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Based on a review of medical records, Medical Staff Rules and Regulations, Agreement for Professional Emergency Services, policies and procedures,and staff interviews, it was determined that the facility failed to provide an appropriate transfer of an individual who needed inpatient pediatric psychiatric treatment for 1(#) of 20 sampled patient medical record reviewed. Instead Patient #1 was discharged to the custody of the police to take to another facility.


Cross refer to A-2409, as it relates to failure to provide an appropriate transfer for patient #1.

Based on a review of medical records, Medical Staff Rules and Regulations, Agreement for Professional Emergency Services, policies and procedures, and staff interviews, it was determined that the facility failed to provide an appropriate transfer of an individual who needed inpatient pediatric psychiatric treatment for 1 of 20 sampled patient medical records reviewed. Patient #1 was discharged to the custody of the police for transport to another facility.

Findings were:

Review of Patient #1's medical record revealed that on 2/14/19 at 7:03 p.m. Patient #1 was bought into the facility's Emergency Room (ER) via an Emergency Medical Services (EMS) ambulance with chief complaints of suicidal ideations (thoughts of killing oneself), non-compliance with home medication regime, and scratching herself. Patient #1 was triaged (assessment by a nurse to determine the priority in which patients will be seen based on their chief complaints and signs/symptoms) at 7:03 p.m. by a Licensed Practical Nurse (LPN) and assigned a triage level of 5 (NON-URGENT per the facility ' s triage protocols).

The Medical Screening Examination (MSE) which was performed by Medical Doctor (MD EE) at 6:47 p.m. revealed a review of systems (including heart and lungs) by MD EE. MD EE noted that Patient #1's psychiatric assessment findings were positive for suicidal ideations and suicidal planning (the person wants to kill herself and has formulated a plan to do so). The record review also indicated MD EE's assessment of all other body systems was otherwise negative. Physician EE also noted that Patient #1 was uncooperative. Review of "Triage/Nurse's Notes" dated 2/14/19 indicated that Patient #1 was awake, communicative, hostile, and aggressive, cursing at, and attempting to hit staff. The local County Sheriff ' s Office was notified and Officers responded. Nurses' notes indicated that Patient #1 was placed into 4-point restraints (both arms and both legs restrained) with every 15 minutes monitoring. Patient #1's initial vital signs were blood pressure 120/64 (normal range 120/80), heart rate 107 (normal range 60-100), respiratory rate 18 (normal range 16-20), oxygen saturation (O2) (normal range 95%-100%) 96% on room air (RA), temperature 98.8 degrees Fahrenheit (normal body temperature is 98.6). Nurses' notes also indicated that Patient #1's height was 6' 3 inches (5' 3"), weight 145 pounds and that the patient had no known drug/food allergies.
Patient #1's vital signs remained within normal range from admission through her release on 2/19/2019 from the facility into the Local County Sheriff's custody. Her comorbidities (presence of other illnesses) included seizure disorder (brain over-activity), mental retardation (developmentally slow), urinary tract infection (bladder infection), and depression (severe sadness). The medical record review further revealed that Patient #1's home medication regime included Trazodone (treats depression), Clonidine (treats attention deficit), Benztropine (controls severe reactions to medications used to treat mental illness), Fluphenazine (antipsychotic) and Sulfamethoxazole/Trimethoprim (antibiotic that treats infections). The record further revealed that the family of Patient #1 was informed by the facility's staff to remain with Patient #1 due to her being underage, however, said family member left requesting the Department of Family and Children Services (DFACS) contact be made. DFACS responded and stayed with Patient #1 throughout the hospital stay. Further record review revealed that Patient #1 resided with her grandparents and they did not want Patient #1 returning to their home.
Review of "Mobile Crisis Referral" dated 2/17/19 indicated that Patient #1 had been in her grandmother's care for three (3) months, however, Patient #1's grandmother was hospitalized at another facility. Patient #1 presented in a euthymic (normal) mood with a congruent (agreeable) affect and kept stating that she wanted to go to a group home or home with an assessor or downstairs to go and buy clothes. Patient #1 denied suicidal ideations stating that she didn't want to kill herself and that she wanted to live.
Continued review of the medical record revealed that initial medical orders included blood drawing for a comprehensive drug screen, complete blood count (CBC), comprehensive metabolic panel (CMP), urinalysis (UA), and urine pregnancy. Laboratory results revealed that Patient #1 had a urinary tract infection (UTI) for which MD EE ordered antibiotic therapy.
The Form 1013 Certificate for Authorizing Transport to Emergency Receiving Facility and Report of Transportation (Mental Health) dated 2/14/2019 at 7:03 PM, was reviewed. The form revealed that the subject individual (Patient #1) appeared to be a mentally ill person requiring involuntary treatment in that he/she appears to be mentally ill, and presented a substantial risk of imminent harm to self and others as manifested by recently expressed threats of violence which presents a probability of physical injury to self and others.
At 10:15 a.m. the local County Sheriff Officer was informed of LPN BB's desire to press assault charges against Patient #1. At 10:30 a.m., documentation revealed the local county law enforcement officers arrived at the facility and at 10:40 a.m. Patient # 1 was discharged in the custody of local County Sheriff Officers. Nurse's notes from Patient #1's admission to the time the patient left the facility on 2/19/19 revealed that Patient #1 continued to exhibit aggressive and violent behavior including screaming, cursing, hitting, attempting to bite, kicking, refusal to follow instructions to stay in her room, attempting multiple times to enter other patients ' rooms, running outside, attempting to stab a DFACS representative with a plastic knife, eating Styrofoam, urinating and defecating on herself and smearing feces (stool) on herself and over the surroundings. The record also revealed the staff's constant attempts to appease Patient #1 by providing frequent snacks and reading to Patient #1. Medications were administered as ordered. The Georgia Crisis and Access Line (mobile mental health assessment team) was notified. Local County Sheriff Office was notified. There were multiple attempts to place Patient #1 in 17 separate facilities, which declined the attempts due to various reasons. Review of Patient #1 ' s medical record failed to reveal a physician order discharging Patient #1 on 2/19/2019 to the custody of the law enforcement. The ED record also failed to reveal documentation that Patient #1 was to be held by law enforcement until transfer, as stated in the facility's policy. The facility failed to ensure that an appropriate transfer was provided on 2/19/2019 for Patient #1 who needed in-patient pediatric psychiatric care and treatment. Instead, on 2/19/2019 Patient #1 was discharged to the custody of Law Enforcement to take the patient to another facility.
Review of the "Medication Record" revealed that Patient #1 was medicated due to her continued aggressive and violent behaviors as follows:
2/14/19 at 9:12 p.m. Haloperidol (treats mental disorders) 5 milligram/1 milliliter (mg/ml) intramuscular (injection into a muscle) (IM).
2/15/19 at 7:47 a.m. Lorazepam (an anti-anxiety medication) 2 mg/1 ml IM.
2/15/19 at 9:17 a.m. Diphenhydramine (causes drowsiness) 50 mg IM.
2/16/19 at 9:11 a.m. Lorazepam 2 mg/1 ml IM.
2/16/19 at 8:43 p.m. Lorazepam 2 mg/1 ml IM.
2/17/19 at 4:09 a.m. Lorazepam 2 mg/1 ml IM.
2/17/19 at 4:09 a.m. Diphenhydramine 50 mg IM.
2/17/19 at 4:09 a.m. Haloperidol 5 mg/1 ml IM.
2/17/19 at 2:50 p.m. Diphenhydramine 50 mg IM.
2/18/19 at 12:15 p.m. Diphenhydramine 50 mg IM.
2/18/19 at 12:15 p.m. Haloperidol 5 mg/1 ml IM.
2/18/19 at 1:17 p.m. Lorazepam 2 mg/1 ml IM.
2/18/19 at 4:16 p.m. Hydroxyzine (treats anxiety) 50 mg/1 ml IM.
2/18/19 at 4:16 p.m. Lorazepam 2 mg/1 ml IM.
2/19/19 at 1:56 p.m. Diphenhydramine 50 mg IM.
2/19/19 at 1:56 p.m. Lorazepam 2 mg/1 ml IM.
2/19/19 at 1:56 p.m. Hydroxyzine 50 mg/1 ml IM.

Further review of the medical record for Patient #1 revealed that on 2/19/19 at 1:14 a.m., Patient #1 exited her room, screaming at staff and deputies and requesting food. Food was offered to Patient #1. Patient #1 refused and remained defiant. Patient #1 was restrained and medicated at 1:56 a.m. with Lorazepam, Diphenhydramine, and Haloperidol. Patient #1 continued to scream and yell at 2:00 a.m., 2:30 a.m. and 3:00 a.m. From 3:30 am to 7:00 a.m., Patient #1 was calm with eyes closed. At 8:30 a.m. Patient #1 was combative, assaulting staff, scratching, hitting, and kicking. Local County Sheriff Office and the facility's risk management were notified. Restraints were applied to Patient #1 at 8:45 a.m.
Review of the Medical Staff Rules and Regulations, signed by the Chief of Staff 1/16/13 and a representative of the Governing Body 2/14/13, revealed the following:
II. Discharge Policies
B. No patient will be transferred to another medical facility until the facility has been contacted and arrangements have been made for the continuing care of the patient.
Review of the Agreement for Professional Emergency Services revealed the agreement was made effective on 5/1/17. This agreement noted the following:
D. Perform the necessary professional emergency and related services unless such services are refused by the patient, or the provision of such services requested by the patient or the patient's attending physician are unnecessary under generally accepted medical practices. In such cases, the professional services requested shall not be provided and the Emergency Physician who makes such a determination shall note the reasons in the patient's treatment records.
E. Perform emergency medical and related services in conformance with:
i.) Applicable federal and state statutes, local ordinances and the rules and regulations of Governmental agencies and applicable standards of accrediting agencies;
ii.) Bylaws, rules, regulations, policies, and procedures of the Hospital and Medical Staff.
Review of facility policies included but was not limited to the following:
I. EMERGENCY DEPARTMENT STANDARD OF CARE, no policy number, last revised 3/2016, revealed that each ER patient who is transferred to another facility will have documentation of treatments and measures taken to prevent deterioration of patient's condition. Each ER patient will be offered medical services by a licensed physician extender with ER privileges or by a licensed physician who will determine the scope of assessment and render care for the patient's in need of emergency services. It is the responsibility of the Chief of Staff to ensure compliance with this policy by all ED Physicians


III. DISCHARGE OF PATIENTS FROM THE EMERGENCY DEPARTMENT, no policy number, last revised 3/2016, revealed patients treated in the ER are discharged when treatment has been completed and their condition has been determined to be stable. Written and verbal instructions are given pertaining to follow up care, specific for each individual case.
IV. CARE OF THE PATIENT EXPERIENCING A MENTAL HEALTH CRISIS UPON PRESENTATION TO THE EMERGENCY DEPARTMENT, no policy number, effective 3/2016, revealed the purpose was to provide and maintain a safe environment for all personnel, patients, and visitors of the Emergency Department (ED) and facilitate the provision of appropriate Mental Health Care.
POLICY: Any person presenting to the ER for a Mental Health Evaluation will first and foremost be treated for any emergent medical presentation (see Policy: Emergency Department Standard of Care). Once it is determined by the ER Physician that no emergent medical presentation exists, or that treatment has been rendered to the patient that resolves or mitigates an emergent medical presentation, the process for facilitating the provision of appropriate Mental Health Care may be initiated.
PROCESS:
A. Medical Clearance
1. The patient will be medically cleared by the ED Physician prior to making an attempt to facilitate the transfer of the patient to an accepting Mental Health facility
2. For these purposes, and in this facility, the term Medical Clearance will be defined as:
a. Assessment by the ED Physician determining that the patient is stable for transfer to a Mental Health Treatment Facility via ambulance or law enforcement
b. Obtaining appropriate diagnostics, as determined by the ED Physician, to support the determination that the patient is stable for transfer to a Mental Health Treatment Facility
c. Although not necessary for Medical Clearance, a reasonable effort will be made to obtain a urine sample for Urine Drug Screen, as it will eventually help guide the patient's treatment.
C. Non-Voluntary Patients
2. Patients not appropriate for Voluntary Mental Health Evaluation:
a. History of violence or currently exhibiting violent behavior.
c. Requiring physical restraints.
d. Any concern for the safety of Hospital staff, themselves, or other patients.
3. If a patient is determined to be Non-Voluntary by either the ER Physician or the Mental Health Evaluator, a Georgia Department of Behavioral Health and Developmental Disabilities Form 1013... must be completed and signed by the ER Physician or Mental Health Evaluator.
a. Form 1013 will be utilized for Mental Health....
c. Completion and signing of either of these forms places the patient in the Protective Custody of Law Enforcement.
4. All patients that are taken into Protective Custody and held in the ER for Mental Health Evaluation and/or transfer to a Mental Health facility shall be provided a guard by the Law Enforcement agency having custody of the patient.
5. A Non-Voluntary patient may be restrained physically or chemically if the ER Physician orders restraints...
7. Non-Voluntary patients shall not share an Examination Room or Bathroom with any other patient and shall have a Law Enforcement Officer at his or her bedside at all times.
8. Non-Voluntary patients shall receive disposable flatware on their meal trays.
9. In the event that the patient becomes violent or is unwilling to remain in the ER pending treatment and/or transfer, immediately call 911 and notify Law Enforcement.
10. If a Non-Voluntary patient becomes violent or it is deemed by the ER Staff that it is not safe for the patient, staff, or other patients for the patient to remain in the ER, the ER nurse can request that the Law Enforcement Officer transport the patient to the Law Enforcement Center to be held until transfer to an appropriate Mental Health Treatment Facility can be arranged. In this case, documentation in the patient's ER Record must indicate that the patient is being held at the Law Enforcement Center until transfer.
11. ER nursing staff shall contact Hospital Administration and Risk Management if the patient is violent and the Law Enforcement Officer does not comply or remain at the patient's bedside, or for any other problems with patients.
D. Minor Patients and Developmentally Delayed Patients
1. Any patient under the age of 18 must be accompanied by a parent or guardian during the patient's entire admission to the ED. At no time shall the Minor Patient be left in the ER without a parent or guardian.
2. Any patient that is Developmentally Delayed must be accompanied by a parent or guardian during the patient's entire admission to the ED. At no time shall the Developmentally Delayed patient be left in the ED without a parent or guardian.
F. Mental Health Evaluation and Disposition
1. When the patient has been Medically Cleared, the process for Mental Health Evaluation and Disposition can begin.
a. The ER nurse should immediately notify Behavioral Health Link (BHL)/Georgia Crisis and Access Line (GCAL) to request that a Mental Health Mobile Crisis Assessor be dispatched to the ER to complete the Mental Health Evaluation.
i. Upon arrival to the ED, the assigned Mobile Crisis Assessor will complete a Mental Health Evaluation provided by BHL/GCAL.
ii. In the event that the assigned Mobile Crisis Assessor and the ER Physician determine that the patient requires inpatient Mental Health treatment, the Mobile Crisis Assessor will contact the appropriate Mental Health Treatment Facilities to obtain acceptance of the patient.
b. The ER nurse may also choose to contact an appropriate Mental Health Treatment Facility for patient acceptance if it has been determined by the ER Physician that the patient requires inpatient Mental Health treatment without a Mobile Crisis Assessor dispatched from BHL/GCAL.
G. Discharge and Transfer of Voluntary and Non-Voluntary Patients Experiencing a Mental Health Crisis
2. If it is determined by the Mobile Crisis Assessor and the ED Physician that the patient requires inpatient treatment at an appropriate Mental Health Treatment Facility, the transporting agency - whether it be EMS or Law Enforcement - will receive a copy of the patient's ED Record in its entirety to deliver to the accepting Mental Health Treatment Facility.
3. If the patient being transferred to an appropriate and accepting Mental Health Treatment Facility is Non-Voluntary, the original Form 1013 or Form 2013 must accompany the patient to the accepting Mental Health Treatment Facility.
However, a copy of the form must remain in the patient's ED Record.
4. A Transfer Form is not required.

V. PATIENT TRANSFER GUIDELINES, no policy number, last reviewed 3/2016, revealed the purpose is to ensure access to emergency care and patient safety when it is necessary to transfer a patient to another healthcare facility.
PROCESS:
1. The patient will be transferred to another facility only after medical evaluation and when possible, stabilization. Initiation of treatment must be started to ensure, within reasonable medical probability that the transfer of the patient will not result in death or in loss or serious impairment of bodily functions, parts or organs.
2. The patient/family is to be informed of the reasons for, and the risks and likely benefits of, transfer and documented in the patient's record. The patient will sign consent for transfer. If the patient is incompetent to make this decision, a person legally responsible for the patient (if available) should accept or refuse the transfer on behalf of the patient by signing the consent or refusal of transfer located on transfer form.
3. The patient should be transferred to a facility that will meet the needs of the patient.
4. A physician at the receiving hospital must agree to accept the patient prior to the transfer.
5. Communication of clinical information between physicians must occur prior to transfer.
6. Copies of the patient's record, to include lab results, x-rays, and an appropriate medical summary must accompany the patient to the receiving facility.
7. Transfer arrangements are to be made with the County EMA (Emergency Medical Ambulance), Lifenet (emergency transport), or by the receiving hospital (such as the pediatric transport team). They are to be informed of the patient status so that qualified personnel and equipment will be accompanying the patient.
8. The nurse is to call the receiving facility's accepting unit, prior to transfer and give a thorough clinical report to the receiving personnel. A transfer checklist form is to be completed and a copy included with the patient's transfer records. The facility failed to ensure that their Policy was followed as evidenced by failing to ensure that patient #1 was transferred to a facility that would meet her needs. There was no evidence of a physician discharge order, transfer form, acceptance by the receiving facility or receiving physician, risks and benefits of the transfer, or that copies of Patient #1's medical record were sent to the receiving facility.
An interview was conducted with the facility ' s Risk Manager, RM AA on 3/4/19 at 3:15 p.m. in the Conference Room, RM AA explained that Patient #1 was in the ER from Thursday 2/14/19 until Tuesday 2/19/19. RM AA explained that while in the ER Patient #1 was combative, soiling herself and throwing feces at staff and whomever was around at the time. RM AA said the ER staff attempted to call every psychiatric facility they could think of and Patient #1 was either put on a waiting list or refused due to the patient's history of mental retardation, no available beds, psychiatric facility's admission criteria, or the fact that Patient #1 was a juvenile. RM AA said that a total of 17 facilities were notified and none would/could accept Patient #1. RM AA said that she contacted DFACS and the DFACS Supervisor informed RM AA that DFACS could not take custody of Patient #1 and that they (DFACS) could not help with Patient #1's placement. RM AA stated that she was called to the ER on 2/19/19 because Patient #1 had physically assaulted LPN BB. The RM said LPN BB reported that Patient #1 had assaulted her and that she (LPN BB) had called the local Sheriff's Office to report the assault. RM AA said LPN BB reported being kicked and slapped by Patient #1. RM AA explained that when she arrived in the ER a local Sheriff's Officer was already in the ED. The RM explained that LPN BB asked the Sheriff's Officer if he could stay in the ED with Patient #1 or if Patient #1 could be arrested on assault charges. RM AA said she asked the officers if they could contact someone that could help with Patient #1 and was told to contact the Chief of the Sheriff's Department. RM AA stated she called the local Sheriff's Department and was instructed to call the local Superior Court Judge. RM AA reported that she called the Judge's secretary, explained the situation, and asked for help. RM AA said an hour and a half later a Sheriff's Deputy arrived with a 1013 (Georgia's legal document that allows a patient to be held involuntarily when the patient is determined to pose a threat to self or others) signed by the Judge. RM AA went on to explain that the ER staff had exhausted every effort to care for Patient #1 and that the facility was totally out of Haldol and Ativan and that nothing was controlling the patient's violent outbursts. RM AA said the physicians were leery about giving the patient anything stronger because of the patient's age. RM AA said the ER physician working in the ER on 2/19/19 refused to release the patient to the officers until he had cleared the patient medically. RM AA explained that the facility did not know that the Sheriff's Officers had taken Patient #1 to another hospital until a call was received from the acute care (receiving) hospital on 2/19/19 a few hours after Patient #1 was taken into custody by the Sheriff's Officers.
An interview was conducted with LPN BB on 3/5/19 at 10:30 a.m. in the Conference Room, LPN BB explained that she worked Friday 2/15/19, Saturday 2/16/19, Sunday 2/17/19 and Tuesday 2/19/19 in the ER. The LPN said that it took all ER staff on duty to deal with Patient #1 and that the RN on the Medical-Surgical Unit also had to respond to the ER a couple of times to assist with Patient #1. The LPN confirmed that Patient #1 went from being calm one minute to being aggressive, combative, threatening and non-compliant the next minute. The LPN said Patient #1 would constantly come out of her ER room and try to leave the ER. LPN BB said there was a DFACS worker at Patient #1 ' s bedside 24 hours a day, but that the DFACS workers did not assist with keeping the patient in the room. LPN BB explained that on 2/19/19 LPN BB was physically and mentally beat-up and was at times scared of Patient #1. LPN BB said that on 2/19/19 Patient #1 was hitting and kicking staff and also spitting and pulling staffs' hair. LPN BB said that on 2/19/19 Patient #1's anger and violence had escalated, and staff could not get Patient #1 physically restrained and could not safely administer any medications to Patient #1. LPN BB explained that she called the local Sheriff's Office because she thought that an officer would come and help control Patient #1 or they would take Patient #1 to jail. LPN BB said she told the Sheriff's Officer that she wanted to press charges against Patient #1 for assault. LPN BB said an officer got her information, and then the officer called his supervisor. LPN BB said a little while later an officer arrived with a 1013 that had been signed by the local Superior Court Judge. LPN BB said the Sheriff's Officer took Patient #1 into custody and removed Patient #1 from the ED. LPN BB said the Sheriff's Officer did not tell the ER staff where he was taking Patient #1. LPN BB confirmed that she has EMTALA training annually.
An interview was conducted with Pharmacist GG on 3/5/19 at 12:30 p.m. in the Conference Room, the Pharmacist confirmed that Patient #1 received numerous doses of Haldol, Ativan, and Benadryl (antipsychotic/sedative medications). The Pharmacist explained that the facility has two (2) Pyxis (medication dispenser) machines, one (1) in the ER and one (1) on the Medical-Surgical Unit and that the ER nurses had used all the Haldol in stock. The Pharmacist said during the time Patient #1 was in the ER there was also another psychiatric patient in the ER and between the two (2) patients the facility's Haldol stock had been depleted. The Pharmacist said that she tried to order additional Haldol on Friday 2/15/19 and Haldol was on back-order. The Pharmacist went on to explain that the Haldol order did not arrive until 2/19/19. The Pharmacist went on to explain that Haldol, Ativan, and Benadryl are used to calm/sedate patients but that sometimes these medications have the opposite effect on teenagers. The Pharmacist confirmed that the facility did not have any other approved antipsychotic/sedative medications available to be administered to Patient #1.
A telephone interview was conducted with Physician EE on 3/5/19 at 1:30 p.m. The Physician explained that Patient #1's grandfather notified law enforcement and the local EMS because Patient #1 was exhibiting suicidal ideations. Physician EE said that once Patient #1 arrived in the ER Patient #1's grandfather refused to stay with Patient #1 and did not want Patient #1 back in his home. Physician EE explained that Patient #1's grandfather informed the ER staff that they should call DFACS. Physician EE said that upon arrival Patient #1 was agitated and uncooperative. Physician EE explained that the patient's behavior included hitting and kicking the staff, throwing things, going in and out of her ER room and that Patient #1 was a constant risk of eloping (leaving without notifying staff) the ER. Physician EE said chemical restraints (medications used to calm/sedate) and physical restraints were ordered for the safety of Patient #1 and others. Physician EE said DFACS and the local law enforcement agencies had been contacted for assistance in managing Patient #1. Physician EE went on to explain that 17 psychiatric facilities had been contacted and that none could or would accept Patient #1. Physician EE said that he was not on duty when Patient #1 was taken into custody by the local Sheriff Officers. Physician EE said that he had EMTALA training approximately two (2) years ago.
An interview was conducted with LPN FF on 3/5/19 at 10:30 a.m. in the Conference Room. LPN FF explained that she worked in the ER on Thursday 2/14/19, Friday 2/15/19, Saturday 2/16/19, and Sunday 2/17/19. LPN FF explained that Patient #1 arrived by ambulance from a family home. LPN FF said that upon arrival Patient #1 was irate, screaming, cursing, and asking the EMT to slap/punch her in the face. LPN FF said she tried to calm Patient #1 and Patient #1 cursed at her. LPN FF said Patient #1 was calm when sedated and other times kicking, scratching, and spitting at staff. LPN FF said Patient #1 threw feces (stool) at staff. LPN FF said the mental health assessors evaluated Patient #1 and they informed the ER staff that there were only three (3) facilities that would accept Patient #1 due to Patient #1's mental retardation. LPN FF said numerous psychiatric facilities were contacted and they could not or would not accept Patient #1 either because of no available beds, that the patient did not meet their criteria, the patient's history of mental retardation, or the fact that the patient was a juvenile.
An interview was conducted with Sheriff's Deputy HH on 3/5/19 at 3:00 p.m. in the Conference Room. Deputy HH explained that on 2/19/19 he received a call to respond to an unruly patient in the ER that had assaulted a nurse. Deputy HH said that when he arrived he called his Supervisor and informed the Supervisor of the situation.
Deputy HH said later he received a 1013 that was signed by the local Superior Court Judge and instructions to take Patient #1 into custody. Deputy HH said Patient #1 was taken into custody and removed from the ER. Deputy HH stated that his Supervisor called later and instructed Deputy HH to take Patient #1 to another acute care hospital (the receiving facility). Deputy HH confirmed that at no time did the hospital staff ask him to take the patient to another facility.
Numerous attempts were made on 3/4/19 and 3/5/19 to contact Physician CC (the physician on duty on 2/19/19 when Patient #1 was released to the Sheriff Officers). Physician CC was out-of-town and unavailable for an interview.
There was no evidence of a discharge order, transfer form, acceptance by the receiving facility or receiving physician, risks and benefits of the transfer, or that copies of Patient #1's medical record were sent to the receiving facility.