Harbor:Involuntary holds

Overview

INVOLUNTARY HOLDS: CODE GOLD, & COLD GREEN

5150 (5585 for Peds) only for a mental health disorder.
Voluntary patients usually not placed on a 5150/5585, but can be.
Non-psychiatric medical personnel can detain anyone who meets criteria until they can be evaluated by a psychiatrist.
5150 can be placed by:
- Psychiatrist ONLY INSIDE MAIN HOSPITAL BUILDING
- Sheriff ANYWHERE OUTSIDE MAIN HOSPITAL BUILDING, including rest of hospital grounds
  - Sheriff has independent authority to place the 5150 or not

Patients who lack capacity and are a danger to themselves or others for non-psychiatric reasons. Do not need psych consult to determine capacity when restraining patient for a medical reasons, and psych cannot override decision to restrain a patient for non-psychiatric reasons. DO NOT REFER TO THIS AS A "HOLD" AS THIS MAY LEAD LAW ENFORCEMENT TO BELIEVE THE PATIENT IS ON A 5150.
If they try to elope you can detain/restrain, if they become violent or aggressive, call a CODE GOLD (see below).
These patients can be held against their will for their own safety no 5150 is required or applies (5150 for psych issues only).
No specific legal form for restraining medical patients - document reasons in chart. Use restraint form for restraints.

For all patients who become physically aggressive, either for psychiatric or medical reasons.
They will be placed in hard restraints by CODE GOLD team
Call x111.
No requirement patient be placed or already on 5150
LASD (Sheriff) responds but is not part of team, only assists if detect or to prevent criminal activity by patient (assault)
Behavioral Response Team leader (BRT) should ID themselves on arrival and ED physician or nurse in charge of patient should brief them.
BRT leader has option of turning over situation to LASD as needed.

Already on or eligible for a 5150/5585 and attempting to, or have physically left the department.
Call x3311 LASD(Sheriff)
On a 5150 hold - LASD will return patient
NOT on 5150 hold
- Inside Hospital Building - LASD can only convince patient to return - can't forcibly return. Only Psych can place 5150 inside hospital building
- Outside Hospital Building - LASD makes independent determination to place patient on 5150
  - Physician or nurse in charge of patient should brief LASD if patient on 5150 or if not, indication for 5150
If LASD decides not to place patient on 5150, document Code Green in chart and officers involved

ANYONE (patient, visitor, staff) who is combative or assaultive and it is not felt due to a medical or psychiatric reason

Above vetted by Law Enforcement, Psychiatry, Behavioral Response Team, ED Leadership, and Nursing leadership

436 Procedures in Cases To Be Reported to Are Investigated by Law Enforcement Authorities
301 Discharge Policy, Procedures, and Guidelines Including Elopement and AMA
138 Law Enforcement Use of Force on Harbor-UCLA Campus
347A The Use of Restraints Including Seclusion
346 Involuntary Holds on and on Psychiatric Units and Emergency Medical Department
379 Safety Attendant (Continuous in Person Monitoring)
453 Patients in Police Custody
347B Code Gold-Behavioral Response Team
620 Consent for Medical Treatment for Patient Lacking the Capacity to Provide Consent
604A Consent
Sheriff "Cheat Sheet" for Code Green and Code Gold

Dir OPS 10/15/18 Dir AED, 10/28/16

Authors: