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Based on record review and interview, the hospital failed to:

a. request and receive acceptance for a patient to be transferred to a facility that provided mental health services,

b. document provider certification that the patient's health benefit of transferring outweighed the risk, and

c. provide the receiving hospital with all clinical records pertaining to the emergency room visit which occurred prior the patient's transport to the receiving facility.

Findings:

A review of the hospital policy titled, "Oklahoma Medical Screening Examination and Stabilization Policy dated 04/16" showed any individual who presented to the dedicated emergency department requesting examination and treatment for an emergency medical condition, a medical screening examination (MSE) would be performed by a qualified provider...the hospital would provide any necessary stabilizing treatment or an appropriate transfer.

On 06/04/17 at 5:33pm, Patient #2 came to hospital's dedicated emergency department in protective custody of the police. Patient #2 was suicidal and had a history of diabetes. Following a medical screening exam, the ED physician assistant determined Patient #2 had an emergency medical condition. The hospital stabilized one of two medical conditions, within the hospital's capabilities by providing medical examination and treatment for his elevated blood glucose: however, Patient #2 continued to have psychiatric issues ie suicidal ideation/depression, the treatment of which was not within the hospital's capabilities.

A review of Patient #2's clinical record showed the physician's assistant did not perform a certification stating the patient accepted the medical benefits and risks of being transferred to another facility for appropriate medical treatment.

On 06/04/17, Staff I stated Patient #2 was in emergency custody of the police, who brought the patient to the hospital for a medical screening examination. Staff I stated prior to the ED visit, the police planned to take Patient #2 to a mental health facility in a nearby city. Staff I stated the patient was discharged from the hospital.

MHH did not contact the receiving facility, CAMH, to accept transfer of Patient #2 and agree to provide appropriate medical treatment.

MHH did not send all medical records available related to Patient #2 emergency medical condition, including the provider and nursing assessment and the administration times of insulin.

The provider discharged Patient #2 from MHH and did not coordinate an appropriate transfer. The provider did not certify that Patient #2 could be safely transported by police to CAMH.

MHH staff were documenting patients were under emergency order of detention when the patients were actually in police protective custody awaiting a mental health assessment. Both the MHH and CAMH staff interchanged the term of discharge and transfer in the clinical record.