- Joined
- Aug 16, 2009
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Hello. I have a conundrum and I’m trying to figure out if I’m simply misunderstanding the issue or if I’m witnessing wrongdoing.
I work in a government (US federal) hospital as an internist. We have psychiatry staff but they will only admit military patients who are actively suicidal or homicidal. They will not admit nonmilitary patients to their inpatient service for any reason.
What we get very often is that an unfunded/uninsured civilian patient will be brought to the ER by the police with active suicidal Ideation or homicidal ideation. In the county, they must be evaluated by a psychiatrist within 12 hours to justify the emergency detention and within 48 hours by the county court to issue an order of protective custody (involuntary commitment for up to 14 days).
Here’s my problem: the psychiatry department will evaluate these patients and write in their chart that they “lack capacity.” And are “admitted voluntarily,” while also writing that, because they lack capacity, the cannot leave AMA and should be physically restrained if they try. This often results in multi day admissions to a medical ward without psychiatric treatment.
But they refuse to provide any treatment or see the patient while inpatient. Often they will also refuse to apply for an order of protective custody for the patient. This means that at the expiration of 48 hours, I am forced to either release them or to force them to stay at the risk of breaking the law.
I have clarified before with our legal council that we are not a psychiatric facility and these patients should not be admitted, but sent to an appropriate facility.
I’ve pointed out to several psychiatry attendings that their recommendations could be considered as violating the patient’s civil rights (involuntary commitment without legal due process). They consistently ignore me and refuse to change their documentation.
Am I not understanding the law here? Does the phrase “voluntary admission but lacks capacity for AMA” really absolve them of following the legal requirements for OPC?
Thanks for your input.
I work in a government (US federal) hospital as an internist. We have psychiatry staff but they will only admit military patients who are actively suicidal or homicidal. They will not admit nonmilitary patients to their inpatient service for any reason.
What we get very often is that an unfunded/uninsured civilian patient will be brought to the ER by the police with active suicidal Ideation or homicidal ideation. In the county, they must be evaluated by a psychiatrist within 12 hours to justify the emergency detention and within 48 hours by the county court to issue an order of protective custody (involuntary commitment for up to 14 days).
Here’s my problem: the psychiatry department will evaluate these patients and write in their chart that they “lack capacity.” And are “admitted voluntarily,” while also writing that, because they lack capacity, the cannot leave AMA and should be physically restrained if they try. This often results in multi day admissions to a medical ward without psychiatric treatment.
But they refuse to provide any treatment or see the patient while inpatient. Often they will also refuse to apply for an order of protective custody for the patient. This means that at the expiration of 48 hours, I am forced to either release them or to force them to stay at the risk of breaking the law.
I have clarified before with our legal council that we are not a psychiatric facility and these patients should not be admitted, but sent to an appropriate facility.
I’ve pointed out to several psychiatry attendings that their recommendations could be considered as violating the patient’s civil rights (involuntary commitment without legal due process). They consistently ignore me and refuse to change their documentation.
Am I not understanding the law here? Does the phrase “voluntary admission but lacks capacity for AMA” really absolve them of following the legal requirements for OPC?
Thanks for your input.