Medical Clearance – Del Norte County

Del Norte 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.

MEDICALLY CLEARED = Toxicity panel has been run and blood alcohol level is below 0.08, comprehensive metabolic and Complete Blood Count laboratory tests are completed. Laboratory tests need to be within normal limits. Behavioral Health staff will be available for assessment only after the above requirements are met.

Levels that are NOT within normal limits are discussed and steps taken to get them within normal limits in order to ensure medical clearance. The admitting psychiatrist will refuse to admit “non-medical” stable or medically clear individuals per their exclusionary list.

Once medically cleared, the individual will be assessed for 5150 criteria. Behavioral Health staff are an outside consultant to Sutter Coast Hospital. Behavioral Health staff comes and conducts the assessment and conducts placement efforts from the Behavioral Health office or Sutter Coast Hospital.

The wait time when psychiatric beds are not available have exceeded 3 days and up to 15 days on occasion, and this causes frustration on the local hospital who have limited beds and want individuals transferred quickly.

One of the biggest issues facing Del Norte County hospitals and Behavioral Health is the lack of available inpatient psychiatric beds. With no designated Psychiatric Health
Facility, designated Acute Psychiatric Hospital, or inpatient psychiatric unit in a General Acute Care Hospital, in Del Norte County all Behavioral health consumers have transfer travel times from 7 to 8 hours to an available psychiatric bed. If an individual is medically cleared and awaiting psychiatric placement for longer than 72 hours, the 5150 hold will be reassessed. Serial holds should not be written, efforts to find a bed need to be documented, but original hold has not “expired” since the individual has not received treatment in a psychiatric facility. Behavioral Health staff will re-evaluate the individual to assess if they continue to meet 5150 criteria, if they do, placement continues to be sought.

ORGANIC DISORDERS:
Individuals who have organic disorders, such as Alzheimer‘s disease, brain damage or intellectual disabilities do not meet criteria for WIC 5150. A Mini Mental Status examination will be administered to rule out organic brain disease

Intellectual disabilities should be referred to:

Redwood Coast Regional Center (707) 464-7488

Currently there is not a simple solution for individuals in crisis with long term and chronic brain issues who display psychiatric behaviors.

BROKERING A BED

Del Norte County Behavioral Health Staff conducts the assessment, and will remain at the Hospital to attempt to find placement.  Behavioral Health Staff will remain there and fax all necessary paperwork to the psychiatric facilities, until our contracted list is exhausted.  Once all the paperwork has been faxed we will remain at the hospital, but may leave while awaiting determination form the psychiatric facility, but only with the ER/Hospital medical staffs agreement.  (The individual is the hospital’s patient under their care).

If the DNCBH crisis worker determines the patient requires a 5150 hold (i.e. psychiatric hospitalization) to resolve the psychiatric crisis, the crisis worker will remain at the hospital to broker a bed.

The ED will provide the following support in the brokering of a bed at a psychiatric facility:

  1. Doctor-to-doctor or nurse-to-nurse consultation, if requested by the admitting facility.
  2. Other medical tests if requested by the admitting facility.
  3. Paperwork that demonstrates the patient is medically stable and cleared for inpatient psychiatric placement.
  • When a bed has been brokered, the ED physician must determine that the patient is stable for transfer and must take appropriate measures, prior to the patient exiting the ED, to ensure the safety of the patient and driver during transport.
  • The ED staff will provide primary treatment and monitoring for a patient placed on a 5150 hold until the patient is transferred to an accepting psychiatric facility.