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REGIONAL ONE HEALTH 877 JEFFERSON AVENUE MEMPHIS, TN 38103 Feb. 21, 2018
VIOLATION: USE OF RESTRAINT OR SECLUSION Tag No: A0154
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review and interviews the hospital failed to ensure 3 of 3 (Patient #1, 2 and 3) sampled patients in the custody of law enforcement for criminal charges, detained in handcuffs and/or shackles and restricted in their acitivies of daily living, received appropriate assessments and care while in the hospital's Emergency Department and awaiting transfer to a psychiatric facility.

The findings included:

1. Patient #1 (MDS) dated [DATE] at 4:23 PM in the custody of police due to assault charges. Her chief complaint was she had been beaten in the head with a pistol when she confronted her boyfriend. Triage was initiated at 4:31 PM and the nurse documented there was no obvious signs of injury from alleged beating. The triage assessment documented Patient #1 complained of head pain and rated it 10 on a scale of 1-10 with ten being the highest. A Medical Screening Exam (MSE) was documented at 5:03 PM. At 12:22 AM on 12/8/18 Patient #1 was evaluated by a contracted mental health professional. The recommendation was made for an involuntary commitment by the mental health professional. On 2/8/18 at 10:34 AM Patient #1 was transferred to Psychiatric Hospital #1 for further treatment. Patient #1 remained in the ED, under police custody and in handcuffs and/or shackles from 2/7/18 at 4:23 PM until 2/8/18 at 10:34 AM. Patient #1 was not administered any medication for pain. On 2/8/18 at 3:50 AM, a nurse documented , "..patient eating and resting quietly..." There was no documentation of what the patient was provided to eat. There was no documentation Patient #1 was provided hydration in the ED. There was no documentation Patient #1 was afforded the opportunity to use the toilet in the ED.

2. Patient #2 (MDS) dated [DATE] at 11:34 PM in the custody of police due to assault with domestic violence charges. His chief complaint was a cheek laceration and previous threats to harm himself and others with his gun. Triage was initiated at 11:56 PM. The triage assessment documented Patient #2 complained of head pain and rated it 10 on a scale of 1-10 with ten being the highest. A MSE was documented at 11:33 PM. On 1/27/18 at 5:10 AM Patient #2 was evaluated by a contracted mental health professional. The recommendation was made for an involuntary commitment by the mental health professional. On 1/27/18 at 8:59 PM Patient #2 was transferred to Psychiatric Hospital #1 for further treatment. Patient #2 remained in the ED, under police custody and in handcuffs and/or shackles from 1/26/18 at 11:34 PM until 1/27/18 at 8:59 PM. Patient #2 was not administered any medication for pain. There was no documentation Patient #2 received a meal tray, sandwich, snack or hydration in the ED. There was no documentation Patient #2 was afforded the opportunity to use the toilet in the ED.

3. Patient #3 (MDS) dated [DATE] at 8:19 PM in the custody of police due to assault charges. Her chief complaint was "I don't know nothing mam." Triage was initiated at 8:26 PM. The triage assessment documented Patient #3 was flat, quiet and uncooperative with no complaints of pain. A MSE was documented at 10:41 PM. On 2/8/18 at 12:40 AM Patient #3 was evaluated by a contracted mental health professional. The recommendation was made for an involuntary commitment by the mental health professional. On 2/8/18 at 12:30 PM Patient #3 was transferred to Psychiatric Hospital #1 for further treatment. Patient #3 remained in the ED, under police custody and in handcuffs and/or shackles from 2/7/18 at 8:26 PM until 2/8/18 at 12:30 PM. . There was no documentation Patient #3 received a meal tray, sandwich, snack or hydration in the ED. There was no documentation Patient #3 was afforded the opportunity to use the toilet in the ED.

4. During an interview in the conference room on 2/21/18 at 11:50 AM, the ED Nurse Manager verified there was no documentation that the patients restrained by law enforcement, were afforded toileting opportunities, offered snacks, meals or hydration consistently or that pain was addressed for Patient #1 and 2 as identified during triage assessment.