U.S. Patients' Bill of Rights

[archipelago]

State: California

A long story, too much to go into, but I'll start with the basic question: according to the Consumer Bill of Rights and Responsibilities (1998), a recent hospitalization left me with treatment that violated 5/8 of the listed principles:

1. Information Disclosure
4. Participation in Treatment Decisions
5. Respect and Nondiscrimination
6. Confidentiality of Health Information
7. Complaints and Appeals (not as strongly violated)

The hospital I attended voluntarily (a behavioral health unit) refused to release me when I had already made plans with the weekly physician to be released freely. Instead, the attending (on call weekend doctor, not the treating physician) threatened me with a "hold" on no grounds whatsoever. A "hold" or a 5150 in California law is 3 days involuntary commitment on the grounds that you present a danger to self, others, or are impaired so as to present a threat to society or self.

I was not only none of the 3, but the nurse on duty who was ordered by the on-call doctor to make the "hold" refused to carry it out, because there were no grounds. The doctor then turned around and came back to the hospital after leaving in order to make the "hold" himself.

What caused this turn around in treatment, that up to that point was excellent care? I don't really know, but I venture to guess that I challenged his "authority" by simply correcting him when I said I had a right to see my file in a timely manner.

He would not discuss the matter with me, denied a phone call made by the head nurse about such a release of the file, denied my rights to the information, denied my rights to consult and discuss the treatment plan, now radically changed even though he brashly admitted that he had not read my file nor had no intention of doing so. And stated this in front of a nurse.

The situation escalated into a full weekend of battles where I was fighting just to leave because the very reason I went there was for refuge and peace and the doctor himself was undermining that treatment goal so much so that staying in the hospital was against my best interests.

But he threatened a "hold" instead, to force me to stay. And though someone, I'm not sure who at this point, talked him out of the hold idea as an impulse, he proposed then that I be forced to stay overnight, when I did not feel safe there any longer or he would put a hold on me if I tried to leave. That simply doesn't make any sense, and sounds to me like a bald attempt at coercion and maybe something like extortion.

The doctor also placed as condition of my release that I promise not to sue. Is not that also a threat of retaliation preemptively taken?

I am confused about what sorts of laws apply. Or whether or not this is worth going into. It was traumatic so I am not sure I am able to handle it now. However, if anyone has ideas about the statute of limitations I would like to hear that info or anything offered.

I see violations of civil rights (false imprisonment), discrimination (against the vulnerable population of those with mental health diagnoses), federal violations, medical ones, and so on.

The hospital CEO and President sent me a letter assuring me that an internal investigation had taken place already and the offending participants "counseled," but is that possibly just a cover up for not wanting any legal action?

What if I did decided, at a later date, to take this up and pursue it? Is there a possibility that it would help others who are in that very vulnerable situation and have things like holds and restraints threatened as punishment when that is against the rights of the person being treated?

I'm not interested in civil suits, or malpractice. I'm interested in the larger picture of what is the reality of those suffering in these hospitals and treated badly, even now, in the 21st century.

 

[PJ_Weber]

I work BH in-patient in California and am disappointed by-

1) By the Psychiatrist not being up on your chart (or at least daily progress)
2) By threatening you with a 5150 for 'what seems' no justifiable cause

I am surprised anybody in authority (let alone the CEO) sent you that letter, it kinda admits a liability issue

You can file a suit . . .but it would be very expensive, and time consuming

Best thing to do is put this behind you and make a vow
never to go back there again

I don't really know, but I venture to guess that I challenged his "authority" by simply correcting him when I said I had a right to see my file in a timely manner.

That means when you are released you can go to Medical Records and
request a copy of your chart. There is usually a fee (per page) for
copying. It is not a 'I want to see my chart now!' matter

 

[archipelago]

I work BH in-patient in California and am disappointed by-

1) By the Psychiatrist not being up on your chart (or at least daily progress)
2) By threatening you with a 5150 for 'what seems' no justifiable cause

I am surprised anybody in authority (let alone the CEO) sent you that letter, it kinda admits a liability issue

You can file a suit . . .but it would be very expensive, and time consuming

Best thing to do is put this behind you and make a vow
never to go back there again


That means when you are released you can go to Medical Records and
request a copy of your chart. There is usually a fee (per page) for
copying. It is not a 'I want to see my chart now!' matter

_______________________________________________

Thanks for your reply. Yes, the situation is confusing in the sense of what on Earth was actually happening, and I haven't even given all the actual details, though they are all documented to the best of my ability. [I am intelligent and have the ability to remember lots of details, including things like tone and gesture; and an RN later reported to me that when I reread the "transcript" so to speak of what the offending Doctor had done, it was deemed clear, accurate, and even insightful, so I have every reason to trust my ability to evaluate the situation.]

And there were also staff who were all but urging me to document the actions of this particular situation because, while "reading between the lines," I got the distinct impression that this particular psychiatric doctor was "problematic." Indeed, there were a number of other "incidents" on the ward (which is all voluntary unless a hold is placed on you, either before you arrive or after you are there) that very day and later throughout the weekend when the doctor appeared. A long term (like 25 years on the ward) RN told me that even police and security were brought in because someone else was "set off." But I don't know details about that because it was of course confidential.


My questions back to you are as follows:

1. Is there a limit on the time in which a formal action can take place?

I ask because I will not be prepared to do anything until around late May or early June. If there were Civil Rights violations or other Federal Laws broken, i.e. not a civil suit of malpractice but something actually in violation of the law, do I have time to take that up later?

2. What do you make of the fact that the CEO admitted liability?

What does that mean exactly? E.g. he admitted, in toned down language, that the behavior I was exposed to was "inappropriate" and "not to be tolerated" and then offered a "person apology" and then quickly moved on to how the matter was wrapped up after an investigation and internal review.

Now does this mean that I may ask for access to those proceedings even if just a summary? And what do you think is behind such a letter? Why not just tell me the Doc was reprimanded and suspended or his case was put up before the Board (APA) or some such code of ethics determining agency in charge of "standard of care." Why all the secrecy in other words?

3. What do you make of using a 5150 as threat?

Doesn't is say somewhere that that is against the law? That restraints, seclusion, and holds can not be used as "punishment" or as ways to "control behavior." There has to be a real and credible threat in order to take away someone's Civil Rights.

I assure you there was nothing of the kind in this situation. I went to the hospital because I think it is the best choice given few options. I had an old case of PTSD "triggered" by some horrific events and so went there to calm down and get some extra care, manage my symptoms, and minimize my routine in order to focus on healing and stablizing.

In other words, I did not go there with anything like the terms of a 5150. While I was anxiety-prone and very much so, given some of what I witnessed, I was not even depressed, let alone suicidal. Plus I have a shrink I see for therapy outside 2-3x a week in depth analysis for 9-10 years. I was not a loose cannon.

When the senior RN told the Doc no to the the 5150, he mentioned all of these qualities and more to the Doc as grounds for having to refuse to carry out the Doc's orders.

4. Why didn't someone stop this "loose cannon" Doc if there were so many problems?

He practically said to me, in fact I think he did but I would have to review my notes, that he could do whatever he wanted to to me because he was in charge. Is that not also a threat? And legal not civil? He threatened forcible removal by "calling the cops" [the RN in the room whose name or purpose was not even disclosed to me, was stunned, and said, "You mean 'security,' don't you?"] He said so because I said we had not discussed the matter at all and was saying I wanted to discuss it before I was "kicked out." He then approached, a large man, and though a Doc, I was "triggered" due to PTSD residual effects. It was then I said, "I've had enough, and I would like to leave the hospital as soon as the paperwork was completed." It was after that the senior RN came back to my room, with me already packed and having called in a ride home, that the Doctor had "decided" to put a hold on me.

5. Why do you suggest no action? Does that mean that there were no laws broken? Just a case of ethics of standard of care?

This hospital was just like a spa retreat practically; it is superior in everyway and I had excellent care up to that point. It is voluntary so that there is not a "locked down" feel though clearly I ran into the inevitable problems that such BH wards have. I had privileges to walk the grounds. Get outdoor exercise and fresh air. And once the treating Doc took me on his own walk himself during which we had a lovely heart to heart about a range of topics. I trusted and still would like to trust the institution, not that I might need care in the future, since my condition has been in remission for 8 years at least. It took an act of domestic terrorism 4 doors down to retrigger my levels of anxiety, an anxiety that most people felt anyway, without a history of a PTSD dx.

I am interested for ethical reasons that are to some extent personal and to some extent professional seeing that this never ever happen again, even if I have to sacrifice for it. There is just too much of this sort of thing in BH wards. And if you are honest you will search the reasons for why that is so.

People in BH wards are very vulnerable. They are by and large suffering a great deal without hope. They do not have the assertive strength to resist in a healthy way for the most part. I do. So why not use this as an example that might set some sort of rules in place or at least get that Doc off the ward.? No action doesn't seem right to me.

PS while it is a standard notion that you may obtain files upon release, it is in fact not the stated policy of the Patient's Bill of Rights. You are allowed access while you are being treated, with the only rescriction in wriing being "in a timely manner."

In other words, you can read your fileo or summaries at any point during your stay. And when nurses early in the morning denied me access to my file, they said the same thing, wait till release and then order them.

But then when I told the nurses that was not correct, they looked up the detailed hospital policy and it stated that they needed a doctors approval and then could be released to me. The head RN then called and left a message which I was a witness to, about the matter of my records and could he handle this as one of many priorities, because I wanted to absorb the report so that I could meet with my private shrink.

Instead, the Doc ignored the call. When I corrected him about the status of patient's access, that's when he started what is commonly called "acting out." Later in an office confrontation, he denied he got the call because he wasn't on duty when it was made. A completely evasive and sophistical answer designed to frustrate me and defend himself.

If a psychiatrist treating hospitalized mentally ill paitents has that many "issues" then he doen's belong anywhere near a BH ward. In fact, did he not violate the "do no harm" oath repeatedly?

 

[PJ_Weber]

1. Is there a limit on the time in which a formal action can take place?

There probably is a time limit but I have no knowledge of it

2. What do you make of the fact that the CEO admitted liability?

It is very unusual for a hospital officer to say anything outside of
'we are conducting an investigation and will let you know the results'

3. What do you make of using a 5150 as threat?

5150s are written within explicit guidelines, to do it for an unjustified
reason could cause many more problems that it solves

4. Why didn't someone stop this "loose cannon" Doc if there were so many problems?

Not knowing the doctor or the situation (other that what you wrote) I cannot answer this

5. Why do you suggest no action? Does that mean that there were no laws broken? Just a case of ethics of standard of care?

Action would cost money and time, you would have to get a
lawyer to fight the wrongs

The hospital already has their lawyers. Knowing hospitals and suits, they would drag this out for a long time with various motions, hoping you will run out of money

 

[archipelago]

Thanks again. I am a bit confused though. If I reported this situation to an oversight committee of some kind, wouldn't they take it on as a legal case? Laws it seems to me were broken. I'm not interested in a civil suit, for the reasons I mentioned.

So wouldn't that mean that I pay nothing because it would be the Doctor and Staff of the Hospital would be defendants in a legal not civil case?