Hillcrest Medical Center

2010 Clinical Policy for Psychiatric Patients

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NON-VOLUNTARY Patients:
1. Non-Voluntary patients (regardless of insurance) will be transported to
Tulsa Center for Behavioral Health (TCBH) once they are medically cleared.
a. TCBH must take the patient even if they are full. They will decide if
they patient needs emergency detention and find a bed for them
either in their facility or somewhere in the state.
b. Parkside also has the capability to treat non-voluntary patients if
they have a payer source. It is acceptable for Parkside to refuse the
non-voluntary patient without insurance as the patient can always go
to TCBH. This is a courtesy by TPD, not mandated.

2. A Third Party Statement must be completed on each patient.

a. The Third Party Statement may be filled out by anyone who is
concerned about the patients’ safety or who witnessed concerning
behavior (i.e. family, COPES, social worker, nurse, physician).
b. If the patient already has a third party statement by someone else, you
do not have to fill out another. UNLESS you have witnessed behavior
that is different or more extreme than is already documented.
c. The Third Party Statement MUST have enough detailed information
to justify the placement of the patient into police custody (it cannot
simply say “suicidal”).
d. The police can refuse to take custody and transport a patient if they
feel there is not enough evidence written on the Third Party
Statement to justify this action.
e. The psychiatric team at TCBH will do an assessment and they will
decide if the patient needs an Emergency Detention (ED). The term
EOD (Emergency Order of Detention) is no longer used for the
legal document and is outdated terminology.

3. Establish Medically Clearance. The Emergency Physician evaluating the

patient will determine what (if any) tests need to me performed to establish
that the patient is medically clear.
a. The patient must be stable enough to be discharged into non-medical
(police) custody, transported to TCBH and wait (up to 2-3 hours) for
their psychiatric evaluation.
 b. Although not necessary for medical clearance, we have agreed that we
will make a reasonable attempt to get a urine drug screen as it will
eventually help guide the patient’s treatment.
c. Don’t delay discharge for urine drug screen results, as these can be
faxed to TCBH when you get the results back.

d. The ETOH level does not determine medical clearance.

HOWEVER-
i. The patient needs to be observed long enough to show that
they are sobering or a repeat level showing that the ETOH is
trending downward.
ii. The patient must be sober enough to sit and hold a
conversation during their intake evaluation.
iii. The patient needs to be at low risk for going into with-drawl or
having a seizure while waiting with the police in the waiting
area for their evaluation.

4. Notify TCBH/Parkside that the patient has been medically cleared and will
be coming to their facility for an evaluation.
a. This is a COURTESY CALL. You are transferring a stable patient from
our facility into non-medical (police) custody. Even though this
technically does not fall under EMTALA, please fill out transfer
paperwork for consistency.
b. If the psychiatrist is not able to talk with you about the patient, inform
the intake specialist that you will allow 30 minutes for them to call
you back, then you will be calling the police and discharging the
patient into their custody.
c. TCBH is the triage facility for all involuntary patients, and cannot
refuse the patient. Parkside can refuse the patient if they don’t take
their insurance, however, not for any other reason.
d. TCBH/Parkside cannot demand that the ETOH level be below a
certain number, HOWEVER, they can send the patient back to the
Emergency Department if they do not feel they are medically
stable for an evaluation.

5. The Tulsa Police Department (TPD) will come to the Emergency

Department and take the patient into protective custody (handcuffs-
discretionary), transport the patient to TCBH *and be responsible for them
until care is turned over to the staff at TCBH.
 *Officers are instructed to transport to TCBH, HOWEVER, if the patient states
that they have insurance and this has been verified by hospital staff, and a
call has been placed with Parkside and they agree to take the patient, then
and only then, you can ask that TPD transport the patient to Parkside.
This is a courtesy location change to Parkside. TPD Officers can still refuse
and transport to TCBH.

a. If the patient has insurance and has been accepted by Parkside, TPD
should be able to transport them to Parkside. This is new information
for officers as TPD historically would only transport to TCBH. Please
call dispatch and speak with a TPD supervisor if the officer is
unfamiliar with this option.
b. TPD has the right to refuse to take a patient into custody if they are
not comfortable with the patients medical stability or if they do not
feel there is enough written justification on the Third Party
Statement. Also, Officers may refuse a patient if what is written still
doesn’t meet State Law requirements.
c. Patients brought by TPD to TCBH are put at this top of the list to be
assessed, however the wait with police in the waiting area may be up
to 2 hours.
d. To be consistent, fill out the transfer paperwork and check that the
patient has an EMC , which has been stabilized.
e. Please send a copy of the patients Emergency Department Record and
a copy of any tests done in the ED.
f. Do not wait on results of the Urine Drug Screen to disposition the
patient. However, please have them faxed to TCBH when you get
them back.

VOLUNTARY Patients
Any patient who has an Emergent Psychiatric Condition but who is willing to get
treatment may be determined Voluntary. However, if you have any concerns about
the sincerity of their intention to stay or if you feel they need physical detention,
then a third party statement needs to be filled out and the patient sent to TCBH.

Patients NOT appropriate for Voluntary Psychiatric Admission:

1. History of violence or currently exhibiting violent behavior

2. Known history of committing rape, molestation or serious crime
3. Requiring physical restraints
4. Any concern for the safety of Hospital personnel or EMSA who will be
transporting the patient.
Once you have determined that you have a VOLUNTARY PSYCHIATRIC
ADMISSION:

1. Establish Medically Clearance. The Emergency Physician evaluating the

patient will determine what (if any) tests need to me performed to establish
that the patient is medically clear.
a. The patient must be stable enough to be transported either upstairs
by our nurses or by EMSA/family to another facility.
b. Although not necessary for medical clearance, we have agreed that we
will make a reasonable attempt to get a urine drug screen as it will
eventually help guide the patient’s treatment.
c. Don’t delay disposition for urine drug screen results, as these can be
faxed when you get the results back.
d. The ETOH level does not determine medical clearance.
HOWEVER-
i. The patient needs to be observed long enough to show that
they are sobering or a repeat level showing that the ETOH is
trending downward.
ii. The patient must be sober enough to sit and hold a
conversation during their intake evaluation.
iii. The patient needs to be at low risk for going into with-drawl or
having a seizure during transport or during their evaluation.
e. Patients must be able to perform activities of daily living, and be
physically able to function in the unit.
f. Some patients may be found to have medical conditions that would
preclude them from functioning in the behavioral unit and should be
Admitted to a Medical Service with Psychiatry Consult.
Examples include:
i. Active, incapacitating physical illness
ii. Bed Bound
iii. Requiring IV catheter
iv. Frequent vital signs (<4hrs)
v. Severe or profound mental retardation
vi. Overdose with long acting medications
g. Hillcrest Behavioral unit CAN take patients in wheelchairs and who
require oxygen.

2. FIRST call Hillcrest Behavioral Unit (x7180). If they have a bed available
they will accept the patient, REGARDLESS of their ability to pay.
a. Every patient that is accepted upstairs WILL BE ADMITTED and seen
by a psychiatrist in the morning.
 b. They can only do one admission at a time (~40 minutes) so your
patient will stay in the Emergency Department until they can admit
them into the locked unit.
c. It is our responsibility to keep the patients safe until they are
admitted upstairs.
d. Be aware that the nurses will be giving your patient an information
sheet to ensure they understand it is a locked unit and they won’t be
allowed to smoke (but given nicotine patches). If your patient
changes their mind about being voluntarily admitted to the unit then
fill out a third party statement and send them to TCBH.

3. If the Hillcrest Behavioral Unit is full, then the patient must be transported to
another mental health facility. There are many other facilities in town that
must take your patient REGUARDLESS OF INSURANCE STATUS if they are
not full.
a. The intake specialist on our unit will be making all the phone
calls to determine where your patient will be accepted. This will
hopefully stop the habit of other facilities trying to verify insurance
status prior to accepting patients.
b. Since your patient has an Emergency Medical (Psychiatric) Condition
and needs a service that we are unable to provide (unit is full), other
facilities that have the capability must take the patient regardless of
the patient’s ability to pay.
c. Other Inpatient Psychiatric Units that take Voluntary patients in Tulsa
include:
i. Parkside (918)-588-8888
ii. Laureate (918)-481-4000
iii. Brookhaven (918)-438-4257
iv. TCBH (918) 293-2100

4. Once accepted to another facility you must ARRANGE TRANSPORTATION of

the patient and understand that you are responsible for the safety of that
patient until they reach the receiving hospital.
a. EMSA is the safest method of transporting a voluntary patient from
one hospital to another.
b. You can let a family member transport the patient. However, you are
liable if you knew the patient was suicidal and they harmed
themselves before they were EVALUATED at the accepting facility.
i. Understand that your voluntary patient may wait hours in the
waiting room of the receiving facility before an evaluation.

Additional Resources
 COPES (Community Outreach Psychiatric Emergency Services)
(918)-744-4800

1. State funded crisis unit that can come to the Emergency

Department to help evaluate your patient to determine if an
Emergency Medical/Psychiatric Condition exists (should be very
rare occasion).
2. Please call them for anyone who you are discharging (because
they didn’t meet criteria for involuntary detention) but who you
feel needs close psychiatric follow up.
3. Will call or go to the patient’s home within 12-24 hours to check
on the patient and arrange mental health follow up appointments
at Family and Children’s Services.

PACT (

CHILDREN Ages 4-17

Hillcrest Child and Adolescent Services (located at OSU Medical Center)

1. 24-hour Intake Department 918-599-5880.

2. 90 Bed inpatient unit with Acute and Residential (sub-acute)
services to children and adolescents

Parkside Hospital

1. 24-hour Intake Department 918-588-8888

2. 15 bed inpatient unit with Acute and Residential services for
(ages 10- 17 only).

Shadow Mountain Behavioral Health System

1. 24-hour Intake Department 918-492-8200.

2. 108 bed facility with Acute and Residential services to children
and adolescents

1. Medically Clear the child as you would for an adult.

2. Notify the Facility that you have medically cleared the child and are sending
them for an evaluation.
3. Fill out transfer paperwork
4. Arrange transportation by the safest means possible.
a. You must determine if it is safe for the child to be transported by the
parents.
b. If your patient is violent or not safe in their legal guardian’s care then fill
out a third party statement and call TPD for transportation.
c. COPES team can also be called to the ED to help transport your pediatric
patient to the pediatric psychiatric hospital safely.