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.

ST HELENA PARISH HOSPITAL 16874 HIGHWAY 43 GREENSBURG, LA 70441 Jan. 10, 2019
VIOLATION: COMPLIANCE WITH 489.24 Tag No: C2400
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on Record review and interview, the hospital failed to ensure compliance with the requirments of CFR 489.24 as evidenced by:

1) Failure to provide a MSE for a patient who (MDS) dated [DATE] with a chief complaint of chest pains for 1 (#8) of 7 (#8, #13, #14, #15, #16, #17, #18) sampled patient records reviewed for chest pains from a total patient sample of 20. (See findings under tag C-2406);

2) Failure to provide further stabilizing treatment,when the hospital had the capacity and capability to further stabilize the patient, for a patient presenting with depression and thoughts of self-harm (by overdose of psychotropic medications combined with alcohol) who left and presented 2 days later with reports of a suicide attempt by drug overdose for 1 (#1) of 7( #1,#2, #3, #4, #5, #6, #7) sampled patient records reviewed for psychiatric chief complaints from a total patient sample of 20. (See findings under tag C-2407); and

3) Failure to ensure 3 (#1, #3, #5) of 7 (#1- #7) sampled psychiatric patients, from a total patient sample of 20, were transferred from the sending hospital to the receiving hospital by individuals who were qualified to provide for the safe and effective transport of a patient in need of acute inpatient psychiatric services. The hospital allowed Company "A" to transport these patients using single drivers whose level of training in medical and/or psychiatric emergencies and use of psychiatric de-escalation techniques had not been documented in the hospital's current transportation contract with Company "A". ( See findings under tag C-2409).
VIOLATION: EMERGENCY ROOM LOG Tag No: C2405
Based on record review and interview, the hospital failed to ensure a central log was maintained on each individual who comes to the ED seeking assistance and whether he/she refused treatment, was refused treatment, or whether he or she was transferred , admited, treated, stabilized and transferred, or discharged . This deficient practice was evidenced by failure to have Patient #8 who presented for ED services on 8/31/18 included in the ED log for 1 (#8) of 20 sampled patient records reviewed. .

Findings:

Review of the hospital's grievances for 1/2018- 1/2019 revealed a grievance, dated 9/4/18, filed by Patient #8 indicating the patient had presented to the hospital's ED on 8/31/18 with complaints of chest pain. Patient #8 further alleged S8Security failed to inform the ED nurse or admissions of her arrival. Additional review revealed Patient #8 left the ED without being seen.

Review of the Hospital's ED Central Log, dated 8/31/18 from 12:00 a.m. - 11:59 p.m., presented by S1DirQA, revealed no documented evidence of Patient #8's name, date, time, means of arrival, nature of complaint, disposition, time of departure, and diagnosis.

In an interview on 1/9/19 at 8:50 a.m. with S1DirQA, she reported Patient #8 had called in a grievance to the former DON on 9/4/18. S1DirQA further reported Patient #8 had explained she told S8Security she had chest pains when she came in to the ED on 8/31/18 and alleged S8Security failed to inform the ED nurse or admissions of her arrival. S1DirQA reported no one had known about Patient #8's issues related to having presented to the ED with chest pains and leaving without being seen until Patient #8 called in a grievance.
VIOLATION: MEDICAL SCREENING EXAM Tag No: C2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record review an interview, the hospital failed to ensure each individual who comes to the ED is provided an appropriate MSE within the capability of the hospital's ED to determine whether or not an EMC exists. This deficient practice was evidenced by failure to provide a MSE for a patient who (MDS) dated [DATE] with a chief complaint of chest pains for 1 (#8) of 7 (#8, #13, #14, #15, #16, #17, #18) sampled patient records reviewed for chest pains from a total patient sample of 20.

Findings:

Review of the hospital policy titled, "EMTALA - Medical Screening Examination and Stabilization", Policy Number:100, revealed in part: Purpose: it is the desire and intent of this hospital to establish guidelines for providing appropriate medical screening examinations (MSE) and any necessary stabilizing treatment or an appropriate transfer for the individual as required by the Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C., Section 1395dd and all Federal regulations and interpretive guidelines promulgated thereunder. Policy: An EMTALA obligation is triggered when an individual comes to a dedicated emergency department (DED) and 1.The individual or a representative acting on the individual's behalf requests an examination or treatment for a medical condition, or 2. A prudent layperson observer would conclude form the individual's appearance or behavior that the individual needs an examination or treatment of a medical condition. Such obligation is further extended to the individuals presenting elsewhere on hospital property requesting examination or treatment for an emergency medical condition (EMC). Further if a prudent layperson observer would believe that the individual is experiencing an EMC then an appropriate MSE, within the capabilities of the hospital's DED shall be performed. If an EMC is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility, or an appropriate transfer as defined and required by EMTALA.

Review of the hospital policy titled," Standard of Care - Chest Pain or Myocardial Infarction", Policy Number: 1307, revealed in part: Policy: A patient who arrives at the ED with chest pain or Myocardial Infarction will receive the following care: Maintain patent airway; Place on cardiac/respiratory monitor and obtain baseline rhythm; Place on pulse oximetry; Obtain room air oxygen saturation; Place on Oxygen 2-6 liters per minute via nasal cannula or 10-15 liters per minute with mask; Obtain vital signs and blood pressure in both arms; Establish IV access, 2 if suspected MI is in progress; Draw blood with IV access - Prothrombin time, Partial Prothrombin time, Total Creatine phosphokinase ( enzyme found in muscles, including the heart, indicating damage/ injury), Creatine Kinase- Muscle/Brain, SMA-12- complete metabolic blood screening tests; Obtain EKG; Obtain portable chest x-ray; if Myocardial Infarction prepare for Thrombolytic Therapy.

Review of the hospital's grievances for 1/2018- 1/2019 revealed a grievance, dated 9/4/18, filed by Patient #8 indicating the patient had presented to the hospital's ED on 8/31/18 with complaints of chest pain. Further review revealed the complainant alleged the security guard (S8Security) informed her the ED was too busy due to an accident and told her she would have to wait in the waiting room when she told him she was having chest pains. Patient #8 further alleged S8Security failed to inform the ED nurse or admissions of her arrival. Additional review revealed Patient #8 left the ED, drove herself home, called 9-1-1 on the way, and was transported to another area hospital for evaluation and treatment.

Review of the Hospital's ED Central Log, dated 8/31/18 from 12:00 a.m. - 11:59 p.m., revealed no documented evidence of Patient #8's name, date, time, means of arrival, nature of complaint, disposition, time of departure, and diagnosis.

In an interview on 1/9/19 at 8:50 a.m. with S1DirQA, she reported Patient #8 had called in a grievance to the former DON on 9/4/18. S1DirQA further reported Patient #8 had explained she told S8Security she had chest pains when she came in to the ED, by the side door, on 8/31/18. S1DirQA indicated Patient #8 had reported to her that S8Security had told her to go and sit in the waiting room because there had been a 3 car accident and the ED was busy. S1DirQA reported Patient #8 had indicated she had not seen S8Security tell the ED nurses she was there so she got in her car and left, called 9-1-1, and met the ambulance at her home. S1DirQA indicated Patient #8 reported no one had known she was there except for S8Security who had been on duty at that time. S1DirQA indicated she had re-educated both S7Security and S8Security on the hospital's triage policy, EMTALA policy, and re-iterated it was not security's decision to determine whether a patient could or could not sit in the waiting room, and to at least notify admissions that the patient was there.

In an interview on 1/9/19 at 9:45 a.m. with S3MD (ED MD), she reported the hospital had a chest pain protocol in place and a chief complaint of chest pains was a ticket straight to the back. S3MD indicated patients with chest pains should never be told to sit in the waiting room. S3MD reported typically an EKG was performed within 10 minutes of a patient with chest pains arrival and the patients were assessed ASAP by the triage nurse.
S3MD confirmed security guards don't have the training to determine if a patient's condition would allow them to wait to be treated and even with training they lack the clinical skills to make that type of judgement. S3MD reported patients typically ring a doorbell at the door of the ED that can be heard throughout hospital so the ED nurse knows there is someone out there. She reported there was no dedicated ED Admissions staff except for 3:00 p.m. - 12:00 a.m. Monday -Friday (days only) with no one on duty on the weekends.

In an interview on 1/9/19 at 11:41 a.m. with S5RN (ED nurse), she reported the hospital has a protocol when a patient comes in with complaints of chest pain. S5RN reported when a patient comes to the door with reports of chest pains they should be brought straight to the back, placed in the trauma room, heparin lock started, placed on Oxygen with saturation monitoring, with an EKG within 10 minutes. S5RN confirmed a security guard should never tell a patient they have to wait in the waiting room, especially a patient with chest pains. S5RN indicated security staff should notify staff in the back that patient is there. S5RN further indicated when there was no admissions clerk and no security guard the patients ring the bell to report to staff what their complaint/symptom is.

In an interview on 1/10/19 at 9:37 a.m. with Patient #8, she reported she had been having chest pains and had gone to the hospital ED on 8/31/18. Patient #8 further reported she had open heart surgery on 4/18/2017 and had required stents to be placed 8 days after the surgery. Patient #8 said she told S8Security she was having chest pains and he told her to have a seat, the ER was busy, and she was going to have to wait her turn. Patient #8 reported she could have died . Patient #8 said she didn't want anyone else to experience what she had, because S8Security had basically refused service to her. Patient #8 said she knew S8Security worked as a deputy and he had not understand the description of his job.Patient #8 explained she wanted the hospital to educate S8Security on what his duties were. Patient #8 reported she had been admitted at another area hospital for observation, kept overnight, and was released the next day.

In an interview on 1/10/19 at 12:02 p.m. with S9MD (ED Director), he reported patients presenting to the ED with complaints of chest pain should be taken straight to the back, triaged immediately, have an EKG ASAP, Oxygen started, and Aspirin and Nitroglycerin should have been administered if not contraindicated.
VIOLATION: STABILIZING TREATMENT Tag No: C2407
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record review and interview, the hospital failed to ensure all patients who presented to the hospital's emergency department (ED) were provided on-going stabilizing treatment for an emergency psychological condition. This deficient practice is evidenced by failing to provide further stabilizing treatment,when the hospital had the capacity and capability to further stabilize the patient, for a patient presenting with depression and thoughts of self-harm (by overdose of psychotropic medications combined with alcohol) who left and presented 2 days later with reports of a suicide attempt by drug overdose for 1 (#1) of 7 (#1,#2, #3, #4, #5, #6, #7) sampled patient records reviewed for psychiatric chief complaints from a total patient sample of 20.

Findings:

Review of the Hospital Policy titled, "Emergency Department Psychiatric Care", Policy Number: 1206A, revealed in part: Subject: Emergency Department Psychiatric Care.
Purpose: It is the desire and intent of this hospital to provide safe and effective care to patients presenting to the hospital Emergency Department who are a potential threat to themselves or others and those patients who may also present with alcohol, psychiatric, or drug related problems.
Policy: This hospital is not licensed to treat psychiatric conditions; therefore, any patient who meets criteria for commitment will be held in the emergency department until transfer appropriate care facility takes place.
Definitions: 1. Psychiatric emergencies are classified as those patients who present with: A. Suicidal- has attempted to harm self or has plans to harm self. C. Gravely disabled- those persons who have acute psychiatric issues which prohibit them from safely caring for self. D. Acute intoxication or substance abuse.
3. PEC: Physician's Emergency Certificate. A.The ER physician is to medically clear patient who is deemed to be a danger to self, others, and/or in need of mental health treatment.
B. Physician Assessment: 1. The physician is responsible for completing a focused medical assessment by which a medical etiology for the patient's symptoms is excluded and other illnesses and/or injuries in need of acute care are detected and treated. 2. Review current medications both prescribed and non-prescribed and known medications.
3. Complete a medical clearance treatment plan to determine medical stability as deemed appropriate by the physician.
4. Identify what precautions are needed if there is a substantial risk of harm to self or others and whether involuntary treatment is necessary.
5. Determine whether the patient requires treatment in a hospital or other supervised setting and what follow-up will be required if the patient is not placed in a supervised setting.

Review of the hospital policy titled, "EMTALA - Medical Screening Examination and Stabilization", Policy Number:100, revealed in part: Purpose: it is the desire and intent of this hospital to establish guidelines for providing appropriate medical screening examinations (MSE) and any necessary stabilizing treatment or an appropriate transfer for the individual as required by the Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C., Section 1395dd and all Federal regulations and interpretive guidelines promulgated thereunder. Policy: An EMTALA obligation is triggered when an individual comes to a dedicated emergency department (DED) and 1.The individual or a representative acting on the individual's behalf requests an examination or treatment for a medical condition, or 2. A prudent layperson observer would conclude form the individual's appearance or behavior that the individual needs an examination or treatment of a medical condition. Such obligation is further extended to the individuals presenting elsewhere on hospital property requesting examination or treatment for an emergency medical condition (EMC). Further if a prudent layperson observer would believe that the individual is experiencing an EMC then an appropriate MSE, within the capabilities of the hospital's DED shall be performed. If an EMC is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility, or an appropriate transfer as defined and required by EMTALA.

Review of Patient #1's medical record revealed the patient (MDS) dated [DATE], arrival time: 7:04 p.m., with complaints of Depression and back pain. Further review revealed the patient had the following co-morbid conditions: Bipolar Disorder, Depression, and Schizophrenia. Patient #1 was seen by S3MD at 7:44 p.m. (40 minutes after arrival).

Additional review of Patient #1's medical record revealed the following documentation by S3MD: HPI (History of Present Illness): Pt. with long history of coming to ER wanting to be sent to psych (psychiatric) facility, sometimes simply because she does not have a place to stay, presents stating she doesn't want to live anymore and complains of pain to right low back /upper buttock from injection at last psych facility. She became irate when asked questions about why she was here, especially when asked about whether she had gotten any help with living arrangements other than living with abusive boyfriend. She states she has not lived with him for months and that she is homeless, sleeping on the streets.

Past Medical History: Positive for Bipolar Disorder, Depression, Schizophrenia. Admits to drug use: THC, Alcohol use: does not drink alcohol.

Physical Exam: Psychiatric: Disheveled, aggressive, combative, agitated, angry, alert, dysfunctional family, suspected substance abuse.

Disposition 1/6/18 7:59 p.m.: Eloped: Unchanged condition. Pt. is irate, combative, states she does not want to live but does not express plan to MD - told nurses she would drink alcohol which would interact with lithium and kill her. She doesn't take lithium so that is not a viable plan. Note per S3MD.

Review of the Medical Decision Making Commentary dated 1/6/18 8:09 p.m. by S3MD revealed in part: Patient #1's medication was taken away from her when she started to take some of her meds, and she was told while she was in ED she can only take meds that we give her. She became angry and retrieved her meds from nurse and walked. Since she was not PEC'd, she was allowed to leave without anything but verbal attempts to get her to stay.

Further review of the hospital's ED log revealed Patient #1 (MDS) dated [DATE] (2 days after last visit) with a chief complaint of overdose.

Review of Patient #1's medical record for the ED visit on 1/8/18 revealed the following History of Present Illness documented per S10MD: Patient presents to ER complains of taking about 30 Seroquel because she wants to die to go see her mother who died last year. Patient with Bipolar and Schizophrenia. Denies alcohol or drug use.

Further review of Patient #1's medical record revealed the following Psychiatric Assessment during the physical exam: Depressive affect; disheveled; crying; depressed; alert; no suspected substance abuse; suicidal; no hallucinations.

Additional review revealed the patient was PEC on 1/8/18 at 4:50 p.m. due to being suicidal, dangerous to self, and unwilling to seek voluntary admission. Patient #1 was transported to an area inpatient psychiatric hospital for treatment.

In an interview on 1/9/19 at 9:45 a.m. with S3MD, she reported she had seen Patient #1 multiple times in the ED and knew the patient well. She reported Patient #1 has worked the system because she is homeless and came in to be admitted to a psychiatric hospital (for a place to stay) when her boyfriend kicks her out. S3MD confirmed Patient #1 has had problems since her mother died . S3MD reported Patient #1 had told her she wanted to die, but that wasn't a reason to PEC the patient. She confirmed she had seen the patient, but she had not PEC patient. S3MD reported there are gradations of suicidality and you weigh the seriousness of the threat and clinical judgement comes in to determine the seriousness of the threat. S3MD explained wanting to die and intent to kill yourself are different things. S3MD further explained she was asking Patient #1 questions, taking the patient's past actions into consideration, and not just basing her decisions on the patient's words from that day to determine the patient's status.
S3MD confirmed Patient #1 had been hospitalized in psychiatric facilities multiple times in a month and the psychiatric facilities had not kept her. S3MD reported Patient #1 had told nurses she would drink alcohol which would interact with Lithium and kill her, but the patient had not told her. S3MD reported Patient #1 had not been taking Lithium so expressing she was going to take Lithium with alcohol was not a viable plan. S3MD confirmed she had not been sure if Patient #1 may have had access to someone else's Lithium. S3MD reported the patient's threats to take Lithium with alcohol was like a patient saying, "they were going to commit suicide by laying on train tracks when there were no train tracks around." S3MD indicated Patient #1 had not been PEC and therefore she had not been detained in the ED when she had eloped. S3MD reported they notified the police when she left.

S3MD reviewed Patient #1's ED record from 1/8/18 when she came in for a reported overdose of having taken 30 Seroquel pills and was subsequently PEC and sent for inpatient psychiatric treatment. S3MD indicated Patient #1 had "upped her game" to get admitted to a Psychiatric hospital because her threat of taking Lithium with alcohol "had not gotten her what she wanted." S3MD reported a PEC Pt. ties up an exam bed/room for up to 72 hours. She said Patient #1 knew the mental health system and came in over and over trying to get PEC for a place to sleep for 72 hours. S3MD reported this pattern came into play when deciding whether or not the patient was going to be PEC'd. S3MD indicated she can't PEC the patient every time she says she is going to kill herself in order for the patient to have a place to sleep. S3MD said she would not have made the same decisions with someone that she had not had a history with.

In an interview on 1/9/19 at 11:30 a.m. with S4LPN (ED nurse), she confirmed she knew Patient #1 and was familiar with her and her history. S4LPN also confirmed if a patient came into the ED, expressed a desire to hurt themselves, and reported they would take Lithium and drink alcohol she would consider that to be an expression of suicidal ideation with a plan.

In an interview on 1/9/19 at 11:41 a.m. with S5RN (ED nurse), she confirmed if a patient came into the ED, expressed a desire to hurt themselves, and reported they would take Lithium and drink alcohol she would consider that to be an expression of suicidal ideation with a plan. She reported if the patient was PEC they would have been placed on 1:1 Supervision in the ED until a place had accepted them for inpatient psychiatric treatment.

In an interview on 1/10/19 at 8:22 a.m. with S6RN (ED nurse), she reported she had worked with Patient #1 and was familiar with her history. S6RN confirmed if a patient came into the ED, expressed a desire to hurt themselves, and reported they would take lithium and drink alcohol she would consider that to be an expression of suicidal ideation with a plan. S6RN further reported PEC patients were placed on 1:1 Supervision in the ED until placement for inpatient psychiatric treatment was found for the patients.

In an interview on 1/10/19 at 12:02 p.m. with S9MD (ED Director), he reported patients with psychiatric symptoms would have been assessed in the ED, PEC if needed, and would have been stabilized in the ED prior to transfer for inpatient psychiatric treatment.
VIOLATION: APPROPRIATE TRANSFER Tag No: C2409
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record review and interview, the hospital failed to ensure for the appropriate transfer of psychiatric patients (evaluated to be a danger to self and/or others and placed on a Physician's Emergency Certificate) who were in need of acute inpatient psychiatric services of which the sending hospital was unable to provide at the time of transfer. This was evidenced by the hospital's failure to ensure 3 (#1, #3, #5) of 7 (#1- #7) sampled psychiatric patients, from a total patient sample of 20, were transferred from the sending hospital to the receiving hospital by individuals who were qualified to provide for the safe and effective transport of a patient in need of acute inpatient psychiatric services. The hospital allowed Company "A" to transport these patients using single drivers whose level of training in medical and/or psychiatric emergencies and use of psychiatric de-escalation techniques had not been documented in the hospital's current transportation contract with Company "A".

Findings:

Review of the hospital's policy titled, "Emergency Department Psychiatric Care", Policy Number: 1206 A, revealed in part: G. Placement: C. Once an appropriate bed is located, law enforcement officials need to be contacted for transport. If law enforcement is not able to transport patient, use Company "A". H. EMTALA Guidelines. A. Once a patient has been accepted to a psychiatric facility, follow EMTALA guidelines for transfer which includes a transfer form, and sending copies of all records.

Review of the hospital's transportation agreement with Company "A", dated 6/14/10 (automatically renewed on a month to month basis unless otherwise agreed upon by the parties in writing), provided as the hospital's current transport contract by S1DirQA, revealed in part: This contract ("Agreement") is entered into between Company "A" and this hospital and is legally binding upon all parties under Louisiana law upon signing.
II. Duties of Company "A": A. Company "A" agrees to provide secure one-way transportation for PEC patients from this hospital in Greensburg, Louisiana to any psychiatric and/or chemical dependency treatment facility within the state of Louisiana and Mississippi. Company "A" requires the patients to be physically fit for travel and will only transport patients upon a signature of release from a treating physician or otherwise authorized personnel of the hospital.
D. Company "A" will dispatch a transport unit to the hospital for patient pick-up after being contacted by an answering service hired by Company "A" for this purpose. The patient will be transported from the hospital to other facilities located within the state of Louisiana and Mississippi.
E. Company "A" will not transport violent, bedridden patients. Violent patients have to be mildly sedated at the time of pickup.
F. Company "A" agrees to transport patients of the hospital in a safe and timely manner. Company "A" agrees to provide vehicles equipped with video equipment (for monitoring and observation of patients) and tracking devices. Additionally, each vehicle shall be equipped with a cage/separator between the driver and the back seat passenger for safety purposes. The driver will assist the patient into the back seat of the vehicle and assist the patient out of the vehicle. The driver will ensure that the patient is properly secured in a seat belt.
G. In the event of an emergency during transport, such as illness, Company "A" will notify the treating physician and hospital. Company "A" staff will not be held responsible to administer first aid.
H. Company "A" is not responsible for the medical care of the patients of the hospital nor will Company "A" seek services, other than emergency care as warranted during transport.

Patient #1
Review of the medical record for Patient #1 revealed the patient had (MDS) dated [DATE] with suicidal ideation and a suicide attempt of intentional overdose. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to self and gravely disabled. Patient #1 was transferred to another facility for inpatient psychiatric treatment, via Company "A". The travel time to the receiving facility was approximately 1 hour and 20 minutes- 83 miles.

Review of Patient #1's Transport Trip Sheet for Company "A", dated 1/9/18, revealed one staff signature for the transport.

Patient #3
Review of the medical record for Patient #3 revealed the patient had presented to the ED 1/20/18 with suicidal ideation and a suicide attempt of intentional overdose. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to self and gravely disabled. Patient #3 was transferred to another facility for inpatient psychiatric treatment, via Company "A". The travel time to the receiving facility was approximately 1 hour and 12 minutes- 68 miles.

Review of Patient #3's Transport Trip Sheet for Company "A", dated 1/21/18, revealed one staff signature for the transport.

Patient #5
Review of the medical record for Patient #5 revealed the patient had presented to the ED 2/2/18 with suicidal ideation and a suicide attempt of suffocation by placing a bag over her head. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to self and gravely disabled. Patient #5 was transferred to another facility for inpatient psychiatric treatment, via Company "A". The travel time to the receiving facility was approximately 1 hour and 31 minutes- 89 miles.

Review of Patient #5's Transport Trip Sheet for Company "A", dated 2/3/18, revealed one staff signature for the transport.

In an interview on 1/8/19 at 8:50 a.m. with S1DirQA, she confirmed patients were transported by Company "A" with only the driver. S1DirQA reported the drivers did not intervene in the event of an emergency. S1DirQA indicated the drivers would pull over to the side of the road and call the hospital to notify them of the emergency. S1DirQA reported she was not sure if the driver's had training in basic life support and/or crisis prevention intervention. S1DirQA confirmed hospital nursing/security staff only escorted the patient to the transport unit and did not accompany the PEC'd pts. on transport.


In an interview 1/9/19 at 8:27 a.m. with S2IntDON, she reported PEC's patients were transported by Company "A". S2IntDON further reported Company "A" was called to request a transport and they dispatched a driver. She said personally she has had more than one person show up to transport a PEC'd patient but for the most part it is usually one person. S2IntDON stated she was not aware of what training, if any, that the transport company employees had. S2IntDON reported she was not sure what the driver's process would be if any event, medical or psychological, occurred during transport. S2IntDON reported she was not sure if the driver was allowed to open the door in the event of a medical or psychiatric emergency.

In an interview on 1/9/19 at 9:45 a.m. with S3MD (ED MD), she reported PEC'd patients were transported by Company "A". S3MD further reported a driver was dispatched from the company for transports and she wasn't sure whether the driver had someone with them or not for the transport. S3MD indicated she was not sure what type of training employees of Company "A" had and really didn't know much about the company they used for patient transport. S3MD further indicated she was trusting that whomever made the decision to contract with Company "A" had vetted the company before contracting with them. S3MD reported she did not know what actions the transport employees would take in the event of a medical or psychological emergency during transport. S3MD explained patients had to be calm before they could be transported.

In an interview on 1/9/19 at 11:41 a.m. with S5RN, ED nurse, she reported PEC'd patients were transported by Company "A". S5RN reported a driver from Company "A" transported the PEC'd patients.

In an interview on 1/9/19 at 1:54 p.m. with S11LPN, ED nurse, she reported PEC'd patients were transported by a transportation service (Company "A"). She said they call the company and the dispatcher sends out the driver to picks the patient up for transfer. S11LPN reported only one person comes for transport of the PEC'd patients and it is the driver.

In an interview on 1/10/19 at 8:22 a.m. with S6RN, ED nurse, she reported PEC'd patients were transported by Company "A". S6RN reported the company was called and a driver was dispatched for transporting the patient. S6RN reported there is usually only one person transporting the PEC'd patients and that is the driver.

In an interview on 1/10/19 at 10:41 a.m. with S7Security, he confirmed Company "A" transports the hospital's PEC'd patients. S7Security reported he helped secure the patients in the back of the transport unit. He reported the driver is in the front, separated from the patient in the backseat by a partition. S7Security said at times there may be two people for transport, but usually it is one person who picks up the patients for transport.

In an interview on 1/10/19 at 12:02 p.m. with S9MD (ED Director), he reported the hospital used a transport company (Company "A") to transport PEC'd patients. S9MD reported, as far as he knew, the transport company's staff training would have been addressed as part of the contract for services and would have been something the hospital would have been aware of prior to signing a contract with Company "A". S9MD reported it had been his experience that one employee, a driver, was sent to transport the hospital's PEC'd patients. S9MD reported he imagined the transport company's policy would be that they would go to the nearest emergency room with any type of emergency and if they called and asked him that is the advice he would give them. When asked if it was safe to transport patients PEC'd for being a harm to self or others with one person, S9MD responded the assumption is that the PEC'd patients being transported were stable enough for transport. S9MD reported the hospital would not transport PEC'd patients unless they were stable and indicated they would have to do further stabilization prior to transport if the patient was unstable.