The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.
| PARIS REGIONAL MEDICAL CENTER | 865 DESHONG DR PARIS, TX 75460 | Jan. 4, 2019 |
| VIOLATION: PATIENT RIGHTS | Tag No: A0115 | |
| Based on observation interview and document review, the facility failed to: A. accommodate patient/family request for treatment options in one (pt #1) of 6 (#1, #2, #4, #6, #11 and #18) minors who were evaluated for psychiatric services. Refer to Tag A 0130 B. have or follow a facility policy addressing physical and/or chemical restraint of patients who were brought into the Emergency Department for evaluation, in 1 (#5) of 6 (#1, #3, #6, #11, and #18) patients under the age of 18 and 1 (#4) of 12 (#2, #4, #5, #7, #8, #9, #10, #12, #13, #14, #15, #16, #17) patients 18 years of age or older. Refer to Tag A 0144 C. provide documentation or rational for the use of restraint (psychoactive drugs and handcuffs) during the treatment and evaluation of 2 (patient #4, #6) of 18 patients (patients #1 through #18) identified. Refer to Tag 0154 |
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| VIOLATION: PATIENT RIGHTS: PARTICIPATION IN CARE PLANNING | Tag No: A0130 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to accommodate patient/family request for treatment options in one (pt #1) of 6 (#1, #2, #4, #6, #11 and #18) minors who were evaluated for psychiatric services. This deficient practice had the likelihood to affect all patients of the facility. Findings: On 1/3/2019 at 11:00 am, in the board room, the electronic medical record (EMR) for patient (Pt/pt) #1 was reviewed with the assistance of staff #1. The EMR indicated, pt# 1, who was a minor, was voluntarily brought to the Emergency department (ED) by her mother for evaluation on 10/23/2018 at 9:13 PM. The EMR revealed, pt #1 was discharged [DATE] at 9:36 AM. Staff #1 confirmed the facility could provide no documentation that the patient or her mother had been provided opportunity for input or that their choices for hospital admission had been considered or investigated. Review of the nursing triage documentation indicated pt #1 felt safe at home and had no thoughts of suicide or self harm. The nursing triage psychiatric portion indicated all aspects of the nursing psychiatric evaluation were within normal limits (WNL) except "Depressed, flat affect, lack of eye contact and soft speech" Further review of the nursing triage indicated, PT #1 ran away from school at 3:30 PM. Found by city police at 9:10 PM. This occurred last month. Her reason for skipping school was to avoid a bully. She reported that she attempted suicide by using a knife and overdosing. She indicated, she had those thoughts again today. A review of (Dr. staff #9), the initial ED physician's documentation revealed, "Findings have been discussed with the patient and her mom. She has never had inpatient treatment for depression and suicidal ideation's. The (sic) She might benefit from more intensive evaluation. When the (sic) little HealthNet is identified the patient will be transferred to that facility for inpatient evaluation. Patient is currently stable for psychiatric evaluation." A tele-psychiatric evaluation was performed by a contracted psychiatric service that arranged the transfer to the hospital in Desoto, TX . A review of the physician's interaction with pt #1 and her mother was recorded by the Registered Nurse (RN). The RN documented on 12/24/2018, at 9:36 am, "Dr. (Staff #8), at bedside explaining to mother that pt needed further interventions for treatment. Dr. (Staff #8) explained to mother that IF SHE DID NOT TAKE pt #1 to Psychiatric hospital that police and CPS would be notified. Mother stated that she would take pt to facility". On 10/24/2018, at 9:36 AM, Pt #1, who was suicidal to the point of requiring in-patient treatment, was discharged to her mother's care with "all paperwork sent with her". Pt #1's mother drove her to the Desoto facility. There was no documentation as to why ground transportation was not attempted or why all paper work required for the admission was not faxed in advance of the transfer. Discussion with the hospital staff regarding the evaluation process and transfer arrangements when admission for an in-patient facility was required revealed the contracted psychiatric services handled all the arrangements. This was confirmed by staff #1 and Staff #7. The mother reported in a written complaint, she brought pt #1 to the ED for evaluation because of depression, anxiety, and running away. The mother wrote, "My daughter was not actively suicidal nor was there an ED (Emergency Detention) or court order for her to be there". The mother further reported, "I was told my daughter was being sent to an adolescent psych hospital 2 1/2 hours away in Desoto, TX. I asked them to find a hospital closer to our home multiple times and they refused. I was told that my daughter had been accepted to the facility in Desoto, TX and it would take too much paper work and time to send her somewhere else. When I complained and asked the day shift charge nurse and day shift ER (emergency room ) doctor to call to see if beds were available at closer hospitals or a hospital that I thought would be better, I was threatened. (If you don't take her to this treatment center we will call CPS (Child Protective Services))". The mother continued to write that the ED reported that the receiving psychiatric hospital had been told she was refusing to have her daughter admitted for treatment. She reported she never refused admission, she only wanted to try to find a facility closer to where they lived. |
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| VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING | Tag No: A0144 | |
| Based on document review and interview, the facility failed to have or follow a facility policy addressing physical and/or chemical restraint of patients who were brought into the Emergency Department for evaluation in 1 patient (#6) of 6 (#1, #3, #6, #11, and #18) patients under the age of 18 and 1 (#4) of 12 patients (#2, #4, #5, #7, #8, #9, #10, #12, #13, #14, #15, #16, #17) 19 years of age or older. This deficient practice had the likelihood to effect all patients of the facility. Findings: 1/3/2019 in the afternoon, a review of the electronic medical records (EMR) for patient's #1-though #18 were reviewed. Documentation found in pt #6's EMR indicated he was brought to the ED by a female identifying as his legal guardian, (sometimes referred to as his aunt and other times referred to as his mother). The EMR did not contain a copy of the legal guardianship documentation. 12/29/2018 12:05 AM, "Patient to ED to room 04 on bed and handcuffed to side rails by Paris PD officer #10. Mother is at bedside. PD discussing patient care with Paris PD officer and mother. Patient continues to threaten PD officers". 12/29/2018 at 12:16 AM "Patient arrived via private vehicle with aunt (legal guardian) and police escort. Aunt walked in ED triage and states pt has locked himself in vehicle (sic) eith her infant and states he will kill himself. Aunt reports patient was released from ________ (Behavioral Health Facility) on 10/23/18 and that contact has already been made with ______ regarding readmission. Patient uncooperative in ED triage and states "If yall put me back in a Damn room I'll find something to hurt himself and sue (sic) yalls ass". The date and time were noted as 10/29/2018 at 12:16 AM. A review of documentation within the content of the EMR for pt #6 failed to identify an Emergency Detention Warrant (EDW) or Police Officers Warrant (POW). Pt #6 was brought to the ED voluntarily by his guardian, (no evidence of legal guardianship could be found). Pt #6's EMR indicated he was uncooperative with police and hand cuffed to the bed rail while his mother and police officers discussed his treatment plan. No EDW or POW was provided within the EMR to support the use of hand cuffs. The EMR indicated the order for suicide Precautions was entered at 12:45 by physician staff #9, forty minutes after the pt's arrival in the ED. Pt #6 was handcuffed by police during this time. Up to this point in the EMR timeline the ED staff have not interacted with pt #6 other than to record what they were hearing/seeing, and to record vital signs. Review of the facility Policy, "Suicide in NON-Psych settings" (Not a Psychiatric hospital) " 2.0 One-to-One Observation- the act of remaining within arms length of and in constant visual sight 360 degree (sic) of patient's environment at all times including during toileting." On 12/29/2018 at 12:22 RN, staff #12, notified the house supervisor of a physician's verbal order for 1:1 sitter. "Paris PD Officer, #10, will remain with patient until sitter can be obtained". At 1:04 AM, Licence Vocational Nurse (LVN), Staff #14, documented, "Pt asleep in bed no signs of distress noted. PD Officer #10 at patients bedside". At 1:20 AM LVN, staff #14, documented, "Officer #10, removed handcuffs at this time patient is acting appropriate (sic)". This documentation implies that pt #6 was asleep for 20 minutes and remained handcuffed during that time and a police officer was in the room observing him. At 1:55 a sitter was obtained. Staff RN #13, became the 1:1 sitter. The EMR documentation indicated she sat in the doorway, well outside the arms length required in the facility policy. Pt #6 was kept in the ED until his readmission to the Behavioral Hospital could be arranged. At 4:50 AM, PT #6 was transported by ground transport to the behavioral facility. There was no documentation that staff attempted behavioral intervention. Staff #1 confirmed, all ED staff were trained in nonviolent crisis intervention. The documentation did not reflect that staff witnessed any physical behavioral outburst after entering the ED. The staff documented verbal outbursts and physical behaviors that occurred at the point of arrival, while still in the parking lot. The ED staff permitted the Police Officer to Physically restrain pt #6 using hand cuff. The only behavior documented after entry into the ED was documented was a verbal threat against the Police officer, and a threat to hurt himself if anyone attempted to put him back in a "Room". A review of the facility's policy that was available to the staff for behavioral interventions revealed. "CODE WHITE", "To provide the best care, welfare, safety, and security for all individuals in the event escalating behavior could lead to harm to another individual." "Guideline": "The (Medical Center) will utilize the term "Code White" as a means to alert trained individuals in nonviolent crisis intervention to respond to situations in which additional help is needed." "3.0 Initiation of "Code White" "3.1 Any staff member may initiate a "code white" when an individual exhibits acting out behavior over which the staff had little or no control". "6.2 Unsuccessful non-physical intervention" "6.2.2 In cases where the staff member feels there is imminent danger, Law Enforcement should be contacted immediately". Interview with staff #2 confirmed, the facility did not have a policy addressing guidance with a POW/EDW vs. a forensic patient under the custody of police. There was no documentation of pt #6 being a forensic patient under arrest or any documentation of completion of a detention that pt #6 had behaviors observed within the ED that threatened others. An interview with the Chief Nursing Officer, staff #2, confirmed, the facility had no policy for the use of handcuffs as restraint and had always followed the lead of the police when they brought patients in to be evaluated. He further commented, he didn't realize they could stop the police from cuffing a patient or request the cuffs be removed if they (police) brought him in. The leadership of the hospital was not familiar with police detention warrants vs forensic patients in the custody of police. The facility did not consistently require accountability from police by requesting evidence of the POW or EDW, when patients were brought to the facility. They also were unfamiliar with the fact that a patient, who has been brought into the ED by police for mental health evaluation, when seen by the physician, was no longer under police custody or care. Patient (Pt/pt) #4: With the assistance of staff #1, a review of the Electronic Medical Record (EMR) for pt #4 revealed, pt #4 was brought to the facility's Emergency Department (ED) by local EMS (Emergency Medical Services) for "erratic behavior at a public movie theater". She arrived via ambulance to the ED at 12:20 AM, the morning of 11/19/2018. At 12:35 AM (15 minutes later) an order for intramuscular (IM) injection of Haldol Lactate was identified in the EMR. A review of the Physician's Desk reference (PDR.net) revealed, "Haldol Lactate is a prompt usage drug when given intravenous, 2 to 5 mg IV single initial dose, if oral therapy is not appropriate. May administer as frequently at one hour intervals. Maximum dose is 20 mg per day. USE THE LOWEST EFFECTIVE DOSE IN ALL PATIENTS. For patients with mania 5-10 mg may be administered every 4-6 hours". An Intramuscular dose was not mentioned in the PDR.net information. There was no documentation this order was carried out and there was not documentation the patient received the Haldol. On 10/29/2018 at 12:45 AM (25 minutes after arrival) pt #4's EMR indicated, a physician's order for IM injection of Haldol Lactate 10 mg and Ativan 2 mg with Benadryl 50 mg. Haldol Lactate is used for treatment of psychosis, while Ativan is most often use for treatment of anxiety or agitation and Benadryl is an anti-histamine which can induce sleep. This order was documented as given at 12:59 AM. A review of the "Patient Observation Flow Sheet" found in the EMR, indicated no behavioral documentation prior to the time of 12:45 AM. At 12:45 AM on 10/29/2018, pt #4 was in her assigned room, lying down, sleeping. Review of the nursing triage intake, recorded no physical behaviors that were aggressive toward herself or others. Triage documentation recorded at 12:20, indicated her verbal response as "inappropriate" but she "obeys commands". Pt #4 answered "yes" to having thoughts of suicide or self harm. Later during this same triage assessment the nurse recorded "Inappropriate speech, speech loud, homicidal ideation delusional." Documentation recorded pt #4 asleep at 1:00 AM, at 2:00 AM, a 1:1 sitter was documented in the room while she slept. Pt #4 slept until 10:55 AM when the EMR recorded, "eyes spontaneously open, oriented, obeys commands. Transfer to courthouse then (sic) to go to courthouse". A review of pt #4's EMR indicated an "Application for Temporary Mental Health Services" was signed by the county judge on 10/29/2018, for a 90 day commitment to a facility for mental health services. A waiver of the hearing related to her court ordered placement in a mental health facility was also identified within the EMR. The full "Order for Protective Custody" was not completed and left entirely blank, but kept as part of the EMR. Interview with staff #1 and ED staff #7 indicated, police usually provided an Emergency Detention Warrant, but confirmed there was no Emergency Detention Warrant or Police Officer Warrant available within pt #4's EMR. Pt #4's rights were fully intact until the time of the Judges order for 90 day placement in a mental facility. A review of facility policies did not identify a policy issuing guidance for the use of medications for treatment of a pt who exhibited mental illness or suicidal/homicidal thoughts or tendencies. There was no policy which permitted a physician to use his medical judgment to treat a patient exhibiting mental illness or suicidal/homicidal thoughts or tendencies without a full psychiatric evaluation with no established medical history of Haldol, Ativan, or Benadryl as part of the patient's routine medication regimen and/or treatment plan. Pt #4 was given IM medications without documentation indicating pt #4 gave consent to receive Haldol lactate, Ativan, or Benadryl. The ED physician had documented the patient could give no information. There was no documentation within the pt's EMR indicating Haldol, Ativan, or Benadryl were among routinely prescribed medications. Behaviors documented at the time the injections were given indicated pt #4 was in her assigned room asleep. No documentation was recorded prior to the injections indicating physical aggression or hostility. |
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| VIOLATION: USE OF RESTRAINT OR SECLUSION | Tag No: A0154 | |
| Based on documentation review and interview, the facility failed to provide documentation or rational for the use of Restraint (psychoactive drugs and handcuffs) during the treatment and evaluation of 2 (patient #4, #6) of 18 patients (patients #1 through #18) identified. This deficient practice had the likelihood to effect all patients of the facility. Findings: Patient (Pt/pt) #4: On 1/3/2019 in the board room the electronic medical record (EMR) for patients (Pt/pt) #1 through #18 were reviewed. Documentation found in Pt #4's EMR indicated, she received an intramuscular injection of Haldol Lactate 10 mg, Ativan 2 mg, and Benadryl 50 mg, 25 minutes after her arrival to the emergency department (ED). No physical behaviors indicating a threat to self or others was documented. No verbal de-escalation interventions or physical interventions were documented indicating the staff felt threatened or feared for the safety of others from pt #4's verbal ideation's of self harm or homicidal intentions, prior to the use of multiple (3) medications given intramuscularly. Pt #4 was brought via ambulance for "erratic behavior at a movie theater". The "Emergency Medical Report" authored by staff physician #9 read, "Subjectively the patient has been drinking alcohol tonight. She went to see"Halloween" at the movie theater this evening. Since that time, she has been acutely altered and is crying out she wants to stab people. This prompted her emergency department evaluation. She was given 4 of Ativan by EMS in route to the the ED. The patient is unable to provide any appropriate information at this time". The above listed ED physician entered the orders for Haldol, Ativan, and Benadryl, however there was no accompanying documentation as to what behavior prompted the need for the three medications. (Haldol is used for treatment of psychosis, Ativan is an anti anxiety, and Benadryl is an anti-histamine that often induces sleep). Physician #9 had previously documented, "the patient was not able to give appropriate information" at the time of her arrival. Pt #4 slept from 012:45 AM until she was taken to the courthouse for a mental health evaluation at 10:55 AM. Just over 10 hours. A review of the lab work done upon admission reflected a blood alcohol level of 132 milligrams (mg) per Deciliter (dl). The expected range would have been less than 5 mg/dl. Pt #4 also had a "high" positive for Benzodiazepine. Pt #4 was intoxicated and in a drug induced state upon arrival to the ED. The physician failed to document if the medication was not prescribed for behavior, why were the medications prescribed and given. Neither physician, Registered nurse nor sitter documented any physically aggressive behavior that implied pt #4 was an immediate threat to herself or others. Pt. #6: Documentation found in pt #6's EMR indicated, he was brought to the ED by a female identifying as his legal guardian, (sometimes referred to as his aunt and other times referred to as his mother). The EMR did not contain a copy of the legal guardianship documentation. 12/29/2018 12:05 AM, "Patient to ED to room 04 on bed and handcuffed to side rails by Paris PD officer #10. Mother is at bedside. PD discussing patient care with Paris PD officer and mother. Patient continues to threaten PD officers". 12/29/2018 at 12:16 AM "Patient arrived via private vehicle with aunt (legal guardian) and police escort. Aunt walked in ED triage and states pt has locked himself in vehicle (sic) eith her infant and states he will kill himself. Aunt reports patient was released from________ (Behavioral Health Facility) on 10/23/18 and that contact has already been made with __________regarding readmission. Patient uncooperative in ED triage and states "If yall put me back in a Damn room I'll find something to hurt himself and sue (sic) yalls ass". The date and time were noted as 10/29/2018 at 12:16 AM. A review of documentation within the content of the EMR for pt #6 failed to identify an Emergency Detention Warrant or Police Officers Warrant. Pt #6 was brought to the ED voluntarily by his guardian, (no evidence of legal guardianship could be found). Pt #6's EMR indicated, he was uncooperative with police and hand cuffed to the bed rail while his mother and police officers discussed his treatment plan. No Emergency Detention or Police Officer Warrant was provided within the EMR to support the use of hand cuffs. Pt #6 had no physician's order for the physical restraint and the facility staff were not monitoring the patient while the restraint was in use. The documentation of pt #6's behavior were not documented until after the physician's verbal order for suicide precautions. The EMR indicated, the Physician's order for Suicide Precautions was entered at 12:45 by physician staff #9, forty minutes after the pt's arrival in the ED. Pt #6 was handcuffed by police during this time. Up to this point in the EMR timeline the ED staff have not interacted with pt #6 other than to record what they were hearing/seeing, and to record vital signs. Review of the facility Policy, "Suicide in NON-Psych settings" (Not a Psychiatric hospital) Is this a policy?? "2.0 One-to-One Observation- the act of remaining within arms length of and in constant visual sight 360 degree (sic) of patient's environment at all times including during toileting." On 12/29/2018 at 12:22 RN, staff #12, notified the house supervisor of a physician's order for 1:1 sitter. "Paris PD Officer, #10, will remain with patient until sitter can be obtained". At 1:04 AM, Licence Vocational Nurse (LVN), Staff #14, documented, "Pt asleep in bed no signs of distress noted. PD Officer #10 at patients bedside". At 1:20 AM LVN, staff #14, documented, "Officer, #10, removed handcuffs at this time patient is acting appropriate (sic)". This documentation implies that pt #6 was asleep for 20 minutes and remained handcuffed during that time and a police officer was in the room observing him. At 1:55 a sitter was obtained. Staff RN #13, became the 1:1sitter. The EMR documentation indicated she sat in the doorway, well outside the arms length required in the facility policy. Pt #6 was kept in the ED until his readmission to _______ could be arranged. At 4:50 AM, PT #6 was transported by ground transport to the behavioral facility. There was no documentation that staff attempted behavioral intervention. Staff #1 confirmed all ED staff were trained in nonviolent crisis intervention. The documentation did not reflect that staff witnessed any physical behavioral outburst after entering the ED. The staff documented verbal outbursts and physical behaviors that occurred at the point of arrival, while still in the parking lot. The ED staff permitted the Police Officer to physically restrain pt #6 with hand cuffs. The only behavior documented after entry into the ED was documented was a verbal threat against the Police officer and a threat to hurt himself if anyone attempted to put him back in a "Room". A review of the facility's policy that was available to the staff for behavioral interventions revealed: "CODE WHITE", "To provide the best care, welfare, safety, and security for all individuals in the event escalating behavior could lead to harm to another individual." "Guideline": "The (Medical Center) will utilize the term "Code White" as a means to alert trained individuals in nonviolent crisis intervention to respond to situations in which additional help is needed." "3.0 Initiation of "Code White" "3.1 Any staff member may initiate a "code white" when an individual exhibits acting out behavior over which the staff had little or no control". "6.2 Unsuccessful non-physical intervention" "6.2.2 In cases where the staff member feels there is imminent danger, Law Enforcement should be contacted immediately". Interview with staff #2 confirmed the facility did not have a policy addressing guidance with a POW/EDW vs. a forensic patient under the custody of police. There was no documentation of pt #6 being a forensic patient under arrest. Documentation did not indicate that pt #6 had behaviors observed within the ED that threatened others. An interview with the Chief Nursing Officer, staff #2, confirmed the facility had no policy for the use of handcuffs as restraint and had always followed the lead of the police when they brought patients in to be evaluated. He further commented he didn't realize they could stop the police from cuffing a patient or request the cuffs be removed if they (police) brought him in. The leadership of the hospital was not familiar with police detention warrants vs forensic patients in the custody of police. The facility did not consistently require accountability from police by requesting evidence of the POW or EDW, when patients were brought to the facility. |
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| VIOLATION: DISCHARGE PLANNING NEEDS ASSESSMENT | Tag No: A0806 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to meet the discharge needs of 2 (#1) of 18 patients (#1 through #18) by allowing or directing the family to transport a patient to a higher level of care. This deficient practice had the likelihood to effect a patients of the facility. Findings included. On 1/4/2019 at 11:00 am in the board room, the electronic medical record (EMR) for patient (Pt/pt) #1 was reviewed with the assistance of staff #1. The EMR indicated pt# 1, who was a minor, was voluntarily brought to the Emergency department (ED) by her mother for evaluation on 10/23/2018 at 9:13 PM. The EMR revealed pt #1 was discharged [DATE] at 9:36 AM. Staff #1 confirmed the facility could provide no documentation that the patient or her mother had been provided opportunity for input or that their choices for hospital admission or method of discharge transportation had been considered or investigated. The EMR indicated a tele-psychiatric evaluation was performed by a contracted psychiatric service that arranged the transfer to the hospital in Desoto, TX . A review of pt #1's EMR revealed the physician's interaction with pt #1 and her mother was recorded by the Registered Nurse (RN). The RN documented on 12/24/2018, at 9:36 am, "Dr. (Staff #8), at bedside explaining to mother that pt needed further interventions for treatment. Dr. (Staff #8) explained to mother, that IF SHE DID NOT TAKE, pt #1 to Psychiatric hospital, that police and CPS would be notified. Mother stated that she would take pt to facility". Further review of pt #1's EMR indicated on 10/24/2018, at 9:36 AM, Pt #1, was discharged to her mother's care. "all paperwork sent with her". There was no documentation as to why ground transportation was not attempted, or why, all paper work required for the admission, was not faxed to the receiving psychiatric hospital in advance of the transfer. Discussion with the facility staff, regarding the evaluation process and transfer arrangements when admission for an in-patient facility was required, revealed the contracted psychiatric services handled all the arrangements. This was confirmed by staff #1 and Staff #7. The mother reported in a written complaint, "she brought her daughter (pt #1) to the ED for evaluation because of depression, anxiety, and running away". The mother wrote, "I was told my daughter was being sent to an adolescent psych hospital 2 1/2 hours away in Desoto, TX. I asked them to find a hospital closer to our home multiple times and they refused. I was told that my daughter had already been accepted to the facility in Desoto, TX and it would take too much paperwork and time to send her somewhere else When I complained and asked the day shift charge nurse and day shift ED doctor to call to see if beds were available at closer hospitals or a hospital that I thought would be better, I was threatened. "It you don't take her to this treatment center we will call the police and CPS (Child Protective Services) On 10/24/2018 Pt #1, who the physician felt was suicidal to the point of requiring in-patient treatment at a higher level of care, was discharged to her mother, who drove her in a private vehicle to the receiving psychiatric hospital 2 1/2 hours away from their home. There was no documentation explaining why Emergency Medical ground transportation was not arranged. The mother wrote in the complaint that the receiving psychiatric hospital informed her the discharging facility had told them, she was refusing to admit her daughter. The patient's mother stated, she was not refusing to admit. She reported she never refused admission, she only wanted to try to find a facility closer to where they lived. |
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