Harbor:Involuntary holds

Overview

INVOLUNTARY HOLDS: CODE GOLD, & COLD GREEN

Psychiatric reason

• • 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

Medical reason

• • 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.

Code GOLD

• • 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.

Code GREEN

• • 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

Code GRAY

• • 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
• Additional References
  • 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
  • Sheriff "Cheat Sheet" for Code Green and Code Gold

Public Health

• • (213) 745-0800 (Tb)
  • 213-974-1234 after hours

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

See Also

• Harbor:Operations manual