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Based on review of clinical records and interview, the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department.

Findings included:

Review of the clinical record for patient #4 revealed the patient presented to the emergency department via ambulance on 4/9/17 at 8:02 pm. Patient #4 had been having many outbursts at home, threw glass at the dog, hit her sister and had a history of hitting her mother, who was pregnant. Her mother stated her father was deployed and she was very overwhelmed. Her mother stated the patient is very aggressive and she cannot handle her. Patient #4's condition was chronic but had been worsening the last two days.
The pediatric behavioral department staff was contacted for possible admission of patient #4. The nurse indicated they had spoken with the psychiatrist who wanted patient #4 to be seen in the morning. Patient #4 was discharged and instructed to follow up in the morning.

On 4/10/17 at 8:10 am, a partial inpatient admission assessment was completed and patient #4 attended the partial inpatient program for the next few hours. During this visit, it was reported that patient #4 had significant mood swings, depression, sleep problems and rage attacks during which she hits, kicks, throws things and breaks things. At 1:14 pm, there was a conference with the family, psychiatrist, case manager, psychologist, recreational therapist and nursing staff and all agreed to admit the patient to inpatient status. She was diagnosed with "Mood Disorder," which was described as "severe." She was admitted to manage or rule-out bipolar affective disorder, dysthymic disorder, anxiety disorder and posttraumatic stress disorder.

During the first emergency department [ED] visit, psychiatry was called for purposes of admission, but a non-qualified medical provider made the decision, without interviewing the patient, that the patient could follow-up in the morning. This assessment could not have been made over the phone, by a non-qualified medical provider, without having spoken with the patient. It required a psychiatric history and physical examination. An appropriate MSE was not performed to the hospital's capabilities. The patient was not stabilized during the first ED visit.

In an interview with staff #9 on the afternoon of 7/27/17, staff #9 stated, "The ED staff discussed with staff at the behavioral health unit. RN [registered nurse] to RN. The RN on the behavioral health side discussed the case with [the psychiatrist on-call]. [The psychiatrist on-call] recommended admission to the partial program and was set up for 7:30 am. The ED physician determined with [the psychiatrist on-call] that the partial program would be OK. Whatever started occurring at home, there was a discussion with the physician and the mother and decided the partial program was not working."