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Based on interview and record review, Hospital A failed to enforce its policy to ensure compliance with 489.24 (d) (1) (i) and 489.24 (a) (1) (ii). The Emergency Department (ED) did not provide appropriate medical screening examination to Patient #3 on 12/14/2020. The patient presented to the hospital on an Emergency Detention Order after being found laying in the middle of the road. The patient was discharged to the jail with an unstable medical condition the same day.

Cross refer A2406 and A2409.

Based on interview and record review, the hospital failed to provide appropriate medical screening examination to 1 of 1 (Patient #3) patients that arrived at the Emergency Department (ED)on 12/14/2020.

Findings:

Patient #3 arrived at the ED on 12/14/2020 at 0828 on an Emergency Detention Order after being found lying in the middle of the road by police officers. Patient #3 was placed on a stretcher in the hallway until a room was available. Patient #3 was placed in a room approximately 45 minutes after arrival to the ED . At 0920, Personnel #6 charted the patient became violent and kicked a nurse and the patient's condition was noted as worsening. The hospital called the police and discharged the patient to be transported to jail. No lab work was completed.

Patient #3 received Ativan 1 mg Intramuscularly at 0943 and was discharged into police custody at 0956. There was no document of the patients reaction to the medication.


During an interview on 12/28/2020 at 1105 Personnel #1 stated the labs were canceled and not resulted.

Personnel #6 stated ..."he wanted to get blood work and a psychiatric evaluation on the patient but when he was moved into a room he began to destroy the room ... The police were called, four police officers subdued the patient. A mutual decision was made to take the patient to jail. The patient was too dangerous to have around the staff ...Personnel #6 stated the police can stabilize a psychiatric patient. At the time of discharge the patient was medically cleared. When asked how the patient was medically cleared with no lab work, Personnel #6 stated he was medically cleared ..."


Medical Records obtained from Facility B reflected the patient had attempted to hang himself using the seatbelt of the police car during transport to the jail. The patient had to be emergently medicated and restrained after hitting his head and body against the cell wall.

During an interview on 12/29/2020 at 1535, via telephone with Personnel #11 from Facility B stated ..."the patient was brought to the jail and was given several emergency injections and he ended up on a restraint bed. The patient was taken to a different hospital for medical clearance ... the officers only have de-escalation training they would be unable to stabilize a patient ..."

During an interview on 12/30/2020 at 1135 Personnel #9 stated ..."the patient was still very agitated when he arrived at the jail. The patient was unable to be booked into jail and was taken straight to the infirmary. The internal SWAT team had to be called to control the patient until he could be emergently medicated ..."

Based on interview and record review, the hospital discharged 1 of 1 (Patient #3) patient that arrived the Emergency Department (ED)on 12/14/2020 in an uneatable condition.


Findings:

Patient #3 arrived at the ED on 12/14/2020 at 0828 on an Emergency Detention Order after being found lying in the middle of the road by police officers. At 0920, Personnel #6 charted that the patient became violent and kicked a nurse and the patient's condition was noted as worsening. The hospital called the police and discharged the patient to be transported to jail. No lab work was completed. No medical screening was conducted. Patient #3 received Ativan 1 mg Intramuscularly at 0943 and was discharged into police custody at 0956. There was no document of the patients reaction to the medication. Patient #3 remained in a psychiatric crisis status at discharge.

Personnel #6 stated ..." he wanted to get blood work and a psychiatric evaluation on the patient, but when he was moved into a room he began to destroy the room ... The police were called, four police officers subdued the patient. The patient was too dangerous to have around the staff ...Personnel #6 stated the police can stabilize a psychiatric patient. At the time of discharge the patient was medically cleared. When asked how the patient was medically cleared with no lab work, Personnel #6 stated he was medically cleared ..." There was no appropriate medical screening performed. There was no documentation to justify how Patient #3 was "medically cleared."


Medical Records obtained from Facility B reflected the patient had attempted to hang himself using the seatbelt of the police car during transport to the jail. The patient had to be emergently medicated and restrained after hitting his head and body against the cell wall.


During an interview on 12/29/2020 at 1535 via telephone Personnel #11 from Facility B stated ..." the patient was brought to the jail and was given several emergency injections and he ended up on a restraint bed. The patient was taken to a different hospital for medical clearance ... the officers only have de-escalation training they would be unable to stabilize a patient ..."


During an interview on 12/30/2020 at 1135 Personnel #9 stated ..."the patient was still very agitated when he arrived at the jail. The patient was unable to be booked into jail and was taken straight to the infirmary. The internal SWAT team had to be called to control the patient until he could be emergently medicated ..."