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Based on review of medical record and interviews with staff an appropriate medical screening was not provided for this patient.

Findings:

1. On 6/4/2020, at 4:23 p.m., a 39-year-old uninsured male presented to the hospital under review via private vehicle with his sister for a psychiatric complaint. He had a history of bipolar disorder, and a previous suicide attempt by overdose 10 years prior. Per his sister, he was hallucinating, and believed people were going to harm him. She described him as agitated and paranoid. He was not sleeping and he was taking illegal drugs. The patient was witnessed by staff looking uneasy and pacing, but he denied suicidal ideation's himself.

A nurse practitioner and an emergency department physician evaluated the patient and placed him on a suicide watch. A paramedic noticed he was very jittery and anxious. A drug screen was performed, which demonstrated the presence of cocaine, amphetamines, and marijuana. The patient was medically cleared and the emergency department physician intended to transfer the patient to a psychiatric facility.

The patient was evaluated by a remote behavioral health team on three telephone conferences during the night. The patient indicated he was open to inpatient psychiatric hospitalization if needed. The mother of the patient stated that she could not monitor him at home because she had no control of who comes or goes once she is asleep. The behavioral health team finally recommended discharge of the patient home.

The patient was discharged at 11:09 p.m. Four hours later, he returned in cardiopulmonary arrest after committing suicide by hanging.

2. There is no indication that the crisis screener was supervised by a psychiatrist in this patient's case. There is also no indication that the crisis screener was a qualified medical provider. Even if the crisis screener was a qualified medical provider, there is no indication that the patient was being supervised by a psychiatrist.

The patient did not receive an appropriate medical screening examination. The patient was not stabilized prior to discharge.

Based on review of medical record and interviews this requirement was not met.


Findings:

1. The patient a 39-year-old uninsured male who presented to the Christus Spohn Hospital Alice, TX via private vehicle with his sister for a psychiatric complaint. He had a history of bipolar disorder, and a previous suicide attempt by overdose 10 years prior was not stabilized. The patient could have been transferred for inpatient psychiatric management, or evaluated by a team with a supervising psychiatrist after medical screening

2. The patient denied suicidal ideation's. After the screening, Coastal Plains recommended the patient be discharged with a safety plan. After the patient was discharged, he returned four hours later in cardiopulmonary arrest after committing suicide by hanging.

3. Interviewed Staff # 7, MD ER Physician who covered the ER as ER physician 6pm-6am shift on June 4-5,2020. Interviewed ER Physician on June 24, 2020 from 4:05pm-4:15pm via telephone while in the facility.

Staff #7, MD explained he took over care of the patient, 39y/o male when staff #7, MD came on the pm shift (6pm-6 am) on June 4, 2020. He described patient as restless, could not keep still. The patient was not aggressive and answered all questions. He said the patient never admitted to being suicidal, and through his interactions with the patient, he never would have suspected the patient was suicidal. But the patient being restless, and not keeping still whether or not it was from being under the influence of illegal drugs caused him concern to believe the patient needed a psychological assessment. He had the patient observed for several hours. He said he cleared the patient medically so he can receive a psychological assessment.

Coastal Plains Community MHMR was the group that conducted the psychological assessments. They conducted the psychological assessment through teleconference with the patient. They conducted at least 3 assessments on the patient. He admitted the MHMR group who psychologically assessed the patient (3 times) never contacted him (MD) and verbally talked to him about the patient over the phone.

MHMR staff made a safety plan agreement with the patient and gave resources and contact numbers to the patient. When this physician saw that Coastal Plain made a safety plan and agreement with Mr. Cuevas he did not think much of it. Though he did think the patient could benefit from inpatient behavioral health stay. But this could not really be supported if the patient did not show evidence of a suicidal/homicidal ideation during his ER visit. He said when he spoke to the patients the patient only wanted to be discharged after evaluation. The patient was not in the emergency room on an emergency detention (ED). He volunteered with his sisters concern on coming to the emergency room.

Staff #7, MD said after he saw Coastal Plains recommendation and the safety plan he agreed to discharge the patient to home.