagnosis and secondary diagnosis of substance abuse. The hospital will assess on a case by case basis, with approval from a physician, to determine if a patient can be safely treated for withdrawal from chemical agents at the hospital".

In a face to face interview on 06/12/12 at 2:30pm Administrator SF2 indicated patients with substance abuse are admitted to the facility if substance abuse is the not the primary diagnosis.


Patient #F12
A review was done of the document for Patient #F12 titled "Initial Intake Assessment & Inquiry Information". The document was dated 5/19/12 with a start time of 12:50 a.m. and ending time of 8:00 a.m. The "Presenting Problem" was listed as danger to self. It further read pt. (patient) denies SI (suicidal ideations) but cut L (left) arm open on purpose to "relieve his stress". Under the section titled "Criteria For Admission", two boxes were checked which indicated legally mandated and PEC (Physician's Emergency Certificate). Under the section titled "Initial Diagnostic Impression" , SI and danger to self was listed. The "Clinical Reason Client was not Admitted" was listed as: Denied per Psychiatrist SF7. He (F12) needs another facility. We can't help him.

In a face to face interview on 6/12/12 at 1:00 p.m. Administrator SF2, reviewed the document for Patient #F12 dated 5/19/12 which was titled "Initial Intake Assessment & Inquiry Information". SF2 indicated that based on the documentation, the reason given by Psychiatrist SF7 that Patient #F12 needed another facility and we can't help him were not appropriate reasons for denial of admission. Corporate staff member SF3 agreed that the reason given for denial was inappropriate. When asked why the difference from the initial call to the completion of the referral was 7 hours and 10 minutes, SF2 stated she did not know why it took so long.

Patient #F13
A review was done of the document for Patient F13 titled "Initial Intake Assessment & Inquiry Information". The document was dated 5/14/12 with a start time of 4:51 p.m. and an ending time of 6:45 p.m. Under the section titled "Presenting Problem", it was documented that the pt (Patient #F13) having an increase in agitation, change in behavior, not sleeping, hyper religious. Pt sent to ER (Emergency Room) from Hospital "B" on 5/3 for being "catatonic", is non-verbal. Under the section titled "Initial Diagnostic Impression", Bipolar and Anxiety were listed. Under the section labeled "Clinical Reason Client was not Admitted", the response was: Pt. is a hospital "Fb" pt. and needs to return to hospital "Fb" per Psychiatrist SF6. Also written under that section was a sentence stating prior pt. of Psychiatrist SF6 last d/c (discharge) of 4/13/12.

In an interview on 6/12/12 at 12:55 p.m. with Administrator SF2, she reviewed the intake sheet dated 5/14/12 for Patient F13. She stated the reason given by Psychiatrist SF6 for denial of admission was not acceptable.

In an interview on 6/12/12 at 2:00 p.m. with Chief Executive Officer SF1, she stated the Psychiatrist stating Patient F13 had previously been a resident of another hospital and needed to return to that facility was not an appropriate reason for denial of admission.

Patient #F14
Review of the " Initial Intake Assessment & Inquiry Information " form for Patient #F14, a 30 year old female, which was dated/timed 06/01/12 @11:15am revealed .... " Presenting Problem: SI (suicidal ideation) attempt via OD (overdose) Tylenol ingestion. No other information available " . Further review of the form revealed the initial diagnostic impression was MDD (Major Depressive Disorder). The Criteria for Admission was checked next to PEC (Physician's Emergency Certificate) and legally mandated. In the section titled " Clinical Reason Client Was not Admitted " revealed ..... " Acetaminophen levels 66.9/49.5. Pt. doesn't meet criteria " . Further review revealed no documented evidence a physician had been involved in the denial process of determining the Acetaminophen level was unacceptable.

Review of policy # IN.003 titled " Admission Criteria: Clinical Appropriateness " last revised 05/01/12 and submitted as the one currently in use revealed no documented evidence acceptable levels of Acetaminophen had been included as part of the criteria for admission to the hospital.

In a face to face interview on 06/12/12 at 2:30pm in the presence of CEO SF1, Administrator SF2, Corporate LCSW SF3, Director of Intake SF4, Director of Corporate Relations S5 and the Corporate Compliance Officer S8 indicated all were aware the Admission Criteria did not include specific levels of medications or drugs which would indicate make a patient inappropriate for admit. Further CEO SF1 indicated the former Medical Director, SF7 removed all specific medical criteria from the Admission Criteria policy during the revision process (05/12). S1 indicated the Medical Director wanted control of the acceptance /denial process and felt many of the patients sent from the Emergency department had not been properly assessed since most of the ER physicians were Internal Medicine physicians and not psychiatrists.

MD S7 former Medical Director could not be interviewed due to termination of employment.

Patient #F15
A review was made of the document for Patient F15 titled "Initial Intake Assessment & Inquiry Information". The document was dated 5/11/12 with the start time of 3:30 p.m. and the completion time of 9:30 (a.m. or p.m. not documented). Under the section titled "Presenting Problem", danger to self and others was circled and GD (Gravely Disabled) was written next to it. The document also listed the presenting problem as the pt. having SI/HI (suicidal ideations/ homicidal ideations) 2x (two times) by OD (overdose), last suicide attempt was 4 days ago, is angry at family. Written under the label "Clinical Reason Client was not Admitted" was: sent a message to Psychiatrist SF6. No further documentation was recorded on the intake sheet about the disposition of Patient #F15.

Review of the Intake Log for 5/11/12 revealed the call about admission for Patient F15 from Hospital "Fc" was taken at 3:30 p.m. The end time was listed as 9:30 p.m. The number of minutes for the end result was listed as 6 hours. The disposition/reason was listed as "waiting on DOC (Doctor)".

In a face to face interview on 6/12/12 at 1:15 p.m., Administrator SF2, indicated she did not know why Psychiatrist F6 did not call the facility back after being asked about admitting Patient #F15. SF2 said although no specific time frames were in policies for returning calls, 6 hours was not acceptable. When asked what happened to Patient F15, she said she was not sure. SF2 said she had no recourse because SF6 was also the Medical Director.

Patient #F16
Review of the " Initial Intake Assessment & Inquiry Information " form for Patient #F16, a 55 year old female, which was dated/timed 06/01/12 @7:30pm revealed .... " Presenting Problem: Chronic pain and SI (suicidal ideation) with a plan to shoot herself " . Further review of the form revealed the initial diagnostic impression was MDD (Major Depressive Disorder). The Criteria for Admission was checked next to PEC (Physician ' s Emergency Certificate) and legally mandated. In the section titled " Clinical Reason Client Was not Admitted " revealed ..... " Explained can admit, but potassium is too low needs to be min (minimum) of 3.5 " . Further review revealed no documented evidence a physician had been involved in the denial process of determining the potassium level was unacceptable.

Review of policy # IN.003 titled " Admission Criteria: Clinical Appropriateness " last revised 05/01/12 and submitted as the one currently in use revealed no documented evidence acceptable levels of Potassium had been included as part of the criteria for admission to the hospital.

In a face to face interview on 06/12/12 at 2:30pm in the presence of CEO SF1, Administrator SF2, Corporate LCSW SF3, Director of Intake SF4, Director of Corporate Relations S5 and the Corporate Compliance Officer S8 indicated all were aware the Admission Criteria did not include specific levels of medications or drugs which would indicate make a patient inappropriate for admit. Further CEO SF1 indicated the former Medical Director, SF6 removed all specific medical criteria from the Admission Criteria policy during the revision process (05/12). S1 indicated the Medical Director wanted control of the acceptance /denial process and felt many of the patients sent from the Emergency department had not been properly assessed since most of the ER physicians were Internal Medicine physicians and not psychiatrists.

Patient #F17
A review was made of the document for Patient #F17 titled "Initial Intake Assessment & Inquiry Information". The document was dated 5/6/12 with the start time of 11:02 a.m. and completion time of 2:00 p.m. Under the section titled "Presenting Problem", the document stated the patient was brought to ER (Emergency Room) by BR (Baton Rouge) police. She was found wondering the streets. She is very paranoid and fearful, carries a screwdriver in her pocket for protection. Recently spent one year in jail for fleeing from the police. Patient denies SI/HI (suicidal ideations/homicidal ideations). Under Active Medical Issues, A/V (audio visual) hallucinations and anxiety were listed. Under "Criteria for Admission", legally mandated and PEC (Physician's Emergency Certificate) were both checked. The "Initial Diagnostic Impression" was listed as Paranoid Schizophrenia. The "Clinical Reason Client was not Admitted" was listed as: High risk for elopement. Safety for the patient a big risk. We are probably not the right facility.

In a face to face interview on 6/12/12 at 1:15 p.m. Administrator SF2, indicated the facility had locked units, so a patient being a risk for elopement would not prevent a patient from admission. She said the explanation given by Psychiatrist SF7 was not appropriate. Intake Director SF4 stated an elopement risk was not a reason for denial of admission.

Patient #F18
Review of the " Initial Intake Assessment & Inquiry Information " form for Patient #F18, a 41year old male, which was dated/timed 06/08/12 @9:10pm revealed .... " Presenting Problem: (Danger to Self circled) Pt (patient) depressed over recurrent seizures, had a knife with intention to stab himself " . Further review of the form revealed the initial diagnostic impression was MDD (Major Depressive Disorder). The Criteria for Admission was checked next to CEC (Coroner ' s Emergency Certificate). In the section titled " Clinical Reason Client Was not Admitted " revealed ..... " Per MD S11 Phenytoin level must be less than 20.

Review of policy # IN.003 titled " Admission Criteria: Clinical Appropriateness " last revised 05/01/12 and submitted as the one currently in use revealed no documented evidence acceptable levels of Phenytoin had been included as part of the criteria for admission to the hospital.

In a face to face interview on 06/12/12 at 2:30pm in the presence of CEO SF1, Administrator SF2, Corporate LCSW SF3, Director of Intake SF4, Director of Corporate Relations S5 and the Corporate Compliance Officer S8 indicated all were aware the Admission Criteria did not include specific levels of medications or drugs which would indicate make a patient inappropriate for admit. Further CEO SF1 indicated the former Medical Director, SF6 removed all specific medical criteria from the Admission Criteria policy during the revision process (05/12). S1 indicated the Medical Director wanted control of the acceptance /denial process and felt many of the patients sent from the Emergency department had not been properly assessed.

Patient #F19
A review was made of the document for Patient #F19 titled "Initial Intake Assessment & Inquiry Information" dated 5/18/12. Under the section titled "Presenting Problem", danger to self was circled. Also written was pt. (patient) having SI (suicidal ideations) w/ (with) plan to OD (overdose) on meds, having problems at home, pt. has attempted at home, pt has attempted to elope from ER (emergency room), ignoring commands, pt does not feel safe to return home, UDS - (urine drug screen negative). Under the label "Criteria for Admission", PEC (Physician' s Emergency Certificate) was checked. Under the heading "Clinical Reason Clint was not Admitted", the following was written: Per Psychiatrist SF6 does not meet criteria-not appropriate for admissions. No explanation was written as to why Patient #F19 was not considered appropriate for admissions.

In a face to face interview on 6/12/12 at 1:10 p.m. Administrator SF2, reviewed the intake sheet dated 5/18/12 for Patient #F19 and verified an appropriate reason for denial of admissions was not charted.

Patient #F20
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F20, dated 5/23/12, revealed the patient was listed as a 28 year old male. The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " Increase depression and feelings of hopelessness. Crying and not eating, body feels weak, very strange behavior. " Review of the criteria for admission legally mandated and PEC was checked. The initial diagnostic impression was listed as MDD (major depressive disorder). Under the section labeled clinical reason client was not admitted was handwritten, " SF5MD requested CAT(Computed Axial Tomography) scan, CAT scan normal, sent message to SF5MD. 5/24 Per SF6MD acuity too high @ (at) 6:35 a.m.

Patient #F21
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F21, dated 5/6/12, revealed the patient was listed as a 26 year old male. The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " Gravely Disabled, No sleeping, eating, poor hygiene, agitated, hostile, aggressive, + AH. Criteria for admission was listed as legally mandated, PEC, recent suicide attempt or high risk including refusal to eat, wandering or self mutilating. The initial diagnostic impression was listed as history of bipolar, schizophrenia. The clinical reason the client was not admitted was handwritten on the form, " SF7MD -Denied pt recently d/ced (discharged) from Hospital Fe. "

Patient #F22
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F22, dated 5/6/12, revealed the patient was listed as a 51 year old male. The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " Violent bx. Agitated, paranoid, suicidal, threatening to kill his self if not given help. Cut electrical wires at group home. Long psych hx. Criteria for admission was listed as legally mandated, PEC, and CEC (coroner ' s emergency certificate). Initial diagnostic impression was listed as SI and mood d/o (disorder). Under the section labeled, " Clinical Reason Client Was Not Admitted " was handwritten, " Per S7MD Denied, Pt does not meet inpatient criteria. Denied. Follow up with psychiatrist at Hospital " Fa " . Acuity too high. " The referral hospital was listed as Hospital " Fe " .
Patient #F23
Review of the Initial Intake Assessment and Inquiry Information sheet for Patient #F23, dated 5/6/12, revealed the patient was listed as a 47 year old male. The section labeled " Presenting Problem (Danger to Self or Others) " included the following information, " Anxious, Suicidal (no plan), took OD (overdose) of Tramadol/Ambien, decrease sleep, depressed, stress. " The criteria for admission was listed as legally mandated and PEC. The Initial Diagnostic Impression was listed as history of schizophrenia, anxiety, depression and stress. Under the section the clinical reason the client was not admitted was listed as, " per SF7MD does not meet criteria for inpt (inpatient) psychiatric hospital. "

An interview was conducted wit