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Based on reviews of the Emergency Department Transfer log, medical records, Security Incident Report, Local law enforcement report, policy and procedure, and interviews the hospital failed to provide an appropriate transfer for 1 (#2) of 20 sampled patients who needed specialized psychiatric treatment. Refer to findings in Tag 2409.

Based on reviews of the Emergency Department Transfer log, medical records, Security Incident Report, Local law enforcement report, policy and procedure, and interviews the hospital failed to provide an appropriate transfer for 1 (#2) of 20 sampled patients who needed specialized psychiatric treatment.

Findings include

Review of the facility's policy entitled, "Transfer Activities in Accordance with EMTALA (Emergency Medical Treatment and Labor Act) Requirements", dated 04/2014 revealed, the hospital will provide an appropriate medical screening examinations, stabilization treatment and an appropriate transfer of patients in accordance with EMTALA. Further review revealed the hospital will:
a. provide medical treatment within its capacity that minimizes the risk to the individual's health and, in the case of a woman in labor, the health of the unborn child.
b. The receiving facility: has available space and qualified personnel for the treatment of the individual, and has agreed to accept transfer of the individual and to provide appropriate medical treatment;
c. The transferring hospital sends to the facility all medical records (or copies) related to the emergency condition which the individual has presented that are available at the time of transfer.
d. The transfer is effected through qualified personnel and transportation equipment, as requires, including the use of necessary and medically inappropriate life support measures during the transfer. Continued review of the policy revealed involuntary (1013-allows detention of a mentally ill person against his/her will until he/she can be transferred to the nearest available emergency receiving facility for a mental health evaluation) patients would receive a medical screening examination and stabilizing treatment within the capabilities of the hospital. If the condition remains unstable an EMTALA appropriate transfer will be arranged for them. The appropriate involuntary transfer forms (1013, 2013) for general psychiatric referral or drug or alcohol, must be utilized and completed in addition to the hospital transfer forms. No consent for transfer from the patient is required. The policy revealed a decision regarding patient transfer may be made by either patient request or by a Qualified Medical Personnel (QMP).

Review of the medical record for patient #2 revealed the patient presented to the facility on 06/23/14 at 1:32 p.m. Patient #2 reported while on the bus someone was following them and believed that demons were torturing them. Patient #2 was placed on a 1013(involuntary) admission. Patient #2 had a history of Bipolar Disorder, Schizophrenia, Anxiety and Depression.

Continued review revealed patient #2 was assessed in Triage to be a level 3-Urgent and placed on 1:1 observation (constant eye contact). Further review revealed on 6/24/14 at 2:44 p.m. patient became threatening to staff after being non-compliant with request to go back in the room. Patient #2 was placed in restraints and medicated after hospital security and local the police department was called. Patient #2 was then placed into police custody at 5:04: p.m. and at 5:33 p.m. taken to another local acute care hospital for lock up by ambulance, escorted by the arresting police officer who rode in the ambulance with patient #2. All consent ' s, assessments, physicians orders, and treatment plans were completed, however there was no evidence that a physician written certification for transfer documentation was present for patient #2 on 06/23/2014.Patient #2 was medically cleared and awaiting transfer to an acute care hospital with psychiatric capability at 11:11 a.m. on 6/23/14 at Piedmont Hospital. However patient #2 was not transferred to another acute care facility until 6/24/14 at 5:04 p.m. (thirty hours later) while still awaiting transfer patient #2 became agitated and then was arrested for disorderly conduct and placed in police custody.

Further review of medical record indicated that, after patient #2 was arrested, the police requested an ambulance. The police stated they wanted to transfer patient #2 to a receiving hospital from Piedmont Hospital. Documentation in the medical record by Registered Nurse (RN) #5 revealed that, patient #2 was transferred to the receiving facility from the hospital but released to police custody who stated their intention was to bring patient to the receiving hospital's locked unit.

Review of the facility's transfer log on 06/24/14, revealed no evidence that patient #2 was transferred to an appropriate facility.

Review of Piedmont Hospital's Security Incident Report dated 06/25/14 at 12:16 p.m., revealed that on 6/25/2014 " at approximately 2:22 p.m. " , a hospital Security officer dispatched another hospital security officer and a Policemen (contracted local police department) working in the emergency department to room 9 for patient #2 " who was becoming increasingly non-compliant with nursing staff, " refusing to go back into room 9.

Further review indicated that 2 additional hospital Polices officers responded as well. Hospital Police along with the nursing staff was asking patient #2 to comply with the nursing staff request to go back to bed. Patient #2 became increasingly non-complainant with the staff. The Security officers secured the area and cleared the room, patient #2 then held an oxygen tank up and threatened to throw it. Patient #2 ' s bed was removed from the room because patient#2 had thrown water on the bed. After the bed was returned to the patient ' s room " Security went hand on with patient #9 and physically four points restrained him to his bed. All officers cleared room 9 at approximately 2: 50 p.m. During this process Nursing contacted ...911 to request assistance from the Local Police Department. " The contracted Policeman who was working in Piedmont Hospital ' s emergency room arrested patient #2 on disorderly conduct charges and the patient was transferred to the receiving hospital ' s holding unit.

The Local policemen arrived and took patient #2 in custody. The police stated patient #2 would be going to another local hospital where they had a secure area to contain the patient. The contracted Policemen accompanied the ambulance to the acute care hospital per the local police department policy. Review of patient #2's medical record and the Security incident report verified the Piedmont Hospital staff was aware of the name of the receiving hospital and location as to where patient #2 was being transferred to by the local police department. There was no evidence to indicate/verify that the receiving hospital was notified or agreed to accept patient #2 on 06/24/14.

The hospital failed to ensure that their policy was followed as evidenced by failing to contact a representative at the receiving hospital that agreed to accept the patient. The hospital also failed to confirm that the facility had available space and qualified personnel to treat patient #2 on 6/24/14 to provide appropriate psychiatric care and treatment. Additionally, the hospital failed to send the receiving hospital copies of pertinent medical records for patient#2 on 6/24/2014.

The incident was witnessed by security officer #2. Further review revealed that Piedmont Hospital staff reported they would not be able to handle this type patient and that patient #2 would need to go to the receiving facility's mental ward. Transportation ambulance came at approximately 6:00 p.m. and patient #2 was taken to the receiving facility accompanied by the arresting hospitals ' contracted police. Further review revealed that upon arrival at the receiving facility, the receiving staff indicated patient #2 was transferred inappropriately, " Hospital dumping. " Piedmont Hospital contracting officer completed a 1013 on patient #2 to have the receiving facility do a mental evaluation on the patient.

Interview on 7/15/14 at 12:15 p.m. the ED physician #4 revealed being familiar with patient #2, who was brought to the ED by ambulance due to paranoid and delusions. The ED physician #4 stated that patient #2, was threatening, non-compliant and was detained by hospital security and was placed into custody by the police. During this interview it was revealed that there was no evidence of a written physician certification in the medical record for patient #2 to transfer the patient on 6/24/14. The hospital failed to ensure that their policy was followed as evidenced by failing to document/provide written physician transfer form for patient #2 on 6/24/2014 who required in patient definitive psychiatric care.


Interview on 7/15/14 at 1:20 p.m., the RN #5 reported patient #2 was at nursing station, demanded phone to call someone to come patient up. Patient #2 became increasing agitated. Security was notified, patient #2 became violent. Patient #2 heard RN #5 asking for medication, then patient #2 shoved a stretcher at the staff. RN #5 also stated being unsure once patient #2 was in police custody who had the authority to take the patient. RN #5 explained the transfer policy was not followed when patient #2 was transferred; no transfer documentation for an appropriate transfer was completed.

Based on reviews of the Emergency Department Transfer log, medical records, Security Incident Report, Local law enforcement report, policy and procedure, and interviews the hospital failed to provide an appropriate transfer for 1 (#2) of 20 sampled patients who needed specialized psychiatric treatment. Refer to findings in Tag 2409.

Based on reviews of the Emergency Department Transfer log, medical records, Security Incident Report, Local law enforcement report, policy and procedure, and interviews the hospital failed to provide an appropriate transfer for 1 (#2) of 20 sampled patients who needed specialized psychiatric treatment.

Findings include

Review of the facility's policy entitled, "Transfer Activities in Accordance with EMTALA (Emergency Medical Treatment and Labor Act) Requirements", dated 04/2014 revealed, the hospital will provide an appropriate medical screening examinations, stabilization treatment and an appropriate transfer of patients in accordance with EMTALA. Further review revealed the hospital will:
a. provide medical treatment within its capacity that minimizes the risk to the individual's health and, in the case of a woman in labor, the health of the unborn child.
b. The receiving facility: has available space and qualified personnel for the treatment of the individual, and has agreed to accept transfer of the individual and to provide appropriate medical treatment;
c. The transferring hospital sends to the facility all medical records (or copies) related to the emergency condition which the individual has presented that are available at the time of transfer.
d. The transfer is effected through qualified personnel and transportation equipment, as requires, including the use of necessary and medically inappropriate life support measures during the transfer. Continued review of the policy revealed involuntary (1013-allows detention of a mentally ill person against his/her will until he/she can be transferred to the nearest available emergency receiving facility for a mental health evaluation) patients would receive a medical screening examination and stabilizing treatment within the capabilities of the hospital. If the condition remains unstable an EMTALA appropriate transfer will be arranged for them. The appropriate involuntary transfer forms (1013, 2013) for general psychiatric referral or drug or alcohol, must be utilized and completed in addition to the hospital transfer forms. No consent for transfer from the patient is required. The policy revealed a decision regarding patient transfer may be made by either patient request or by a Qualified Medical Personnel (QMP).

Review of the medical record for patient #2 revealed the patient presented to the facility on 06/23/14 at 1:32 p.m. Patient #2 reported while on the bus someone was following them and believed that demons were torturing them. Patient #2 was placed on a 1013(involuntary) admission. Patient #2 had a history of Bipolar Disorder, Schizophrenia, Anxiety and Depression.

Continued review revealed patient #2 was assessed in Triage to be a level 3-Urgent and placed on 1:1 observation (constant eye contact). Further review revealed on 6/24/14 at 2:44 p.m. patient became threatening to staff after being non-compliant with request to go back in the room. Patient #2 was placed in restraints and medicated after hospital security and local the police department was called. Patient #2 was then placed into police custody at 5:04: p.m. and at 5:33 p.m. taken to another local acute care hospital for lock up by ambulance, escorted by the arresting police officer who rode in the ambulance with patient #2. All consent ' s, assessments, physicians orders, and treatment plans were completed, however there was no evidence that a physician written certification for transfer documentation was present for patient #2 on 06/23/2014.Patient #2 was medically cleared and awaiting transfer to an acute care hospital with psychiatric capability at 11:11 a.m. on 6/23/14 at Piedmont Hospital. However patient #2 was not transferred to another acute care facility until 6/24/14 at 5:04 p.m. (thirty hours later) while still awaiting transfer patient #2 became agitated and then was arrested for disorderly conduct and placed in police custody.

Further review of medical record indicated that, after patient #2 was arrested, the police requested an ambulance. The police stated they wanted to transfer patient #2 to a receiving hospital from Piedmont Hospital. Documentation in the medical record by Registered Nurse (RN) #5 revealed that, patient #2 was transferred to the receiving facility from the hospital but released to police custody who stated their intention was to bring patient to the receiving hospital's locked unit.

Review of the facility's transfer log on 06/24/14, revealed no evidence that patient #2 was transferred to an appropriate facility.

Review of Piedmont Hospital's Security Incident Report dated 06/25/14 at 12:16 p.m., revealed that on 6/25/2014 " at approximately 2:22 p.m. " , a hospital Security officer dispatched another hospital security officer and a Policemen (contracted local police department) working in the emergency department to room 9 for patient #2 " who was becoming increasingly non-compliant with nursing staff, " refusing to go back into room 9.

Further review indicated that 2 additional hospital Polices officers responded as well. Hospital Police along with the nursing staff was asking patient #2 to comply with the nursing staff request to go back to bed. Patient #2 became increasingly non-complainant with the staff. The Security officers secured the area and cleared the room, patient #2 then held an oxygen tank up and threatened to throw it. Patient #2 ' s bed was removed from the room because patient#2 had thrown water on the bed. After the bed was returned to the patient ' s room " Security went hand on with patient #9 and physically four points restrained him to his bed. All officers cleared room 9 at approximately 2: 50 p.m. During this process Nursing contacted ...911 to request assistance from the Local Police Department. " The contracted Policeman who was working in Piedmont Hospital ' s emergency room arrested patient #2 on disorderly conduct charges and the patient was transferred to the receiving hospital ' s holding unit.

The Local policemen arrived and took patient #2 in custody. The police stated patient #2 would be going to another local hospital where they had a secure area to contain the patient. The contracted Policemen accompanied the ambulance to the acute care hospital per the local police department policy. Review of patient #2's medical record and the Security incident report verified the Piedmont Hospital staff was aware of the name of the receiving hospital and location as to where patient #2 was being transferred to by the local police department. There was no evidence to indicate/verify that the receiving hospital was notified or agreed to accept patient #2 on 06/24/14.

The hospital failed to ensure that their policy was followed as evidenced by failing to contact a representative at the receiving hospital that agreed to accept the patient. The hospital also failed to confirm that the facility had available space and qualified personnel to treat patient #2 on 6/24/14 to provide appropriate psychiatric care and treatment. Additionally, the hospital failed to send the receiving hospital copies of pertinent medical records for patient#2 on 6/24/2014.

The incident was witnessed by security officer #2. Further review revealed that Piedmont Hospital staff reported they would not be able to handle this type patient and that patient #2 would need to go to the receiving facility's mental ward. Transportation ambulance came at approximately 6:00 p.m. and patient #2 was taken to the receiving facility accompanied by the arresting hospitals ' contracted police. Further review revealed that upon arrival at the receiving facility, the receiving staff indicated patient #2 was transferred inappropriately, " Hospital dumping. " Piedmont Hospital contracting officer completed a 1013 on patient #2 to have the receiving facility do a mental evaluation on the patient.

Interview on 7/15/14 at 12:15 p.m. the ED physician #4 revealed being familiar with patient #2, who was brought to the ED by ambulance due to paranoid and delusions. The ED physician #4 stated that patient #2, was threatening, non-compliant and was detained b