SSM St Joseph Health Center

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 49489 Based on policy review, the hospital failed to provide within its capability and capacity, an appropriate medical screening examination (MSE) for one patient (#21) of 21 Emergency Department (ED) records reviewed from 05/07/25 through 11/06/25. These failed practices had the potential to cause harm to all patients who presented to the ED seeking care for an emergency medical condition (EMC). Findings included: Review of the hospital’s policy titled, “Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an emergency medical condition),” revised 12/13/23, showed the following: - Any individual who presented to the ED requesting treatment would be provided a MSE to determine whether the individual was experiencing an EMC. - An EMC was a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy, serious impairment to any bodily functions or serious dysfunction of any bodily organ or part. - An MSE was an examination sufficient to reasonably indicate the presence or absence of an EMC for an individual. The MSE would be provided within the capability of the hospital’s ED including ancillary services routinely available to the ED. - Any individual experiencing an EMC would be stabilized prior to transfer or discharge. - Stabilization was when an EMC was managed such that no material deterioration of the condition was likely within reasonable medical probability to result from or occur during the transfer of the individual from a facility. Please refer to 2406 for further details.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 49489 Based on interview, record review and policy review the hospital failed to provide, within its capability and capacity, an appropriate medical screening examination (MSE) sufficient to determine the presence of an emergency medical condition (EMC) for one patient (#21) of 21 Emergency Department (ED) records reviewed from 05/07/25 through 11/06/25. These failed practices had the potential to cause harm to all patients who presented to the ED seeking care for an EMC. Findings included: Review of the hospital’s policy titled, “Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an emergency medical condition),” revised 12/13/23, showed the following: - Any individual who presented to the ED requesting treatment would be provided a MSE to determine whether the individual was experiencing an EMC. - An EMC was a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy, serious impairment to any bodily functions or serious dysfunction of any bodily organ or part. - A MSE was an examination sufficient to reasonably indicate the presence or absence of an EMC for an individual. The MSE would be provided within the capability of the hospital’s ED including ancillary services routinely available to the ED. - Any individual experiencing an EMC would be stabilized prior to transfer or discharge. - Stabilization was when an EMC was managed such that no material deterioration of the condition was likely within reasonable medical probability to result from or occur during the transfer of the individual from a facility. Review of the Patient #21’s Hospital C medical record, dated 10/16/25, showed: - At 6:24 PM, she presented to the ED with a complaint of a fall off a scooter onto concrete the previous day. She landed on her buttocks and did not strike her head or have any loss of consciousness. She reported concern of frequent concussions in the past and was worried the whiplash (an injury caused by a sudden jerk or jolt to the head) caused headaches and dizziness or another concussion. - She was seen earlier that day by a chiropractor who adjusted her neck which made it “lock up even more.” She stated her buttocks was sore, but she did not feel like anything was broken. She was able to sit without difficulty. - Her blood pressure (BP, normal adult blood pressure is between 90/60 and 120/80) was slightly elevated, but her vital signs (VS, measurements of the body’s most basic functions) were otherwise normal. - At 7:47 PM, she was seen by the physician. He noted she described a sensation of her head being “not right,” similar to whiplash with dizziness. Her symptoms worsened after a deep tissue neck massage. She also reported having difficulty focusing, felt overwhelmed, and was unable to complete tasks such as homework or reading. She was concerned about her ability to function normally and was uncertain about her capacity to drive home. - Her physical exam showed she appeared distressed with signs of anxiety and feeling overwhelmed. Her neurological (neuro, relating to or affecting the nervous system) exam showed she reported dizziness and difficulty focusing but was otherwise normal. Her other body systems were within normal limits. - Differential diagnoses included concussion related to her history of multiple concussions, and anxiety. He advised rest, avoiding activities that could exacerbate symptoms, and follow-up with her primary care physician or a mental health professional. - No additional testing or treatments were completed. - The discharging nurse documented that he and the charge nurse had an extensive conversation with the patient going over her discharge instructions attempting to address all of her concerns. The patient was reluctant to be discharged, she wanted instead to stay in the ED room with the lights turned down. She was educated that she had been medically cleared from the ED and was to follow up with a neurologist (a physician who specializes in the care of the nervous system) and rest in dark rooms. She was capable of ambulating to the ED and drove herself. She was taken to the ED waiting room and instructed to drive herself home or use her phone to have someone come get her. - At 8:58 PM, she was discharged. Review of the Emergency Medical Services (EMS, emergency response personnel, such as paramedics, first responders, etc.) report, dated 10/17/25 showed: - EMS was called for a sick person with an altered level of consciousness (the state of being fully alert, aware, oriented, and responsive to the environment). - EMS arrived at 2:59 PM and found Patient #21 lying on an exam table in a college clinic. She was a 31-year-old woman, and the clinic provider reported that she had been in several times over the past few days after having an accident on a scooter. She did not hit her head in the accident, but she had a history of a traumatic brain injury (TBI, an injury in how the brain works) and was concerned about her current symptoms. - She was alert and oriented times four (A&O x4, a person is oriented to person, place, time, and situation), her Glascow Coma Scale (GCS, estimates coma severity. The maximum score is 15 which indicates a fully awake patient) was 15, and her stroke (a medical emergency that occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients) assessment was normal. - She complained of dizziness and headache for several days, otherwise her physical exam was normal. - Her VS were stable with a slightly elevated BP. - An electrocardiogram (EKG, test that records the electrical signals from the heart to check for different heart conditions) showed a normal heart rhythm. - An intravenous catheter (IV, small flexible tube inserted into a vein through the skin to deliver medications or fluids into the bloodstream) was placed, but no additional treatment was given during transport. Review of Patient #21’s medical record, dated 10/17/25, showed: - At 3:34 PM, she arrived via EMS with a complaint of head pain and light sensitivity. She reported a fall the previous week and her pain was worsening after seeing a chiropractor (a healthcare professional who specializes in the diagnosis and treatment of musculoskeletal disorders, primarily focusing on the spine). - Staff P, ED Physician, documented that his first encounter with the patient was at 4:26 PM. She was having significant difficulty articulating the nature of her complaint and she refused to take off her sunglasses for evaluation. - A review of systems was positive for dizziness and headaches. A psychiatric/behavioral examination was negative. No detailed neurological or psychiatric assessments were documented. - Her physical examination showed normal body systems. - Her BP was slightly elevated at 131/98; her other VS were normal, and she was A&O x4. - Staff P documented that he had an extensive discussion over discharge instructions and attempted to address any concerns the patient might have had. She was reluctant to be discharged and wanted to stay in the ED room with the lights turned down. - At 6:26 PM, the clinical impressions listed included, “anxiety states,” and “concussion without loss of consciousness.” - Staff O, RN, documented that she gave the patient her discharge instructions and answered the patient’s questions. However, the patient was stating her questions were not answered. When Staff O asked her what questions weren’t answered, she hid under her blanket and did not answer. She refused to leave, and security was called to escort her out. - The discharge instructions stated she should follow up with her primary care physician and included generic resources and information about pain and BP management. - At 6:35 PM, the police were noted to be at the bedside. - At 6:42 PM, Staff O noted Patient #21 was ambulatory and left the ED with the police. - No ancillary testing was completed and no medications were administered. Review of the St. Charles Police report dated 10/17/25, showed the officer responded to a complaint that a patient was refusing to leave the hospital after she had been discharged. He told the patient that she needed to leave, but she became argumentative. She curled up into a ball while lying on the ED bed and pulled a blanket over her body. He continued attempting to ask her to leave voluntarily but she continued to refuse. He grabbed the blanket, and she became combative. Security staff assisted with physically removing her from the bed. She then became dead weight and actively resisted being removed by trying to grab onto the bedding. She was moved to the ground on her stomach, her arm was moved behind her back. He used a closed fist to strike her back which was successful in unclenching her other arm and he was able to apply handcuffs. She was taken to the police car. Upon arrival for processing, she refused to get out of the vehicle. Additional personnel were utilized to escort her into a jail cell. She was given two municipal court summons for trespassing and resisting arrest. During an interview on 11/11/25 at 9:00 AM, Staff P, ED Physician, stated that he recalled Patient #21. His impression was that her symptoms were primarily anxiety related. When he first attempted to assess her and discuss her symptoms she wouldn’t answer his questions. She refused to remove her sunglasses, had a hoodie up and covered her head with a blanket. He offered to come back later and reassess her. When he came back in for his second attempt to assess her, he spent a long time with her trying to determine the nature of her complaints. He was able to do a thorough neurological exam, and she did not have any deficits. She was not altered; she was fully alert and oriented and understood where she was and what he was asking. She did not appear visibly to be in pain or distress and had no signs of injury. She could not verbalize any specific complaint that he could investigate. She reported a headache, but she also said she had chronic daily headaches, and this was not different from her baseline. She denied nausea or vomiting. He was not aware if the college clinic had sent any communication about their concerns for the patient’s symptoms or condition. However, he was able to see that the patient had been seen in Hospital C’s ED the day before. He reviewed that encounter and found that her presentation was similar and there were no concerning findings at that time. Staff P stated that he offered her multiple opportunities to relay more information. She did not request any specific testing or treatment, she just refused to leave the ED room without communicating any medical concerns. During an interview on 11/11/25 at 8:35 AM, Staff O, RN, stated she remembered Patient #21. She was her primary nurse. Patient #21 had autism but was capable of verbalizing normally. When Staff O tried to talk to the patient she would go under a blanket and would not answer questions. EMS gave report to triage, but did not have much additional information to supply. She stated that work ups for headache complaints were based on the provider’s impression and there were no standard treatment plans. Treatment was based on the individual’s presentation. Patient #21 did not seem to be in any visible pain or distress. She did not appear dizzy or unsteady when she ambulated. Staff O attempted to give her discharge instructions, but the patient refused and went under the blanket. She tried to ask her what questions she had but she would not answer. Patient #21 did not ask to speak with the doctor again and would not verbalize what she wanted. She was escorted out by the police. She was fully oriented and had no signs of an altered mental status.”

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 47504 Based on record review and policy review, the hospital failed to provide within its capability and capacity, an appropriate medical screening examination (MSE) for one patient (#23) of 31 Emergency Department (ED) records reviewed from 11/01/23 through 08/15/24. These failed practices had the potential to cause harm to all patients who presented to the ED seeking care for an emergency medical condition (EMC). Findings included: Review of the hospital’s policy titled, “Emergency Medical Treatment and Labor Act (EMTALA),” revised on 12/13/23, showed: - A MSE should be performed for any individual who comes to the ED or hospital and requests emergency care regardless of diagnosis. - If the patient displays mental disorders (organic, mental, or emotional impairment that effects a person’s cognitive ability or a person’s ability to participate in activities of normal living) then the patient should receive a medical screening by the physician. - If the patient presents with the likelihood to harm self or others an affidavit (a written statement confirmed by oath, for use as evidence in court) should be completed to address involuntary status or emergency detention. - If an EMC is determined to exist, any necessary stabilizing treatment or an appropriate transfer should be provided. - Psychiatric patients are considered stable when they are protected and prevented from injuring or harming him/herself or others. - If an individual chose to leave without an MSE or treatment, they were determined as leaving against medical advice (AMA) after they had been informed of the risks and benefits of remaining for further treatment. Reasonable attempts to obtain the individual’s written refusal to examination or treatment should be completed and the medical record must contain a description of what was refused by or on behalf of the patient. - If the patient refuses treatment and presents with likelihood of serious harm to themselves or others, staff were directed to complete an affidavit or other document to file with the courts to address involuntary status or emergency detention. - There should be evidence of ongoing monitoring of the patient’s EMC until the patient is stabilized and prior to discharge or transfer. Review of the hospital’s document titled, “Rules and Regulations,” dated 01/05/23, showed, Qualified Medical Personnel (QMP) under EMTALA include physicians, RNs, Advanced Practice RNs (APRN), Physician Assistants (PA, a type of mid-level health care that can serve as a principal healthcare provider), and Behavioral Health (BH) Central Intake (CI) Assessors. QMPs were considered competent based on education, training, and experience to perform a MSE and to determine whether or not a patient has an EMC. Review of the hospital’s policy titled, “Required Elements of Daily Assessment/Reassessment (REDA),” revised 01/24/24, showed the RN was accountable for the nursing assessment of patients. Any reassessment, or review of patient information that had changed since the previous assessment, was based on the patient’s diagnosis, change in condition, previous abnormal findings, and the response to interventions provided. Shift Assessments should include any changes in patient condition. There was no guidance in the policy to perform reassessment prior to discharge of ED patients. Review of the hospital’s policy titled, “Management of the Behavioral Health Patient in the ED,” reviewed 11/15/22, showed patients that express homicidal ideation (HI, thoughts or attempts to cause another’s death) may have their body or belongings searched and be placed in a safe environment. An affidavit should be completed. Please refer to 2406 for further details.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 44536 Based on interviews, record review, and policy review, the hospital failed to provide, within its capability and capacity, ongoing assessment and reassessment of a medical screening exam (MSE) sufficient to determine the presence of an Emergency Medical Condition (EMC) for one patient (#23) of 31 Emergency Department (ED) records reviewed from 11/01/23 through 08/15/24. This failed practice had the potential to cause harm to all patients who presented to the ED. Findings included: Review of the hospital’s policy titled, “Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an EMC,” revised 12/13/23, showed: - The requirements of EMTALA ensured any individual presenting to the hospital or dedicated emergency department (ED) requesting emergency care received a MSE conducted by a Qualified Medical Personnel (QMP) to determine the presence of an EMC. - An EMC was a medical condition manifested by acute symptoms of sufficient severity, including psychiatric (relating to mental illness) disturbances such that the absence of immediate medical attention could reasonably be expected to place the individual in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any body part or organ. - The MSE was an examination sufficient to reveal whether the patient suffers from an EMC and must include medically indicated screens, tests, mental status evaluations and a history and physical examination. - Psychiatric patients were considered stable when they were protected and prevented from harming themselves or others. Administration of a physical (any manual method, physical or mechanical device that limits the ability of free movement of arms, legs, body, or head) or chemical restraint (a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient) may stabilize a psychiatric patient for a period of time and remove the immediate EMC; however, the underlying medical condition may persist and the patient may experience an exacerbation of the EMC. Therefore, practitioners should use great care when determining if the medical condition was stable after a chemical or physical restraint was administered. - An individual has the right to refuse a MSE. If the individual chose to leave without an MSE or treatment, they were determined as leaving against medical advice (AMA) after they had been informed of the risks and benefits of remaining for further treatment. The hospital’s obligation under EMTALA was met after the refusing individual was informed of risks of refusing further care or treatment. Reasonable attempts to obtain the individual’s written refusal to examination or treatment were to be completed and the medical record must contain a description of what was refused by or on behalf of the patient. The “Release of Responsibility (Refusal of Screening Exam, Refusal of Care, Leaving AMA)” form was completed and included in the medical record. - Adult behavioral health patients who displayed mental disorders with effects to the person’s cognitive or emotional function and impaired their ability to participate in activities of normal living should receive a medical screening by the physician. If the patient refuses treatment and presents with likelihood of serious harm to themselves or others, staff were directed to complete an affidavit (a written statement confirmed by oath, for use as evidence in court) or other document to file with the courts to address involuntary status or emergency detention. In the state of Missouri, the forms were called “Civil Involuntary Detention.” Required documents are filed with the court and a copy retained in the patient’s electronic medical record (EMR). - The hospital’s EMTALA obligation ended when the physician or QMP decided that there was no longer an EMC (even though the underlying medical condition persisted) and the patient was discharged with appropriate follow-up instructions; the EMC remained, and the patient was appropriately transferred; or the EMC remained, and the individual was admitted to the hospital. - There should be evidence of ongoing monitoring of the status of the patient’s EMC until the patient is stabilized and prior to discharge or transfer. Review of the hospital’s document titled, “Rules and Regulations,” dated 01/05/23, showed, Qualified Medical Personnel (QMP) under EMTALA were deemed to include physicians and non-physician medical personnel. Non-physician QMPs included designated RNs, designated Advanced Practice RNs (Nurse Practitioner [NP, a nurse with advanced clinical education and training]) who were on the Allied Health Professional Staff, designated Physician Assistants (PA, a type of mid-level health care that can serve as a principal healthcare provider) who were on the Allied Health Professional Staff, and Behavioral Health Central Intake (CI) Assessors. Non-physician QMPs were considered competent by way of education, training, and experience to perform a MSE and determine, in consultation or collaboration with a physician, whether a patient did or did not have an EMC. Review of the hospital’s policy titled, “Required Elements of Daily Assessment/Reassessment (REDA),” revised 01/24/24, showed the RN was accountable for the nursing assessment of patients. Any reassessment, or review of patient information that had changed since the previous assessment, was based on the patient’s diagnosis, change in condition, previous abnormal findings, and the response to interventions provided. Shift Assessments should include any changes in patient condition. There was no guidance in the policy to perform reassessment prior to discharge of ED patients. Review of the hospital’s policy titled, “Management of the Behavioral Health Patient in the ED,” reviewed 11/15/22, showed patients that express homicidal ideation (HI, thoughts or attempts to cause another’s death) may have their body or belongings searched and be placed in a safe environment. An affidavit should be completed. Although requested, the hospital could not provide a policy on discharge criteria from the ED. Review of Patient #23’s medical record, dated 06/05/24, showed: - He was a 16-year-old that presented to the ED at 11:57 PM by law enforcement for a psychiatric evaluation. - Medical history included Autism and DMDD. - His mother woke up and found him standing over her on the bed. He would not get off the bed, so the mother called the police. - Patient #23 had been off all prescribed psychotropic medications (any medication capable of affecting the mind, emotions, and behavior) for the past five to six months. - The mother wanted him to be admitted for inpatient psychiatric treatment however, she did not want him started on any psychiatric medications. - Staff R, ED physician, ordered a mental health assessment. - On 06/06/24 at 1:24 AM, he was evaluated by Staff Z, Behavioral Health Therapist, and it was determined that Patient #23 did not meet criteria for inpatient psychiatric treatment. During the mental health assessment, he did not cooperate and answer the questions that were presented by Staff Z. Staff Z determined that he was not an imminent risk to harm self or others, not acutely psychotic (false beliefs or seeing/hearing/smelling/feeling things that are not there occurring in the absence of insight into their nature), or unable to care for himself. Patient #23 could continue treatment on an outpatient basis and was safe to discharge. He was able to contract for safety. - The case was discussed with Staff QQ, APRN, who was the psychiatric provider on call. There was no report of suicidal (SI, thoughts of causing one’s own death) or homicidal (HI, thoughts or attempts to cause another’s death) ideation. She agreed that he did not meet criteria for inpatient psychiatric treatment. She talked to Staff R and he agreed as well that Patient #23 did not meet criteria for inpatient psychiatric treatment. - On 06/06/24 at 1:40 AM, Patient #23 was discharged. During an interview on 08/07/23 at 7:30 AM, Staff QQ, APRN, stated she was the on-call provider for psychiatry. Patient #23 had no SI/HI, no auditory (hearing things that are not heard by others, imaginary) or visual hallucinations (seeing things which are not there) and was not a threat to self or others. His mother specifically stated that she did not want any psychotropic medications administered but did request for him to be admitted. Patient #23, did not meet admission criteria. During an interview on 08/07/24 at 3:30 PM, Staff Y, RN, stated Patient #23 had normal behaviors for a patient diagnosed with Autism. He showed no aggression, no screaming outbursts, and laid down and fell asleep. He had been evaluated by a behavioral health therapist and he denied SI/HI and did not meet criteria for inpatient psychiatric treatment. She stated that his mother stayed outside in the hallway and kept stating that he needed to be admitted for inpatient behavioral health care. Once he was discharged, Staff Y assisted Patient #23 out to the car without incident. During an interview on 08/07/24 at 10:30 PM, Staff Z, Behavioral Health Therapist, stated she was assigned to do a mental health assessment for Patient #23. He was not suicidal or homicidal and was not a threat to himself or others. She did speak with the on-call psychiatric provider and it was determined that he did not meet criteria for inpatient behavioral health. She recommended discharge and for Patient #23 to continue with outpatient therapy. His mother did not want any psychiatric medications given or prescribed. He had been off all medications for the last five or six months. Patient #23 refused to cooperate with the behavioral health assessment and answer the necessary questions to determine if he was stable for discharge, therefore an accurate psychiatric assessment was not completed. A MSE was not complete due to the inaccurate psychiatric assessment.”