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Based on record review and interview the facility failed to ensure that transfer documents are completed with patient specific (to the condition of the patient) risks and benefits explained to them in 2 of 3 transferred records reviewed (Patient #'s 3 & 17), failed to have documented medical record information being sent to the receiving hospital in 1 of 3 records reviewed (Patient #12), failed to have patient specific statement of stability in 3 of 3 records reviewed (Patient #'s 3, 12 & 17) and failed to have patient signatures on transfer form in 2 of 3 records reviewed (Patient #'s 3 & 17).

Findings include:

The facility policy titled "Psychiatric Crisis Service(PCS) Policy & Procedure" #5756284 last revised on 12/21/18 was reviewed on 1/17/19 at 11:30 AM. This policy revealed on page 4 "E. Transfers to Private Hospitals: 1. The psychiatrist determines that the patient needs inpatient psychiatric admission. If the patient is appropriate for transfer to a community hospital, the psychiatrist refers the patient to the RN (Registered Nurse) Transfer Coordinator (when available)...5. The RN Transfer Coordinator and MD (Psychiatrist) completes the Hospital Certification and Transfer Form and Crisis Discharge Summary/Instruction forms and obtains the patient signature."

Patient #3's medical record was reviewed on 1/17/19 at 9:15 AM. Patient #3 was seen in Psychiatric Crisis Services (PCS) on 1/7/19 at 9:30 PM with a past history of sexual abuse, a diagnosis of Major Depressive Disorder with previous inpatient behavioral health stays (at a different facility) after being involved in an altercation with parent on 1/7/19 and threatening suicide. An "Individual Progress Note" on 1/7/19 at 9:30 PM completed by Registered Nurse G documented "Per [Psychiatrist F] would like to transfer to community hospital. Parents prefer [in patient behavioral health facility]. Advised patient of transfer to [receiving facility city] by Ambulance and explained transfer process. patient is agreeable to transfer and signed EMTALA form. patient is calm and cooperative." "Medical Screening and Status of EMC (emergent medical condition) completed by Psychiatrist F on 1/7/19 at 7:46 PM revealed under "Does a Physical EMC or an Urgent Physical Condition Exist for the Patient? NO." Patient # 3 was transferred to another in-patient behavioral health facility.

Review of the form "MILWAUKEE COUNTY BEHAVIORAL HEALTH HOSPITAL CERTIFICATION AND TRANSFER FORM" on Patient #3 revealed on 1/7/19 at 8:41 PM general transfer risks with no documentation of unique risks related to Patient #3's presenting condition, no patient signature of receiving risks and benefits about transfer and no documented "emergent medical condition" on Patient #3 that would have prevented patient signature, no documented delineation of statement of stability applicable for Patient #3. The incomplete and non-patient specific areas of transfer form were confirmed in an interview with Chief Medical Officer B on 1/17/19 at 1:00 PM who stated, when shown the transfer sheet and asked if the expectation would be for transfer form to be completed thoroughly and patient specific replied "Yeah I would."

Patient #12's medical record was reviewed on 1/17/19 at 10:00 AM. Patient #12 was seen in the PCS on 1/12/19 at 8:30 PM with a past history of cocaine use, cannabis use and daily alcohol use who was brought in voluntarily by spouse for evaluation of bizarre behaviors such as muscle movements and removing clothing. An "Individual Progress Note" completed by Psychiatrist I on 1/12/19 at 8:53 PM revealed "Patient was evaluated in the triage area due to concerns of medical emergency. Patient's (spouse) stated that patient stopped speaking, having abnormal muscle movements. Started today. Has not occurred previously. Patient unable to answer questions. Patient's (spouse) declined to transport voluntarily as patient has previously gotten out of the car and took off [his/her] clothes in the driveway to PCS. Review of Systems: Unable to obtain due to emergency medical condition (patient mute). Patient transferred via paramedic to [acute care hospital name] Emergency Department for sudden onset mutism and abnormal muscle movements. Given cocaine use, concerns of stroke. Vitals unable to be obtained due to flinging arm motions and twitching. -Paramedics called and patient transferred. -No medications given in PCS. -No discharge summary completed due to medical emergency status."

Review of the form "MILWAUKEE COUNTY BEHAVIORAL HEALTH HOSPITAL CERTIFICATION AND TRANSFER FORM" on Patient #12 revealed on 1/12/19 at 8:38 PM revealed general transfer risks with no documentation of unique risks related to Patient #12's presenting condition, no documented medical records were sent with Patient #12 to receiving hospital and no documented delineation of statement of stability applicable for Patient #12. The incomplete and non-patient specific areas of transfer form were confirmed in an interview with Chief Medical Officer B on 1/17/19 at 1:00 PM who stated, when shown the transfer sheet and asked if expectation would be for transfer form to be completed thoroughly and patient specific replied "Yeah I would."

Patient #17's medical record was reviewed on 1/17/19 at 8:30 AM. Patient #17 was seen in the PCS on 1/15/19 at 8:15 PM with a past history of opioid use disorder in sustained remission, active THC (marijuana) use disorder, tobacco use disorder who presented to PCS on an emergency detention after punching own car window out at another behavioral health center's (without and emergency room) parking lot. Review of "Individual Progress Note" on 1/15/19 at 8:42 PM revealed "Patient is highly delusional, paranoid, not willing to truly engage in interview. Talkative and obviously manic with psychosis. [other facility psychiatrist name] did call to give heads up and is willing to accept back. Meets criteria for inpt (in-patient) hospitalization for med mgt (medical management), safety, and stabilization." A "Medical Screening and Status of EMC (emergent medical condition) completed by Psychiatrist H on 1/15/19 at 8:19 PM documented "Does a Physical EMC or an Urgent Physical Condition Exist for the Patient? NO."

Review of "MILWAUKEE COUNTY BEHAVIORAL HEALTH HOSPITAL CERTIFICATION AND TRANSFER FORM" was completed on 1/15/19 at 8:30 PM revealed general transfer risks with no documentation of unique risks related to Patient #17's presenting condition, no patient signature of receiving risks and benefits about transfer and no documented delineation of statement of stability applicable for Patient #17. The incomplete and non-patient specific areas of transfer form were confirmed in an interview with Chief Medical Officer B on 1/17/19 at 1:00 PM who stated, when shown the transfer sheet and asked if expectation would be for transfer form to be completed thoroughly and patient specific replied "Yeah I would."

During an interview conducted on 1/17/19 at 1:00 PM with Director of Nursing A, Chief Medical Officer B, Chief Executive Officer C, Case Manager D and Registered Nurse Manager E, in response to the above noted missing documentation on Patient #'s 3, 12 & 17 and incomplete transfer forms Chief Medical Officer B replied "I see what you mean they (the forms) need some tweaking and cleaning up."