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					COUNTY OF LOS ANGELES                                      DEPARTMENT           OF HEALTH        SERVICES

                                HARBOR-UCLA           MEDICAL       CENTER

SUBJECT:        INVOLUNTARY HOLDS ON NON-PSYCHIATRIC                                      POLICY NO. 346
                UNITS AND THE EMERGENCY
                MEDICAL DEPARTMENT

POLICY

Involuntary holds -- "5150," "5250," "30 day holds, " L-P-S conservatorship -- can be
initiated/continued by physicians and psychologists on the psychiatric service.

Involuntary holds initiated by the police and psychiatric mobile response team (PMRT) staff ARE
NOT VALID BEYOND THE EMERGENCY DEPARTMENT (ED) UNLESS they are approved by a
psychiatrist or psychologist.

GUIDELINES

Harbor-UCLA Medical Center is authorized to hospitalize mentally disordered patients. They may be
hospitalized against their will on any ward in the hospital if they will not or cannot accept necessary
psychiatric services on a voluntary basis and, on the basis of a mental disorder, they meet one or more ofthe
following criteria.

A person appears to be:
• Dangerous to self,
• Dangerous to others, or
• "Gravely disabled" (Le., unable to provide for basic needs for food, clothing or shelter),

The fact that a patient may be detained involuntarily for a mental disorder, of itself, does not allow the
patient to be treated without consent for any other medical or surgical condition except in an medical
emergency (see Hospital Policy 604A - Informed Consent). Only the medical emergency can be treated.
Further treatment requires the consent of the patient, patient surrogate (see Hospital Policy 604A), or the
permission of the patient's probate guardian, or permission of the court under Section 3200 of the Probate
Code.

Once a patient is on a legal hold, the patient must receive continuous in-person observation when in a non-
psychiatric area (see Hospital Sitter Policy #379).

Any involuntary hold must be indicated on the ED orders, admitting orders, intrahospital transfer orders, and
communicated verbally during handoffs.




EFFECTIVE DATE: 07/03/85                                                                       SUPERSEDES:
REVISED: 12/01192,04/16/93,08/12/94,06/06/95,11/14/95,01199, 01/03, 7/05, 03/07, 08/10
REVIEWED: 09/12/89, 11/92, 12/9~ 06/95,11/95,01/99,10/01,02/02,01/03,08/10


APPROVED      BY:   ---
                    Miguel
                    Chief Ex,

                                utive Office~
                                iz-M~quin               ")       Chief Medical Officer
                                                                J::ail V. Anderson, Jr., M.D., M.B.A.
                                          pegg        rey, R.N      S.N ..
                                           /~              ~~~
                                          Chief Nursing Officer
                                                                                               PAGE 1 OF 4
COUNTY OF LOS ANGELES                                   DEP ARTMENT          OF HEALTH          SERVICES

                            HARBOR-UCLA           MEDICAL        CENTER

SUBJECT:     INVOLUNTARY HOLDS ON NON-PSYCHIATRIC                                     POLICY NO. 346
             UNITS AND THE EMERGENCY
             MEDICAL DEPARTMENT

PROCEDURES
I.   EMERGENCY DEPARTMENT
     A.      5150Patients
             Frequently, patients are brought to the Emergency Room on a 5150 involuntary hold
             initiated by the police. In such cases, the Emergency Department staff should:

             I.     Provide the medical treatment required with the consent of the patient or on the
                    affidavit of two (2) physicians, and

             2.     Obtain an evaluation from a psychiatrist or psychologist.
                    a.      If the psychiatrist or psychologist determines there is no cause for a hold,
                            the 5150 involuntary hold is discontinued, and recommendations made. If
                            the patient requires further medical treatment after the 5150 is discontinued,
                            Admitting has the patient or patient representative sign the General Consent.

                             If the patient does not object and there is a family or a legal representative
                             involved, they are notified of the removal ofthe hold and the hospital's
                             limitation to hold the patient ifthe patient wants to leave. If the psychiatrist
                             or psychologist determines the hold is appropriate, the psychiatrist or
                             psychologist:
                             • writes an order to continue the hold
                             • notifies nursing verbally of the hold so that continuous in-person
                               observation for patients in the non-psychiatric areas can be arranged (see
                               Hospital Sitter Policy 379)
                             • documents the evaluation and agreement with the hold in a progress note,
                             • advises the patient of his/her rights and completes the "Advisement of
                                Involuntary Hospitalization" form,
                             • complete the firearms prohibition forms, if appropriate,
                             • provide the patient with a Patients' Rights Handbook,
                             • recommend further treatment,
                             • and, if recommending psychiatric medications, advises the patient about
                                the medications and completes the "Medication Advisement" form

             3.      If it is determined the medical condition of the patient dictates the patient be
                     admitted to a medical or surgical ward, the Emergency Department staff makes
                     arrangements for admission and the admitting physician writes the 5150 status on
                     the admission orders. The hold documents are placed in the red colored sleeve as
                     the first document in the chart as a visual cue to alert staff. The 5150 status is also
                     communicated verbally to the receiving ward nursing staff by the ED nursing staff.




                                                                                              PAGE 2 OF 4
COUNTY OF LOS ANGELES                                      DEP ARTMENT OF HEALTH SERVICES

                              HARBOR-UCLA MEDICAL CENTER

SUBJECT:      INVOLUNTARY HOLDS ON NON-PSYCHIATRIC                                       POLICY NO. 346
              UNITS AND THE EMERGENCY
              MEDICAL DEPARTMENT

      B.      Voluntary Patients
              If it is suspected that a patient presenting voluntarily at the Emergency Department meets the
              criteria for a 5150:

              1.       Emergency Department staff requests a consultation from the Psychiatric
                       Emergency staff.

              2.       The psychiatrist or psychologist determines ifthe patient needs psychiatric care, in
                       addition to the medical care and whether or not the treatment for the mental disorder
                       will be on a voluntary or involuntary basis.

                       If involuntary, the psychiatrist initiates the 5150 hold and completes all the
                       advisements, forms, and progress notes as identified above in item b.

                       If the patient requires admission to a medical/surgical unit, the medical/surgical
                       team advises the Department of Psychiatry's Consultation Liaison staff ofthe
                       patient's admission so they can provide appropriate follow-up. For consults between
                       the hours of 8:30 am and 4 pm, the Consultation-Liaison Psychiatry office should be
                       notified (x3128; or for emergencies, the consult pager can be called (310.501.3986)
                       in addition to leaving a message at x3128). After 4 pm on nights, weekends, and
                       holidays, the Psychiatric ER resident provides the consult - x3144.Ifthe consulting
                       psychiatrist knows of the patient's medical admission, he/she also notifies
                       Consultation Liaison Office.

II.   MEDICAL/SURGICAL WARDS
      Whether or not a patient is on a psychiatric hold is irrelevant to the provision of medical care. Once
      a patient has been admitted to a medical/surgical ward, additional medical treatment cannot be given
      without the patient's consent, the permission of the patient's probate guardian, permission of the court
      under Section 3200 of the Probate Code, or in life-threatening emergencies.

      If any patient is admitted on an involuntary hold, the medical/surgical team must request consultation
      from the Department of Psychiatry's Consultation Liaison staff so they can provide appropriate
      follow-up.

      If it is suspected that a newly admitted patient has a mental disorder, it is the responsibility of the
      medical/surgical team to request consultation from the Department of Psychiatry's Consultation
      Liaison staff.

      Once a psychiatric physician or psychologist has determined that an involuntary hold is necessary on
      a medical/surgical ward he/she verbally communicates to nursing staff that the patient is on a 5150
      hold, writes an order stating the legal status, and completes other required forms for the hold and
      places the hold documents in the front of the chart.




                                                                                                PAGE 3 OF 4
COUNTY OF LOS ANGELES                                     DEP ARTMENT OF HEALTH SERVICES

                              HARBOR-UCLA              MEDICAL CENTER

SUBJECT:       INVOLUNTARY HOLDS ON NON-PSYCHIATRIC                                    POLICY NO. 346
               UNITS AND THE EMERGENCY
               MEDICAL DEPARTMENT

III.   ELOPEMENT
       In the event that a patient on a psychiatric hold elopes from a non-psychiatric area the nursing staff
       immediately notify the:
            • Los Angeles County Sheriffs Department; County Services Bureau. After notification of
                the patient's elopement, deputies and/or officers will conduct a reasonable search for the
                patient and return him/her if found. If the patient cannot be found after a reasonable search
                is conducted, the deputies/officers will complete a missing persons report, enter the missing
                person into NCIC within 4 hours, and send the report to the LASD Homicide
                Bureau/Missing Persons Detail. Notification will be made to the law enforcement agency
                having jurisdiction where the patient resides. Deputies/officers will then notify the nursing
                staff of the status of the search.

       •   Nurse Manager/Shift Nursing Supervisor
       •   Physician(s) in charge of the patient
           The physician in charge notifies the:
       •   Patient's family or next of kin, ifknown.
       •   Psychiatry consultation/liaison service

IV.    DISCONTINUING         THE HOLD

       A. The psychiatrist or psychologist writes an order when the hold is discontinued, and the hold
       documents are removed from the front of the chart and placed under the orange "Inpatient Record
       Cover" tab in the medical record.

       B. Ifthe patient remains in the hospital after the hold is discontinued, contact the Admissions Office
       at ext. 2078 to have the patient or the patient representative sign the General Consent, if not
       previously done.

CROSS REFERENCE:
Hospital and Medical Administration Policy No. 379 "Sitter (Continuous In-Person Monitoring)"
Psychiatry Department Policy No. 165.0 "Designation Authority to Write 5150 Applications"




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