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Based on interviews and record reviews, the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including , to determine whether or not an emergency medical condition exists when Patient #3, a delusional patient, was allowed to leave the emergency department placing the patient at risk of injury and possible death.

Findings include:

During interviews on 09/05/23 and 09/06/23 in the administrative conference room, Staff #3, Emergency Department Director stated, "The physician will perform a medical screening examination. If the patient is a risk to themselves or to others the physician will order a one-on-one observation. We have sitters, we use nurses, PCT's (patient care technicians), and the ED (emergency department) techs; sometimes the officer will stay with the patient then transport them to the accepting facility. 'If the patient is non-compliant or has suicidal ideations, we will ask the officer to keep them in the cruiser or sit in the hallway."

Review of Patient #3's medical records reflected the following:
Provider Notes dated 6/22/2023, reflected, "For the past medical history of psychiatric issues, COPD, coronary artery disease, alcohol abuse presenting with request for medical clearance by police department. Per documentation from police, patient was found at a gas station stating that he was going to catch a flight to for Springs
Arkansas in order to be back with his family and have "heart" surgery. He states police brought
him here to be evaluated and make sure that his heart was okay. Currently denies any SI, HI. He
denies any auditory or visual hallucinations. He states compliant with his heart and lung
medications. No other associated symptoms or complaints this time pain...Final diagnoses:
Delusion
(HCC) Hypokalemia
Chronic hyponatremia
Patient left with a disposition of: Transfer to Another Facility."

ED Notes
Nurse's notes dated 6/22/23 at 9:22 PM reflected,
"Pt (patient) walked out of ED, no IV access, security officer notified, MF(marble falls) PD (police department) notified.
Patient left with a disposition of: Transfer to Another Facility." ED Notes

Nurse's notes dated 6/22/23 at 9:22 PM reflected,
"Pt (patient) walked out of ED, no IV access, security officer notified, MF(marble falls) PD (police department) notified.
9:42 MF PD arrived and brought pt back to room.

During a telephone interview on the afternoon of 09/08/23, MF police officer stated in part, "The police were called and had to return Patient #3 to the emergency department. The officer was informed the facility cannot force the patient to stay; the patient could leave Against Medical Advice. The deputy had to keep the patient in the police car until a transfer to a psych facility could be arranged, the patient was still delusional."