Japan's home favourite Yui Ohashi pulled away from a tight field to strike a medley double for the seventh straight Olympics, having already won gold in the 400 m race.
Third at the final turn, Great Britain's Abbie Wood could not hold off Douglass at the finish and settled for fourth 11 hundredths of a second back in 2:09.15.
Canada's 2019 World Championships bronze medallist Sydney Pickrem repeated her sixth-place finish from Rio five years earlier, touching in 2:10.05.
Hungary's defending champion and world record holder Katinka Hosszú was unable to replicate her sterling Rio performance and claimed a distant seventh in 2:12.78.
Up to one swimmer per NOC meeting that time is eligible for selection, allocated by world ranking until the maximum quota for all swimming events is reached.