Medical Clearance

Health and Safety Code 1317.1(2)(A):“Emergency services and care” also means an additional screening, examination, and evaluation by a physician, or other personnel to the extent permitted by applicable law and within the scope of their licensure and clinical privileges, to determine if a psychiatric emergency medical condition exists, and the care and treatment necessary to relieve or eliminate the psychiatric emergency medical condition, within the capability of the facility.

What Medical Clearance Consists Of:

Inpatient psychiatric facilities cannot admit individuals with unresolved medical issues. Therefore most counties have protocols in place that require screening for clearance of any complicating medical issues that must be addressed prior to admission for further evaluation and treatment under a 5150 hold. Chemical issues changing behavior, like drug overdose or intoxication, are also cleared at the Emergency Room because many psychiatric facilities are not licensed detox facilities (Title 22, Division 5, Chapter 9, Article 4 section 77113).

Federal EMTALA law provides that the Medical Screening Exam must be performed by a physician, or if the hospital Bylaws and Rules permit it, by qualified medical personnel (QMP). Although the law does not preclude a nurse or allied health professional from performing the Medical Screening Exam, this must be approved by the hospital Medical Staff and be incorporated into its Bylaws and Rules. In the case of a nurse or allied health professional, the QMP must have a job description for this role, qualifications and competencies must be established, and a formal designation for approved individuals must be in their personnel file; the designation of non-physician QMP’s must also be provided for in the Medical Staff Bylaws and/or Rules.

One reason for “medical clearance” is that a medical screening exam is required by EMTALA whenever an individual comes to a hospital seeking medical care. By definition, EMTALA recognizes that a person who is a danger to self or others has an emergency medical (psychiatric) condition. This is a separate determination from the decision to write a 5150 hold, and the individual’s status as being or not being on a hold is irrelevant to the physician or QMP’s determination that the individual does or does not have an emergency medical condition. Another reason for the medical clearance is to rule out medical or other causes for the dangerous behavior.

The Human Side of Medical Clearance:
Beyond the laws and regulations there is also the human side of medical clearance. No one would want to be mistakenly taken to a mental health facility and be exposed to a unit of people suffering psychiatric crisis when you are vulnerable and ill. It would be a travesty for someone with a medical condition causing their change in mentation and/or behavior to spend one minute in a psychiatric facility when they are in need of a medical hospital and staff. Even one person being placed involuntarily onto a psychiatric unit when they require emergency medical care is unacceptable. So everything is done to ensure the behavior (as the WIC 5150 states) is due to a mental health disorder. The best way this can be accomplished is through medical clearance by astute Emergency Room physicians who rule out the most obvious medical issues… and all serious emergency medical conditions take precedent over psychiatric issues.

If an individual, on a 5150 hold, is deemed medically unstable and admitted to a non-designated hospital for medical treatment due to a physical condition, the WIC 5150 hold is VOID. A WIC 5150 may be re-initiated when medical discharge occurs, if clinically indicated.