Littleton Adventist Hospital failed to properly screen or document potential psychiatric patients in its emergency room and appeared to send them to jail, detox or other medical facilities, a federal investigation found.

A probe by the Centers for Medicare and Medicaid Services said Littleton failed to finish psychiatric evaluations ordered by doctors, and transferred patients without providing case details or following up.

The federal agency, which investigates patient-dumping complaints because it provides much of a hospital’s revenue, has ordered a plan of correction and threatened to withhold future payments.

Centura Health, the nonprofit that owns Littleton Adventist and other hospitals, said it has reworked its ER policies, and it told Medicare it will no longer transfer patients before completing evaluation orders.

“We have cooperated fully with CMS on all aspects of their investigation and submitted a plan of correction,” a Centura spokesman said in a statement. “We cannot speak to specifics of the cases cited because of patient confidentiality.”

The father of one of the patients, who complained initially and has seen the Medicare investigation report, said he was appalled to learn the hospital badly mishandled more than his son’s case.

“This turned out to be systemic,” said the patient’s father, who asked that his family’s name not be used in order to protect his son’s reputation. He said he believed the ER knew his son didn’t have insurance — “that’s why they dump people,” he said.

The dumping allegations, and the hospital’s explanations of how limited mental-health services put it in a bind, underscore the desperate need for a proposed overhaul of emergency psychiatric services in Colorado, experts said.

Fast-growing private hospital chains could do more to contribute resources for solutions, they added.

“Health-care systems need to be able to address what they have knocking on their door,” said Dr. Carl Clark, a psychiatrist and CEO of Mental Health Center of Denver.

“Patient 1” in the federal investigation was brought to the Littleton ER by police after crashing his car in July, his father said. He had hit his head and was disoriented, and had previous psychiatric issues including depression, his father said.

At the hospital, he was restrained and given sedatives. He had been violent in transport and had exhibited “suicidal ideation,” according to the Medicare investigation. An ER order was written notifying the psychiatric-evaluation team.

When the patient was put in restraints again, he lashed out at staff, and a doctor ordered a mental-health hold. Less than an hour later, he was discharged with police to jail, and the ER doctor wrote that the psychiatric evaluation could be done in jail by a visiting team.

The federal probe concluded that the hospital failed to perform a full “medical screening exam” on Patient 1 as required by the Emergency Medical Treatment and Active Labor Act.

In other patient charts probed in the review:

• “Patient 2” was seen by an ER doctor and determined “at risk” because of violent behavior and suicidal tendencies. Doctors ordered a mental- health hold and an evaluation, but the exam was not completed before the patient was discharged with police to jail.

• A separately listed “Patient 2” — it is unclear whether the two are the same person — was on medication and in restraints in the emergency department because of violent behavior

for more than two days. An evaluation said the patient was dangerous and needed inpatient treatment, but no beds were available in Colorado. The hospital finally called the police and dropped the mental-health hold so that the patient could be arrested and sent to jail.

“This is an example of a problem with the system,” the medical director told Medicare in a September interview, quoted in the federal deficiency report. The hospital did not have inpatient psychiatric facilities, and restraining the patient indefinitely was not the right treatment, staff said.

The nursing director told Medicare that the hospital had “over the past year become more concerned regarding staff injuries from patients assaulting staff members.”

Staff believed the county mental-health center could perform psychiatric evaluations at the jail. Medicare said the hospital actions violated rules on transferring patients only after a full evaluation of risks and benefits, and with coordination of medical history and treatment.

• “Patient 7” came to the ER after a spousal fight, expressing suicidal thoughts. The patient was aggressive and in restraints, and got anti-psychotic medication. A hold and psych- evaluation order was placed, but the exam still was not completed more than seven hours later, when the patient was discharged to jail for aggression and making threats.

• “Patient 6” was brought by ambulance after parents said the patient had used “bath salts” and was psychotic. The patient arrived comatose and was put on mental-health hold, then transferred to a detox facility. The Medicare probe said hospital staff did not document the risks of transfer, certify the patient’s condition or coordinate between the facilities’ medical staffs.

• “Patient 4” came to the ER drunk and possibly suicidal, the federal records show. After sobering up, the patient got a screening exam. The hospital determined that the patient was in danger and sought transfer to a psychiatric hospital. The physician did not document the patient’s condition before transfer or assess the risks and benefits of the transfer, the probe said.

Denver’s regional Medicare office said state health inspectors will visit Littleton Adventist to confirm that the plan of correction has been carried out. While a threat of terminating Medicare and Medicaid payments is a powerful lever, the CMS rarely throws facilities out of the programs unless current patients are in danger.

In responses to the federal queries, Littleton Adventist leaders said staff had been educated about the need to complete medical-screening exams in the ER. Policies were changed for patients on mental- health holds, including requiring hospital psychiatric teams to do evaluations and not relying on other facilities.

The hospital told the CMS it would pull 10 ER charts a month for six months to ensure that similar future cases are handled properly.

Colorado ranked 49th in the U.S. for inpatient psychiatric beds, according to a 2011 study, “The Status of Behavioral Health Care in Colorado.” Government and private inpatient beds have closed in recent decades. Inpatient capacity at state institutions dropped by 24 percent from 2002 to 2011, the report said.

Gov. John Hickenlooper has proposed an $18.5 million package of new state spending on emergency mental health, and psychiatrists such as Clark say they think the money could create a useful triage system that doesn’t exist here.

Colorado jails are used too often as backup when police and ER staff have nowhere to turn, Clark said. The state’s proposal for new 24/7 walk-in centers for acute psychiatric cases could help clear ERs of mental-health patients “waiting in line behind the guy with the gunshot wound,” he said.

“It’s been hard to get something like that off the ground,” he said.

Michael Booth: 303-954-1686, mbooth@denverpost.com or twitter.com/mboothdp