Based on record review and interview, the hospital failed to ensure compliance with the requirements of CFR 489.24 as evidenced by: 1) Failing 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 4 (#5, #10, #11, #16) of 5 (#5, #10, #11, #12, #16) 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. ( See findings under tag C-2409).

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 4 (#5, #10, #11, #16) of 5 (#5, #10, #11, #12, #16) 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 transportation agreement with Company "A", dated 6/15/10 (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 S1DON, 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 New Roads, Louisiana to any psychiatric and/or chemical dependency treatment facility within the state of Louisiana. 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. 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 #5 Review of the medical record for Patient #5 revealed the patient had (MDS) dated [DATE] with homicidal ideations. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to others. 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 15 minutes- 75 miles. Patient #10 Review of the medical record for Patient #10 revealed the patient had presented to the ED 03/09/19 with homicidal ideations. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to self and others. Patient #10 was transferred to another facility for inpatient psychiatric treatment, via Company "A". The travel time to the receiving facility was approximately 1 hour - 55 miles. Review of Patient #10's Transport Trip Sheet for Company "A", dated 03/09/19, revealed one staff signature for the transport. Patient #11 Review of the medical record for Patient #11 revealed the patient had presented to the ED 01/03/19 with suicidal ideations. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to self and others. Patient #11 was transferred to another facility for inpatient psychiatric treatment, via Company "A". The travel time to the receiving facility was approximately 2 hours and 30 minutes- 155 miles. Patient #16 Review of the medical record for Patient #16 revealed the patient had presented to the ED 01/01/19 with suicidal ideations. The patient was placed on a PEC (Physician Emergency Certificate) due to being a danger to self and gravely disabled. Patient #16 was transferred to another facility for inpatient psychiatric treatment, via Company "A". The travel time to the receiving facility was approximately 1 hour and 30 minutes - 96 miles. Review of Patient #16's Transport Trip Sheet for Company "A", dated 01/02/19, revealed one staff signature for the transport. On 03/26/19 at 2:30 p.m., S4Physician revealed that only one person (the driver) from Company "A" performs the transports for psychiatric patients. When asked if the driver for Company "A" had any training in medical and/or psychiatric emergencies and the use of psychiatric de-escalation techniques, he stated he did not know. On 03/26/19 at 2:25 p.m., interview with S5Security Guard revealed that when Company "A" transfers psychiatric patients, there is only one staff performing the transport, which was the driver of the vehicle. On 03/27/19 at 7:20 a.m., interview with S1DON revealed that the hospital's Internet Technology staff had viewed video recordings of Patients #5 and #10 exiting the hospital as they were being transferred per Company "A". S1DON confirmed that only one staff member accompanied each patient on their transfers. On 03/27/19 at 7:30 a.m., interview with S2Physician revealed that only one staff member (driver) accompanies the psychiatric patients that are transferred from Company "A". When asked if the driver had any training in medical and/or psychiatric emergencies and the use of psychiatric de-escalation techniques, she stated that she did not know. On 03/27/19 at 9:10 a.m., interview with S7Security Guard revealed that Company "A" transports the hospital's PEC'd patients. S7Security Guard reported that the driver is in the front, separated from the patient in the backseat by a partition. On 03/27/19 at 11:00 a.m., interview with S1DON and S6Administrator revealed that they were unsure if Company "A" staff who were transferring psychiatric patients had training in medical and/or psychiatric emergencies and the use of psychiatric de-escalation techniques. They further confirmed that the usual process was for only one staff member (the driver) to transfer the psychiatric patients.