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Based on record review and interview, the hospital failed to ensure that a medical screening examination that included a Psychiatric Consult was provided to a patient who presented to the hospital's Emergency Department by OPC (Order of Protective Custody) seeking treatment for violent and threatening behaviors for 1 (#1) of 20 (#1-#20) sampled patients.

Findings:

Review of the medical record for Patient #1 revealed a 29 year old male returned to the ED on 02/08/2022 at 7:57 p.m. Patient seen last night in ER with OPC. ER doctor chose to release patient. He returns tonight with another OPC stating he is violent and threatening to family, broke all windows in relative's car. Tested positive for Ecstasy last night.

Triage Note at 8:10 p.m. revealed patient presents to ER with Local Police Department officer with signed order of protective custody (OPC) from the Madison Parish Coroner's office signed. Paper states making threats of doing bodily harm to self, family, officers and anyone he sees, also stating God told him to kill. When he see anyone walking, he threatens them and charges at them. Patient was seen in the ED last night for the same c/o, but order of protective custody was not signed and patient was calm and cooperative and did not state any suicidal or homicidal ideations, was discharged. Patient arrives tonight calm, cooperative with nurse, quiet and appears sleepy. Patient did not verbalize any threats of harm to self or others during time of triage. Patient placed in ED room #2. MD notified of patients arrival.

Interview on 02/22/2022 at 8:44 a.m. with S4RN revealed that she was the RN on duty both nights the patient presented to the ED. She stated that she remembers the patient well, that he is a frequent flyer in the ED. She said he does have a history of psych issues and has been placed in psych facilities in the past. She stated the first night he came in to the emergency department he was very calm and cooperative. She said he was brought by the local police dept. He tested positive for drug use and the ED physician treated him for drug induced behaviors and did not feel he was a threat to himself or others and he was discharged home. She stated the next night he returned again by the police department under an OPC letter from the coroner's office. She remembers the patient being loud but cooperative and calm for the most part during his triage and he was placed in a room. She remembers being with another patient when she heard yelling, screaming and threatening remarks and came out of the room where she was and saw the patient yelling threats at the doctor and other staff. She remembers the hospital security coming in and immediately escorting the patient out of the building. She states that was the last contact with the patient as he was arrested and escorted to jail and did not return.

Interview on 02/22/2022 at 9:30 a.m. with S6Physician stated that he remembered the patient very well. He was the ED physician on the night of the 02/08/2022 ED visit. He remembers seeing the patient and reviewing his history and previous night visit record. He was treated for drug issues and discharged. He was brought in by the police on an OPC and tested positive for drugs. He then went in to do the medical exam and when he entered the room the patient was asleep and he gently shook his arm and when he did the patient arose and became very hostile and aggressive and started yelling threats and gesturing with his hands to do bodily harm to me. He said I immediately backed up out of the room and the patient was following me into the hallway continuing verbal and threatening gestures towards me. Then the hospital security guard came in and immediately escorted the patient out of the ED and I never saw him again. He said he was told he was arrested and taken to jail. He further stated that he had been a ED physician for over 20 years but had never felt as scared as he was that night not only for myself but the rest of the ED staff. Surveyor asked about possible PEC, and he stated that prior to the patient was calm and cooperative, if he would have returned to the ED the patient would have been PEC'd for psychiatric issues, but he never returned.