HospitalInspections.org

Based on reviews of medical records, incident report, policy and procedure, and Emergency Director report, and interviews, the facility failed to ensure that an appropriate medical screening examination within the capability of the hospital's Emergency Department was provided in 1 out of 22 Sample Patients (SP) (SP#1). Refer to findings at Tag A- 2406.

Based on reviews incident report, policy and procedure, Emergency Director report, and interviews, the facility failed to ensure that an individual with an Emergency Medical Condition (EMC) was provided with the necessary stabilizing treatment as required for 1 out of 22 Sample Patients (SP) (SP#1). Refer to findings at Tag A- 2407.

Based on reviews of policy and procedure, incident report, and Emergency Director report and interviews, the facility failed to ensure that an appropriate transfer was provided in 1 out of 22 Sample Patients (SP) (SP#1). Refer to findings at Tag A- 2409.

Based on record review and interview, the facility failed to document and maintain medical and other records related to the individuals transferred to and from the hospital for a period of 5 years from the date of the transfer in 1 out of 22 Sampled Patients (SP) (SP#1).

The findings include:
Review of the Florida Department of Children ' s and Families (DCF) Incident Reporting and Analysis System (Incident Report # 2013-PDSA-19005) conducted on 06-18-13 revealed the name of the sample patient (SP) #1 and the brief description of the incident. It showed: " Child (SP#1) locked himself in his closet, refused to come out and was cutting himself. Mother called Care Coordinator, who was already en route to home. 911 was called. Child resisted police intervention and was tazered. The cuts on his arms, up to elbows were bleeding heavily. He was transported to this facility (#1) under Baker Act but was not held there since bleeding had been abated by EMS (Emergency Medical Support) and that facility doesn ' t ' treat adolescents. He was taken to Facility #2, who had no beds, then to Facility #3 ."

Review conducted on 06-18-13 of the ER Director report dated March 28, 2013 regarding DCF request for information confirmed above findings that the patient (SP#1) was brought to Facility #1 ER by police under Baker Act. The report showed: " That when the police arrived with the patient (SP#1) and approached the Charge Nurse (CN) desk, someone (unclear who) made a statement something similar to " gosh this patient is going to be in the ER all night. " At that point the police officer inquired why and was told that we are not a pediatric facility and we would have to transfer the patient out to a pediatric baker act receiving facility. The police officer then said that he would take the patient to Facility #2. The Charge Nurse (CN) then stated " we are not refusing the patient, we can transfer him. " Based on my report, the police officer said he would just take the patient to Facility #2 since it was nearby and
it was the more appropriate facility. A few minutes after the police officer left with the patient (SP#1), the psychiatric intake nurse called the Facility #2 to notify them of what just transpired and asked if they would like us to attempt to retrieve the patient. Their response was that it was fine and they would take care of it. " The report further confirmed the findings that " the ER should have registered the patient into our system to generate a medical record where we could have documented the occurrences noted above. " The report also showed that the CN was asked of the patient ' s name and anything that could be entered into the system but there was none.

Review of the Electronic Central log of Facility #1 on date of the incident (02-26-2013) conducted on 06-18-2013 showed no documented name of SP#1 or any information about the patient (SP#1) that was brought to ER by the police under Baker Act.

Interview via phone with the Charge Nurse (CN) conducted on 06-18-13 at 10:30 am confirmed above findings. She stated that she worked that night of 02/26/13 at 7pm to 7am when the police came with a minor baker act patient to ER (Facility #1). She stated that, " The first thing the police officer asked was if the facility #1 was taking minor baker act patient. " The CN responded " yes, but we are not admitting but we take them, stabilize and transfer them out to whichever facility is available and can admit minor baker act patient. Then the police said right away, " Ok I ' ll take him to facility #2. " The CN said, " No we are not refusing, we are taking patient but we don ' t admit them here. "" The police said, " No, I'll take him " and was leaving and " I said wait let me have the psychiatric intake nurse (PIN) talk to you. " The CN called the PIN. " The PIN talked to the police but still insisted to take the minor baker act patient to facility #2. So, the PIN asked the police " Are you willing to take him? " and police said, " yes, that ' s why I ' m taking him to facility #2. So they left then I called the supervisor right away and told her what happened and police did not even give me the chance to recept (enter in the computer) the patient and did not even know the name and only found out from facility #2. The supervisor asked the PIN to call facility #2 and find out about the baker act minor patient and she did. The PIN called facility #2 and the nurse said, " don ' t worry because we ' ll take care of him. " " When the CN was asked further about the patient ' s physical condition, the CN stated that the patient (SP#1) was very calm and that she did not notice anything unusual. She also stated that she already received the EMTALA training and she should have recept the patient and a medical record was done and that the patient should have the medical screening by the physician. She also stated that she called the ER Director in the morning before she left and reported to her the incident.

Interview via phone with the Psychiatric Intake Nurse (PIN) conducted on 06-19-13 at 3:10 pm confirmed above findings that she was called at the desk by the CN on the night of 06-26-13. That it was a rapid sequence of event that they never had the chance to assess the patient. That after the police said that he would take the patient to facility #2 that she asked, " Are you willing to do that? " and the police said, " yes " . The PIN further stated that, " it was so fast and the intent was not to avoid to take care of the child but the intent was if possible to get the child get care faster but not for any negative reason. " She also stated that this was an opportunity to review and learn about EMTALA protocol to increase the safety element in her practice. When asked about the patient ' s condition, she stated that the patient was not in any distress and that the patient was calm and relaxed.

Interview via phone with the Medical Director of ER conducted on 06-20-13 at 11:20 am confirmed above findings.

Based on record review and interview, the facility failed to maintain a central log on each individual who comes to the Emergency Department in 1 out of 22 Sample Patients (SP) (SP#1).

The findings include:
Review of the Florida Department of Children ' s and Families (DCF) Incident Reporting and Analysis System (Incident Report # 2013-PDSA-19005) conducted on 06-18-13 revealed the name of the sample patient (SP) #1 and the brief description of the incident. It showed: " Child (SP#1) locked himself in his closet, refused to come out and was cutting himself. Mother called Care Coordinator, who was already en route to home. 911 was called. Child resisted police intervention and was tazered. The cuts on his arms, up to elbows were bleeding heavily. He was transported to this facility (#1) under Baker Act but was not held there since bleeding had been abated by EMS (Emergency Medical Support) and that facility doesn ' t treat adolescents. He was taken to Facility #2, who had no beds, then to Facility #3."

Review conducted on 06-18-13 of the ER Director report dated March 28, 2013 regarding DCF request for information confirmed above findings that the patient (SP#1) was brought to Facility #1 ER by police under Baker Act. The report showed: " That when the police arrived with the patient (SP#1) and approached the Charge Nurse (CN) desk, someone (unclear who) made a statement something similar to " gosh this patient is going to be in the ER all night. " At that point the police officer inquired why and was told that we are not a pediatric facility and we would have to transfer the patient out to a pediatric baker act receiving facility. The police officer then said that he would take the patient to Facility #2. The Charge Nurse (CN) then stated " we are not refusing the patient, we can transfer him. " Based on my report, the police officer said he would just take the patient to Facility #2 since it was nearby and
it was more appropriate facility. A few minutes after the police officer left with the patient (SP#1), the psychiatric intake nurse called the Facility #2 to notify them of what just transpired and asked if they would like us to attempt to retrieve the patient. Their response was that it was fine and they would take care of it. " The report further confirmed the findings that " the ER should have registered the patient into our system to generate a medical record where we could have documented the occurrences noted above. " The report also showed that the CN was asked of the patient ' s name and anything that could be entered into the system but there was none.

Review of the Electronic Central log of Facility #1 on date of the incident (02-26-2013) conducted on 06-18-2013 showed no documented name of SP#1 or any information about the patient (SP#1) that was brought to ER by the police under Baker Act.

Interview via phone with the Charge Nurse (CN) conducted on 06-18-13 at 10:30 am confirmed above findings. She stated that she worked that night of 02/26/13 at 7pm to 7am when the police came with a minor baker act patient to ER (Facility #1). She stated that, " The first thing the police officer asked was if the facility #1 was taking minor baker act patient. " The CN responded " yes, but we are not admitting but we take them, stabilize and transfer them out to whichever facility is available and can admit minor baker act patient. Then the police said right away, " Ok I ' ll take him to facility #2. " The CN said, " No we are not refusing, we are taking patient but we don ' t admit them here. "" The police said, " No, I'll take him " and was leaving and " I said wait let me have the psychiatric intake nurse (PIN) talk to you. " The CN called the PIN. " The PIN talked to the police but still insisted to take the minor baker act patient to facility #2. So, the PIN asked the police " Are you willing to take him? " and police said, " yes, that ' s why I ' m taking him to facility #2. So they left then I call the supervisor right away and told her what happened and police did not even gave me the chance to recept (enter in the computer) the patient and did not even know the name and only found out from facility #2. The supervisor asked the PIN to call facility #2 and find out about the baker act minor patient and she did. The PIN called facility #2 and the nurse said, " don ' t worry because we ' ll take care of him. " " When the CN was asked further about the patient ' s physical condition, the CN stated that the patient (SP#1) was very calm and that she did not notice anything unusual. She also stated that she already received the EMTALA training and she should have recept the patient and a medical record was done and that the patient should have the medical screening by the physician. She also stated that she called the ER Director in the morning before she left and reported to her the incident.

Interview via phone with the Psychiatric Intake Nurse (PIN) conducted on 06-19-13 at 3:10 pm confirmed above findings that she was called at the desk by the CN on the night of 06-26-13. That it was a rapid sequence of event that they never had the chance to assess the patient. That after the police said that he would take the patient to facility #2 that she asked, " Are you willing to do that? " and the police said, " yes " . The PIN further stated that, " it was so fast and the intent was not to avoid to take care of the child but the intent was if possible to get the child get care faster but not for any negative reason. " When asked about the patient ' s condition, she stated that the patient was not in any distress and that the patient was calm and relaxed.

Review of the Facility #1 policy and procedure title: Florida EMTALA Central Log Policy confirmed above findings that the facility failed to follow its own policy and procedure regarding maintenance of Central Log for ER. The policy states: " The hospital will maintain a Central Log, containing information on each individual who comes on the hospital campus requesting assistance or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he or she refused treatment, whether he or she was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged. "

Interview with the Associate CNO, Risk Manager and Director of Behavioral Health Unit conducted on 06-19-2013 confirmed above findings that the facility did not follow its own policy and procedure regarding maintenance of Central Log for ER.

Based on reviews of medical records, incident report, policy and procedure, and Emergency Director report, and interviews, the facility failed to ensure that an appropriate medical screening examination within the capability of the hospital's Emergency Department was provided in 1 out of 22 Sample Patients (SP) (SP#1).

The findings include:

Review of the Florida Department of Children's and Families (DCF) Incident Reporting and Analysis System (Incident Report # 2013-PDSA-19005) (incident date 2/26/2013/Time 7:30 P.M ) conducted on 06-18-13 revealed the name of the sample patient (SP) #1 and the brief description of the incident. It showed: "Child (SP#1) locked himself in his closet, refused to come out and was cutting himself. Mother called Care Coordinator, who was already en route to home. 911 was called. Child resisted police intervention and was tazered. The cuts on his arms, up to elbows were bleeding heavily. He was transported to this facility (#1) under Baker Act but was not held there since bleeding had been abated by EMS (Emergency Medical Support) and that facility doesn't treat adolescents. He was taken to Facility #2, who had no beds, then to Facility #3."

Review conducted on 06-18-13 of the Emergency Room (ER) Director report dated March 28, 2013 regarding DCF request for information confirmed above findings that the patient (SP#1) was brought to Facility #1 ER by police under Baker Act. The report showed: "That when the police arrived with the patient (SP#1) and approached the Charge Nurse (CN) desk, someone (unclear who) made a statement something similar to " gosh this patient is going to be in the ER all night. " At that point the police officer inquired why and was told that we are not a pediatric facility and we would have to transfer the patient out to a pediatric baker act receiving facility. The police officer then said that he would take the patient to Facility #2. The Charge Nurse (CN) then stated, "we are not refusing the patient, we can transfer him." Based on my report, the police officer said he would just take the patient to Facility #2 since it was nearby and it was a more appropriate facility. A few minutes after the police officer left with the patient (SP#1), the psychiatric intake nurse called the Facility #2 to notify them of what just transpired and asked if they would like us to attempt to retrieve the patient. Their response was that it was fine and they would take care of it. The report further confirmed the findings that, "the ER should have registered the patient into our system to generate a medical record where we could have documented the occurrences noted above." The report also showed the CN was asked for the patient ' s name and anything that could be entered into the system, but there was no information.

Interview via phone with the Charge Nurse (CN) conducted on 06-18-13 at 10:30 am confirmed the above findings. She stated, she worked the night of 02/26/13 at 7pm to 7am when the police came with a minor Baker Act patient to ER (Facility #1). She stated that, "The first thing the police officer asked was if the facility #1 was taking minor Baker Act patients." The CN responded, " yes, but we are not admitting, but we take them, stabilize and transfer them out to whichever facility is available and can admit minor Baker Act patients. Then the police said right away, "Ok I'll take him to facility #2." The CN said, " No we are not refusing, we are taking patients but we don ' t admit them here." " The police said, "No, I'll take him" and was leaving and "I said wait let me have the psychiatric intake nurse (PIN) talk to you." The CN called the PIN. " The PIN talked to the police but still insisted to take the minor baker Act patient to facility #2. So, the PIN asked the police, "Are you willing to take him?" and police said, "yes, that's why I'm taking him to facility #2. So they left, then I called the supervisor right away and told her what happened. The police did not give me the chance to " recept " (enter in the patient into the computer). They did not know the name of the patient and only found out from facility #2. The supervisor asked the PIN to call facility #2 and find out about the Baker Act minor patient and she did. The PIN called facility #2 and the nurse said, "don't worry because we'll take care of him." When the CN was asked further about the patient's physical condition, the CN stated, the patient (SP#1) was very calm and that she did not notice anything unusual. She also stated, she already received the EMTALA training and she should have " recept " the patient, started a medical record and the patient should've had the medical screening by the physician. She also stated, she called the ER Director in the morning before she left and reported the incident.

The medical record from facility #2 (an acute care hospital) was reviewed. The medical record revealed that on 2/26/2013 at 2051 (8:51 p.m.) a 15 year old (SP#1) arrived to the emergency department as a Psychiatric emergency. Review of the ED provider note revealed in part, " Procedures: wounds cleansed and dressing with topical antibiotic provided ... Clinical impression: The primary encounter diagnosis was " Suicide attempt and A diagnosis of Depression was also pertinent to this visit ... ED disposition: Pending admit to psychiatry unit... Condition: Serious. . . Admit 8:56 PM discussed ER (emergency room) findings, diagnosis and treatment plan for admission for further evaluation and /or treatment ... Pt (patient) received by Aventura Police in Handcuffs and ankle cuffs. Pt appears anxious. States " voices are coming back " ...Pt arrived with police under a Baker Act after made several self-inflicted lac (lacerations) to L (left) forearm as a suicide attempts. Pt reported he hears voices and today they told him that his life was no long worth living, calling him insane and told him to hurt himself and others. .. pt medically cleared ... Pt received from Peds ED after being seen by an ED psych Liaison RN (Registered Nurse) ...An EKG (measures the electrical activity of your heart) was performed in the Peds ED showing NSR (Normal electrical conduction of the heart). Further record review revealed that SP #1 was appropriately transferred to a psychiatric hospital.


Interview via phone with the Psychiatric Intake Nurse (PIN) conducted on 06-19-13 at 3:10 pm confirmed above findings, she was called at the desk by the CN on the night of 06-26-13. She reports, it was a rapid sequence of events and she never had the chance to assess the patient. She reports, after the police said, he would take the patient to facility #2, she asked, "Are you willing to do that?" The policeman said, "yes". The PIN further stated that, " it was so fast and the intent was not to avoid to take care of the child, but the intent was, if possible, to get the child care faster but not for any negative reason."

Review of Facility #1 ' s policy and procedure title: Florida EMTALA - Medical Screening Examination and Stabilization Policy confirmed the above findings, the facility failed to provide SP#1 a medical screening examination and stabilization. The policy states: "If an EMC (Emergency Medical Condition) is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility as defined by and required by EMTALA."

Interview with the Associate Chief Nursing Officer (CNO), Risk Manager and Director of Behavioral Health Unit conducted on 06-19-2013 confirmed the above findings, the facility did not follow its own policy and procedure and failed to provide an appropriate medical screening examination.

Based on reviews of the incident report, policy and procedure, Emergency Director report, and interviews, the facility failed to ensure that an individual with an Emergency Medical Condition (EMC) was provided with the necessary stabilizing treatment as required for 1 out of 22 Sample Patients (SP) (SP#1).

The findings are:

Review of the Florida Department of Children's and Families (DCF) Incident Reporting and Analysis System (Incident Report # 2013-PDSA-19005) (incident date 2/26/2013/Time 7:30 P.M ) conducted on 06-18-13 revealed the name of the sample patient (SP) #1 and the brief description of the incident. It showed: "Child (SP#1) locked himself in his closet, refused to come out and was cutting himself. Mother called Care Coordinator, who was already en route to home. 911 was called. Child resisted police intervention and was tazered. The cuts on his arms, up to elbows were bleeding heavily. He was transported to this facility (#1) under Baker Act but was not held there since bleeding had been abated by EMS (Emergency Medical Support) and that facility doesn't treat adolescents. He was taken to Facility #2, who had no beds, then to Facility #3."

Review conducted on 06-18-13 of the Emergency Room (ER) Director report dated March 28, 2013 regarding DCF request for information confirmed above findings that the patient (SP#1) was brought to Facility #1 ER by police under Baker Act. The report showed: "That when the police arrived with the patient (SP#1) and approached the Charge Nurse (CN) desk, someone (unclear who) made a statement something similar to " gosh this patient is going to be in the ER all night." At that point the police officer inquired why and was told that we are not a pediatric facility and we would have to transfer the patient out to a pediatric baker act receiving facility. The police officer then said that he would take the patient to Facility #2. The Charge Nurse (CN) then stated, "we are not refusing the patient, we can transfer him." Based on my report, the police officer said he would just take the patient to Facility #2 since it was nearby and it was a more appropriate facility. A few minutes after the police officer left with the patient (SP#1), the psychiatric intake nurse called the Facility #2 to notify them of what just transpired and asked if they would like us to attempt to retrieve the patient. Their response was that it was fine and they would take care of it. The report further confirmed the findings that, "the ER should have registered the patient into our system to generate a medical record where we could have documented the occurrences noted above." The report also showed the CN was asked for the patient ' s name and anything that could be entered into the system, but there was no information.

Interview via phone with the Charge Nurse (CN) conducted on 06-18-13 at 10:30 am confirmed the above findings. She stated, she worked the night of 02/26/13 at 7pm to 7am when the police came with a minor Baker Act patient to ER (Facility #1). She stated that, " The first thing the police officer asked was if the facility #1 was taking minor Baker Act patients. " The CN responded, " yes, but we are not admitting, but we take them, stabilize and transfer them out to whichever facility is available and can admit minor Baker Act patients. Then the police said right away, "Ok I'll take him to facility #2." The CN said, " No we are not refusing, we are taking patients but we don't admit them here." " The police said, "No, I'll take him" and was leaving and "I said wait let me have the psychiatric intake nurse (PIN) talk to you." The CN called the PIN. " The PIN talked to the police but still insisted to take the minor baker Act patient to facility #2. So, the PIN asked the police, "Are you willing to take him?" and police said, " yes, that's why I'm taking him to facility #2. So they left, then I called the supervisor right away and told her what happened. The police did not give me the chance to " recept " (enter in the patient into the computer). They did not know the name of the patient and only found out from facility #2. The supervisor asked the PIN to call facility #2 and find out about the Baker Act minor patient and she did. The PIN called facility #2 and the nurse said, "don't worry because we'll take care of him." When the CN was asked further about the patient's physical condition, the CN stated, the patient (SP#1) was very calm and that she did not notice anything unusual. She also stated, she already received the EMTALA training and she should have " recept " the patient, started a medical record and the patient should've had the medical screening by the physician. She also stated, she called the ER Director in the morning before she left and reported the incident.

Interview via phone with the Psychiatric Intake Nurse (PIN) conducted on 06-19-13 at 3:10 pm confirmed above findings, she was called at the desk by the CN on the night of 06-26-13. She reports, it was a rapid sequence of events and she never had the chance to assess the patient. She reports, after the police said, he would take the patient to facility #2, she asked, "Are you willing to do that?" The policeman said, "yes". The PIN further stated that, " it was so fast and the intent was not to avoid to take care of the child, but the intent was, if possible, to get the child care faster but not for any negative reason."

The medical record from facility #2 (an acute care hospital) was reviewed. The medical record revealed that on 2/26/2013 at 2051 (8:51 p.m.) a 15 year old (SP#1) arrived to the emergency department as a Psychiatric emergency. Review of the ED provider note revealed in part, " Procedures: wounds cleansed and dressing with topical antibiotic provided ... Clinical impression: The primary encounter diagnosis was " Suicide attempt and A diagnosis of Depression was also pertinent to this visit ... ED disposition: Pending admit to psychiatry unit... Condition: Serious. . . Admit 8:56 PM discussed ER (emergency room) findings, diagnosis and treatment plan for admission for further evaluation and /or treatment ... Pt (patient) received by Aventura Police in Handcuffs and ankle cuffs. Pt appears anxious. States " voices are coming back " ...Pt arrived with police under a Baker Act after made several self-inflicted lac (lacerations) to L (left) forearm as a suicide attempts. Pt reported he hears voices and today they told him that his life was no long worth living, calling him insane and told him to hurt himself and others. .. pt medically cleared ... Pt received from Peds ED after being seen by an ED psych Liaison RN (Registered Nurse) ...An EKG (measures the electrical activity of your heart) was performed in the Peds ED showing NSR (Normal electrical conduction of the heart). Further record review revealed that SP #1 was appropriately transferred to a psychiatric hospital.


Review of the Facility #1 policy and procedure title: Florida EMTALA - Medical Screening Examination and Stabilization Policy confirmed above findings that the facility failed to provide SP#1 a medical screening examination and stabilization. The policy states: "If an EMC (Emergency Medical Condition) is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility as defined by and required by EMTALA."

Interview with the Associate CNO, Risk Manager and Director of Behavioral Health Unit conducted on 06-19-2013 confirmed the above findings, the facility failed to provide any necessary stabilizing treatments for sample patient (SP) #1.

Based on reviews of policy and procedure, incident report, and Emergency Director report and interviews, the facility failed to ensure that an appropriate transfer was provided in 1 out of 22 Sample Patients (SP) (SP#1).

The findings include:

Review of the Florida Department of Children's and Families (DCF) Incident Reporting and Analysis System (Incident Report # 2013-PDSA-19005) (incident date 2/26/2013/Time 7:30 P.M.) conducted on 06-18-13 revealed the name of the sample patient (SP) #1 and the brief description of the incident. It showed: "Child (SP#1) locked himself in his closet, refused to come out and was cutting himself. Mother called Care Coordinator, who was already en route to home. 911 was called. Child resisted police intervention and was tazered. The cuts on his arms, up to elbows were bleeding heavily. He was transported to this facility (#1) under Baker Act but was not held there since bleeding had been abated by EMS (Emergency Medical Support) and that facility doesn't treat adolescents. He was taken to Facility #2, who had no beds, then to Facility #3."

Review conducted on 06-18-13 of the Emergency Room (ER) Director report dated March 28, 2013 regarding DCF request for information confirmed above findings that the patient (SP#1) was brought to Facility #1 ER by police under Baker Act. The report showed: "That when the police arrived with the patient (SP#1) and approached the Charge Nurse (CN) desk, someone (unclear who) made a statement something similar to " gosh this patient is going to be in the ER all night. " At that point the police officer inquired why and was told that we are not a pediatric facility and we would have to transfer the patient out to a pediatric baker act receiving facility. The police officer then said that he would take the patient to Facility #2. The Charge Nurse (CN) then stated, "we are not refusing the patient, we can transfer him." Based on my report, the police officer said he would just take the patient to Facility #2 since it was nearby and it was a more appropriate facility. A few minutes after the police officer left with the patient (SP#1), the psychiatric intake nurse called the Facility #2 to notify them of what just transpired and asked if they would like us to attempt to retrieve the patient. Their response was that it was fine and they would take care of it. The report further confirmed the findings that, "the ER should have registered the patient into our system to generate a medical record where we could have documented the occurrences noted above." The report also showed the CN was asked for the patient ' s name and anything that could be entered into the system, but there was no information.

Interview via phone with the Charge Nurse (CN) conducted on 06-18-13 at 10:30 am confirmed the above findings. She stated, she worked the night of 02/26/13 at 7pm to 7am when the police came with a minor Baker Act patient to ER (Facility #1). She stated that, " The first thing the police officer asked was if the facility #1 was taking minor Baker Act patients. " The CN responded, " yes, but we are not admitting, but we take them, stabilize and transfer them out to whichever facility is available and can admit minor Baker Act patients. Then the police said right away, "Ok I'll take him to facility #2." The CN said, " No we are not refusing, we are taking patients but we don ' t admit them here." " The police said, "No, I'll take him" and was leaving and "I said wait let me have the psychiatric intake nurse (PIN) talk to you." The CN called the PIN. " The PIN talked to the police but still insisted to take the minor baker Act patient to facility #2. So, the PIN asked the police, "Are you willing to take him?" and police said, " yes, that's why I'm taking him to facility #2. So they left, then I called the supervisor right away and told her what happened. The police did not give me the chance to " recept " (enter in the patient into the computer). They did not know the name of the patient and only found out from facility #2. The supervisor asked the PIN to call facility #2 and find out about the Baker Act minor patient and she did. The PIN called facility #2 and the nurse said, "don't worry because we'll take care of him." When the CN was asked further about the patient's physical condition, the CN stated, the patient (SP#1) was very calm and that she did not notice anything unusual. She also stated, she already received the EMTALA training and she should have " recept " the patient, started a medical record and the patient should ' ve had the medical screening by the physician. She also stated, she called the ER Director in the morning before she left and reported the incident.

Interview via phone with the Psychiatric Intake Nurse (PIN) conducted on 06-19-13 at 3:10 pm confirmed above findings, she was called at the desk by the CN on the night of 06-26-13. She reports, it was a rapid sequence of events and she never had the chance to assess the patient. She reports, after the police said, he would take the patient to facility #2, she asked, "Are you willing to do that?" The policeman said, "yes". The PIN further stated that, " it was so fast and the intent was not to avoid to take care of the child, but the intent was, if possible, to get the child care faster but not for any negative reason."
She also stated, this was an opportunity to review and learn about the EMTALA protocol to increase the safety element in her practice. When asked about the patient's condition, she stated, the patient was not in any distress and the patient was calm and relaxed.

The medical record from facility #2 (an acute care hospital) was reviewed. The medical record revealed that on 2/26/2013 at 2051 (8:51 p.m.) a 15 year old (SP#1) arrived to the emergency department as a Psychiatric emergency. Review of the ED provider note revealed in part, " Procedures: wounds cleansed and dressing with topical antibiotic provided ... Clinical impression: The primary encounter diagnosis was " Suicide attempt and A diagnosis of Depression was also pertinent to this visit ... ED disposition: Pending admit to psychiatry unit... Condition: Serious. . . Admit 8:56 PM discussed ER (emergency room) findings, diagnosis and treatment plan for admission for further evaluation and /or treatment ... Pt (patient) received by Aventura Police in Handcuffs and ankle cuffs. Pt appears anxious. States " voices are coming back " ...Pt arrived with police under a Baker Act after made several self-inflicted lac (lacerations) to L (left) forearm as a suicide attempts. Pt reported he hears voices and today they told him that his life was no long worth living, calling him insane and told him to hurt himself and others. .. pt medically cleared ... Pt received from Peds ED after being seen by an ED psych Liaison RN (Registered Nurse) ...An EKG (measures the electrical activity of your heart) was performed in the Peds ED showing NSR (Normal electrical conduction of the heart). Further record review revealed that SP #1 was appropriately transferred to a psychiatric hospital.


Review of the Facility #1 policy and procedure title: Florida EMTALA Transfer Policy confirmed above findings that the facility failed to follow its own policy and procedure regarding appropriate transfer. The policy states: " The hospital shall transfer an individual with an EMC (Emergency Medical Condition) to the closest geographically located hospital with capability and capacity to care for the patient. Any transfer of an individual with an EMC must be initiated either by a written request for a transfer from the individual or the legally responsible person acting on the individual's behalf or by a physician order with appropriate certification as required under EMTALA."

Interview with the Associate Chief Nursing Officer (CNO), Risk Manager and Director of Behavioral Health Unit conducted on 06-19-2013 confirmed the above findings, the facility did not follow its own policy and procedure regarding an appropriate transfer for sample patient (SP) #1.