HospitalInspections.org

Based on medical record review, document review, and interview, the facility failed to ensure identification data included the patient's appropriate legal status for 3 of 5 patients reviewed (Patients #1, 3, and 19)

Findings were:

Facility policy titled "Patient Rights - Texas" last revised 7/2020, included the following: " ...G. All patients will give informed consent prior to the delivery of care provided by the organization ..."

Facility policy titled "Discharge Against Medical Advice [AMA]," last revised 02/2017, included the following, "...-If the attending/covering physician assesses the patient to be harmful to self or others, obtain an order to implement the Involuntary Commitment process. Refer to the Involuntary Commitment policy ..."

When the "Involuntary Commitment" policy was requested from the Director of Quality on the afternoon of 7/12/22 at 3:40 p.m., she said no such policy could be located. She stated, "We can't find the involuntary commitment process. I'm going to reach out to corporate to see if they have it ..."
In an e-mail dated 7/14/22 at 11:45, the Director of Quality stated, "In speaking with corporate, they have noticed there is actually no involuntary commitment policy as stated. However, they have shared they the two attached policies incorporates the involuntary commitment process." The policies included were "Patient Rights - Texas" last revised 7/2020 and "Admission Criteria" last revised 5/2020.

In an interview with Staff #16, Intake Director, on 8/9/22 at 11:36 am, When asked about a patient who comes in on an Emergency Detention (ED), she stated, "Usually, if they're on an ED, the police bring them in directly. A lot of times hospitals already filed an OPC (Order of Protective Custody) when they come to us. If they are oriented and appropriate, we give them that right to sign themselves in. If they are not appropriate, they're admitted involuntarily, so at the 48-hour mark or once the physician does their eval, then we decide to file on them or they are going to be discharged ... Every patient is offered [to be admitted voluntarily] unless they're really psychotic or not oriented, not understanding what's in front of them. If they can sign in voluntarily, why go through the courts?" When asked what point a person on an ED gets to decide to be voluntarily admitted, she stated, "In intake once they've been assessed and still meeting criteria and they're going to be admitted. That's when they get consents to treatment." She went on to say, "The EDO expires, so if they're OPC, they're court-ordered to stay here. The EDO expires. If they sign consents and they're on an EDO, they're voluntary; if on OPC and sign informed consent, they're not voluntary."


Review of the medical record for Patient #1 revealed they presented to the facility on an ED on 10/16/19.
The ED dated 10/16/19 at 2:15 pm stated in part, "1. I have reason to believe and do believe that [Patient #1] evidences mental illness.
2. I have reason to believe and do believe that the above-named person evidences a substantial risk of serious harm to himself/herself or others based upon the following: stated [they were] going to kill herself."
Patient #1 signed the form titled "Conditions of Admission" on 10/16/19 at 3:12 pm and was considered a "voluntary patient" although a form titled "Bed Letter" at an unknown date at time stated in part, "We will accept this person on a court commitment and/or an Order of Protective custody to our facility." The Conditions of Admission form did not contain information or indicate patient acceptance of voluntary admission to the hospital.
Patient #1's psychiatric evaluation dated 10/17/19 at 3:49 pm stated in part, "Chief Complaint: Suicidal ideation without a plan.
...Medical Necessity Certification Statement: I certify that inpatient psychiatric hospital admission is medically necessary for treatment, which can be expected to improve the patient's condition. The patient cannot be safely treated or evaluated at a lower level of care. This admission will include evaluation and treatment."

There was no documentation of the date and time during the emergency detention period that a physician believed one of the criteria no longer applied to Patient #1 and they had the option to be released.

Review of the medical record of Patient #3 revealed they were admitted to the facility on an ED on 12/10/20 at 2:16 p.m.
The ED dated 12/10/20 at 1:08 am stated in part, "1. I have reason to believe and do believe that [Patient #3] evidences mental illness.
2. I have reason to believe and do believe that the above-named person evidences a substantial risk of serious harm to himself/herself or others based upon the following: [Patient #3] has been transported to [another area hospital] two times in the last 24 hours by Carrollton PD. [Patient #3] has refused service on both occasions, and ripped IV's out both times. [Patient #3] was unaware of where she is, and ran out of the emergency room and attempted to physically attack her mother in the parking lot in front of security @ the hospital and off duty Plano PD ..."
A document entitled Haven Intake Documentation completed on 12/10/22 at 12:36 p.m. noted [Patient #3] to be voluntary. Under the "Risk" section, the following items were checked: "Gravely Disabled, Psychotic and Delusions..."

Patient #3 signed the form titled "Conditions of Admission" on 12/10/20 at 2:42 pm and was considered a "voluntary patient" although a form titled "High Risk Notification" completed on 12/10/20 at 3:50 p.m. included the following:
" ...Legal Status: [unchecked] Voluntary [checked] Involuntary..."
The Conditions of Admission form did not contain information or indicate patient acceptance of voluntary admission to the hospital.

A Psychiatric Evaluation on 12/11/20, time unknown, included the following:
"Chief Complaint/Reason for Admission: Chief Complaint: Psychosis...
Problem list: Floridly psychotic, noncompliant with the treatment ...

...Medical Necessity Certification Statement: I certify that inpatient psychiatric hospital admission is medically necessary for treatment, which can be expected to improve the patient's condition. The patient cannot be safely treated or evaluated at a lower level of care. This admission will include evaluation and treatment."

There was no documentation of the date and time during the emergency detention period that a physician believed one of the criteria no longer applied to Patient #3 and they had the option to be released.


Review of the medical record for Patient #19 revealed they presented to the facility on an ED on 8/6/22 at 12:11 am, according to intake documentation.
The ED dated 8/6/22 at 12:41 am stated in part, "1. I have reason to believe and do believe that [Patient #19] evidences mental illness.
2. I have reason to believe and do believe that the above-named person evidences a substantial risk of serious harm to himself/herself or others based upon the following: [Patient #19] State he wanted to hurt other people.
[Patient #19] also stated he hears voices
[Patient #19] was uncooperative w/ staff at [another hospital]"

The Physician's Preadmission Examination Orders and Preliminary Plan of Care dated 8/6/22 at 1:50 am stated in part, "Presenting Legal Status: Voluntary, per intake staff report."

There was no documentation of the date and time during the emergency detention period that a physician believed one of the criteria no longer applied to Patient #19 and they had the option to be released.


Texas Health and Safety Code (HSC) Title 7, Subtitle C, Chapter 573, Subchapter A related to Emergency Detention stated in part, "Sec. 573.022. EMERGENCY ADMISSION AND DETENTION. (a) A person may be admitted to a facility for emergency detention only if the physician who conducted the preliminary examination of the person makes a written statement that:
(1) is acceptable to the facility;
(2) states that after a preliminary examination it is the physician's opinion that:
(A) the person is a person with mental illness;
(B) the person evidences a substantial risk of serious harm to the person or to others;
(C) the described risk of harm is imminent unless the person is immediately restrained; and
(D) emergency detention is the least restrictive means by which the necessary restraint may be accomplished; and
(3) includes:
(A) a description of the nature of the person's mental illness;
(B) a specific description of the risk of harm the person evidences that may be demonstrated either by the person's behavior or by evidence of severe emotional distress and deterioration in the person's mental condition to the extent that the person cannot remain at liberty; and
(C) the specific detailed information from which the physician formed the opinion in Subdivision (2).
Sec. 573.023. RELEASE FROM EMERGENCY DETENTION. (a) A person apprehended by a peace officer or transported for emergency detention under Subchapter A or detained under Subchapter B shall be released on completion of the preliminary examination unless the person is admitted to a facility under Section 573.022.
(b) A person admitted to a facility under Section 573.022 shall be released if the facility administrator determines at any time during the emergency detention period that one of the criteria prescribed by Section 573.022(a)(2) no longer applies.
Sec. 573.024. TRANSPORTATION AFTER RELEASE. (a) Arrangements shall be made to transport a person who is entitled to release under Section 573.023 to:
(1) the location of the person's apprehension;
(2) the person's residence in this state; or
(3) another suitable location.
...(c) If the person was apprehended by a peace officer under Subchapter A, arrangements must be made to immediately transport the person. If the person was transported for emergency detention under Subchapter A or detained under Subchapter B, the person is entitled to reasonably prompt transportation."