Issues with recent M1 72 hour hold

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Latest post 07-31-2014 7:10 PM by DOCAR. 25 replies.
  • 08-26-2012 5:51 PM

    • KevinD65
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    Issues with recent M1 72 hour hold

    My wife recently attempted suicide by taking prescription medication.  This is in Colorado.  I took her to the emergency room, and of course they did an M1 hold on her.  Luckily she is doing better and feeling fine now.  She was held for the full 72 hours.  I'm not disputing the validity of the hold, however, there were several issues that came up that I'm currently investigating.  Any thoughts would be appreciated.

    There are 6 specific issues:

    1. The holding facility did not even consider the possibility of releasing her prior to the 72 hours.  In Colorado, the hold is not mandatory.  The person can be released if they no longer require treatment or evaluation.  She was feeling better and non-suicidal after the 1st 24 hours.

    2. The constitutionality of Colorado law related to emergency holds, in that the criteria for release is too vague.  Once you get in, it is not clear how to get out.  What does "no longer require treatment and evaluation" mean, etc.?

    3. I contacted an attorney on behalf of my wife, and they retaliated against her in an emotionally abusive way and gave her false information about what she needed to do to get out (she had to go to group, share in group, write in her journal, and "do the work")

    4. I believe in Colorado the patient bears the responsibility of the cost of treatment.  Is that fair / consitutional when the hold is involuntary?  The state shouldn't have a profit motive for holding people longer than necessary, which may have happened in this case.

    5. Concerns about the cost of transportation.  They transported by ambulance (read: expensive) to a facility approximately 60 miles away because there were no beds available at any closer facilities.  Should the patient bear the cost of transportation in that case?

    6. Concerns about the constitutionality of the facility holding past 72 hours via a short term certification process.  An M1 hold initiation requires "imminent danger" but a short term certification only requires "danger".  Also, the holding facility is allowed to do the short term certification evaluation.  This is problematic because they are not a neutral party.

    I've been reading the Colorado law pretty carefully.  It used to be C.R.S. 27-10-105 and 27-10-107, but the statute numbers changed in 2010.  I haven't researched case law or precedents yet.  I'm not a lawyer and don't have access to a law library so it's hard for me to do that.  I'm sure I'm not the first person to run into some of these issues, so any help would be appreciated.

    Thanks.

  • 08-26-2012 5:59 PM In reply to

    • DPH
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    Re: Issues with recent M1 72 hour hold

    KevinD65:
    I'm not disputing the validity of the hold

    Then what is the purpose of your exercise?  Do you want to dispute the charges?  Treatment?  What is your end goal?  Lawsuit? 

     

    "Never argue with stupid people, they will drag you down to their level and then beat you with experience."  -  Mark Twain

     

  • 08-26-2012 6:05 PM In reply to

    • KevinD65
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    Re: Issues with recent M1 72 hour hold

    I guess I wasn't clear.  I'm not disputing the *initiation* of the M1 hold, that is, I'm not disputing the "imminent danger" aspect of it that got her into it, but I am disputing other aspects of the 72 hour hold period, as I articulated 6 specific items of potential dispute.  Primarily the issue is that they held her longer than was necessary.

    The goals are 1) Cost mitigation, 2) To determine if I have any legal grounds to pursue a case on constitutional grounds, and 3) To educate myself more fully about the law so that I'm better prepared if it ever happens again, which I sure hope it doesn't.

    Thanks.

  • 08-26-2012 6:14 PM In reply to

    Re: Issues with recent M1 72 hour hold

    KevinD65:
    The person can be released if they no longer require treatment or evaluation.  She was feeling better and non-suicidal after the 1st 24 hours.

    The key word in that statement is "can be" there is no requirement that they do so.  Often a treatment team will not release a patient who has made an overt suidicde attempt without ensuring there is appropriate outpatient support in place.  It requires more than "feeling better" to be released.   A single statement that the patient is no longer suicidal is not sufficient either.  The staff is very right in observing the patient for at least 24-48 hours to ensure that is truly the case.

    KevinD65:
    What does "no longer require treatment and evaluation" mean, etc.?

    The reason it appears vague to you is not every patient requires the same treatment so there is no one size fits all answer.  Generally it means when the patient is stable, no longer a danger to themself or anyone else, and appropriate outpatient treatment if warranted is in place.

    KevinD65:
    I believe in Colorado the patient bears the responsibility of the cost of treatment.  Is that fair / consitutional when the hold is involuntary?

    Of course it is fair.  The hold is involuntary because of the patient's own behavior and need.  Why should the tax payers pay it?  Too often the complaint isn't that the patient must pay for care but that hospitals discharge patients who still need treatment because the insurance runs out.  

    KevinD65:
    They transported by ambulance (read: expensive) to a facility approximately 60 miles away because there were no beds available at any closer facilities.  Should the patient bear the cost of transportation in that case?

    Of course the patient should.  No  hospital can guarantee that there is any type of treatment bed available at the closest facility and if the patient isn't medically stable to drive themself or on a mandatory psychiatric hold because they are suicidal then appropriate medical transport is necessary.  Again, the tax payers should not have to pay that bill.

    KevinD65:
    6. Concerns about the constitutionality of the facility holding past 72 hours via a short term certification process.  An M1 hold initiation requires "imminent danger" but a short term certification only requires "danger".  Also, the holding facility is allowed to do the short term certification evaluation.  This is problematic because they are not a neutral party.

    There is no way to have a "neutral party" testify at that hearing that a further hold is necessary.  In order to convince a court to order the patient remain inpatient for treatment the care team must attest to the psychiatric state of the patient and need for treatment.  A medical person who has never met with the patient or provided care would not be able to make an accurate or adequate assessment.  Would you want a complete stranger who knew nothing about you deciding you needed to stay in an inpatient facility?

    KevinD65:
    I'm sure I'm not the first person to run into some of these issues, so any help would be appreciated.

    If you have no problem with the hold then what is the issue?  Number 3 is between you and the attorney you hired it has nothing to do with the psych hold.  One thing to understand about the 72 hour M1 hold is that it can technically be longer than that depending on when the hold actually starts.  M1 does not count weekends or holidays in a 72 hour mandatory hold so depending on when it starts the patient could be held up to five days and it would be legal.  Nothing about the hold requires they place the patient in the same facility or prohibits them from transfering the patient to an open bed in another facility.

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • 08-26-2012 6:24 PM In reply to

    • DPH
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    Re: Issues with recent M1 72 hour hold

    OK, I understand number one.  The problem, and all of your other concerns basically revolve around the same issue, that the patient and/or their family are not in control.  They do not have the training to make the type of decision desired (let me out now, I'm better).  I do not think that a person has to stay for a required 72 ups, just that they can be held that long.  Problem is who gets to make the decision and it's probably not patient or family.

    What are you going to pursue?  length of stay?

    Education is good.

    "Never argue with stupid people, they will drag you down to their level and then beat you with experience."  -  Mark Twain

     

  • 08-26-2012 6:30 PM In reply to

    • KevinD65
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    Re: Issues with recent M1 72 hour hold

    Okay, well it may be hard to fully explore all the issues in this forum.  I was hoping a lawyer would respond with some case precedents and such.  Political opinions about tax payers not bearing the costs aren't helpful to me.

    I appreciate your response.  Some of the words in my original post such as "can be released" and "feeling better" are my words attempting to characterize the situation, and some are quotes from the actual law, and I didn't do a good job distinguishing between the two.

    The exact phrasing from CRS 27-10-105(4) is

    "The person shall be released before seventy-two hours have elapsed if, in the opinion of the professional person in charge of the evaluation, the person no longer requires evaluation or treatment."

    So the actual wording in the statute is "shall be".

  • 08-26-2012 6:35 PM In reply to

    • KevinD65
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    Re: Issues with recent M1 72 hour hold

    An important distinction that I'm trying to make isn't that I disagree with their opinion, but instead, that they never even considered the possibility of releasing her prior to 72 hours.  She did not even see an actual psychiatrist until over 48 hours after her admittance.

  • 08-26-2012 6:36 PM In reply to

    Re: Issues with recent M1 72 hour hold

    KevinD65:

    "The person shall be released before seventy-two hours have elapsed if, in the opinion of the professional person in charge of the evaluation, the person no longer requires evaluation or treatment."

    So the actual wording in the statute is "shall be".

    Correct but you have presented nothing that says the staff felt your wife should be released only that you and her felt she should.  The criteria isn't that the patient or family alone believe release is appropriate.  There are medical legal considerations in that if the staff is not convinced the patient is stable for release they have an obligation to continue to observe the patient and encourage treatment up to the limit of the 72 hour hold.  

    KevinD65:
    I was hoping a lawyer would respond with some case precedents and such. 

    There are no Colorado lawyers that participate in the boards.  The problem with precedents is they must be from Colorado and apply to your wife's specific circumstance.  The only way to get that type of legal opinion is to hire a Colorado attorney who can review her medical records and the reason(s) the staff did not discharge her after 24 hours.

    KevinD65:
    Political opinions about tax payers not bearing the costs aren't helpful to me.

    It is a valid question.  YOU raised the issue.  Who should pay for the care in your opinion?  You seem to believe that once the patient is held due to the danger to themself or others the state should.  If not please explain why patients should not be expected to pay for the care they receive.

    You still haven't explained what the end result you desire is.

    KevinD65:

    An important distinction that I'm trying to make isn't that I disagree with their opinion, but instead, that they never even considered the possibility of releasing her prior to 72 hours. She did not even see an actual psychiatrist until over 48 hours after her admittance.

    Until a psychiatrist evaluates the patient the staff can't consider releasing a patient.  A trained and licensed psychologist or psychiatrist must evaluate the patient at least once prior to determining that discharge is appropriate.  That one was not available for 48 hours is not uncommon.  That is entirely the reason for a 72 hour hold:  staff may need time to be able to come in and do the evaluation and for direct care staff to have enough documentation for a thorough review.  The law does not set a minimum time in which that evaluation occurs, it just must be done within the 72 hour mandatory hold.  That the patient and/or family thinks everything is fine again and its time to go home doesn't change anything.  It would be considered a deviation from the standard of care to discharge the patient because they say "never mind I am fine now" and not have done the evaluation.  The hospital would then be liable of something bad happened as a result of the discharge without evaluatlon.

     

     

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • 08-26-2012 6:46 PM In reply to

    • KevinD65
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    Re: Issues with recent M1 72 hour hold

    I just read on this forum another 72 hour hold dispute that was responded to by a lawyer with case precedents.  I don't know if he was a Colorado lawyer or not, but the case under discussion was a Colorado case.

    I clearly articulated 3 end results that I am seeking.

    Yes, I brought up the issue of costs, but I was looking more for legal opinions, not political opinions.  Are there specific cases where the costs of a 72 hour hold have been challenged and if so, what were the results?

    To me there is a legitimate legal issue in charging someone for the full cost of a 72 hour hold if they could have been safely released prior to 72 hours, they were never considered for the possibility of release, and the holding facility has a profit motive.  Those are legitimate civil liberties issues that go beyond your personal political opinion.

  • 08-26-2012 6:56 PM In reply to

    Re: Issues with recent M1 72 hour hold

    I'll give you my humble legal opinion.

    I agree with the other responses.

    The facility did nothing wrong.

    You and your wife have no case.

    Has nothing to do with politics or civil liberties.

    If you can't accept what's written here by our volunteers, feel free to consult an attorney and review your options.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • 08-26-2012 7:08 PM In reply to

    • Cica
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    Re: Issues with recent M1 72 hour hold

    A 24 hour release after popping pills in an attempted suicide simply does not make sense.  Aside from the fact that it takes time to decently flush the meds from the system, the likelihood that the person is totally coherent or others should assume that "everything's okay" is questionable at best.  This especially depends upon what the drug(s) were -- and the fact that it takes a doctor more than 24 hours to analyze the patient.

    Then, too, if anything were to happen after such a release, the hospital coud be held liable.

    Google the following:  "neglient discharge of suicidal patient"

  • 08-26-2012 7:20 PM In reply to

    Re: Issues with recent M1 72 hour hold

    KevinD65:
    Are there specific cases where the costs of a 72 hour hold have been challenged and if so, what were the results?

    You would have to go to the CO court house and research it or hire a CO attorney as I said before;  there are NO CO attorneys on the boards.  Westlaw might also have case laws.  I have no knowledge of anyone successfully suing saying they were held for a profit motive.  Especially considering most hospitals operate at a defecit due to uninsured patients.  

    KevinD65:
    To me there is a legitimate legal issue in charging someone for the full cost of a 72 hour hold if they could have been safely released prior to 72 hours, they were never considered for the possibility of release, and the holding facility has a profit motive.

    What proof do you have that your wife was medically stable for release beyond her saying "I am find now and no longer suicidal" ?  

    KevinD65:
    Those are legitimate civil liberties issues that go beyond your personal political opinion.

    It isn't a personal political opinion.  It is based on 27 years in the medical field many of them working with a patient placed on a mandatory hold.  The reality is if the patient can't pay the hospital eats it on the charges because legally they have to hold them.  If the patient has insurance:  they pay for their care.  It is that simple.  It appears there is no civil liberty issue just your problem with having to pay for her care.   

     

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • 08-26-2012 7:23 PM In reply to

    • KevinD65
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    Re: Issues with recent M1 72 hour hold

    I respect their opinion, but so far there's only been a couple of non-lawyers who have weighed in.  Maybe others will have different opinions.  Maybe I'll check back in a few days to see if everyone agrees and they all think the same and no one sees any civil liberties questions in this at all.

    You may be right.  There may be no case here.  To me they are legitimate civil liberties issues, even if I end up being on the wrong side of the consensus.  The patient has no control over how much funding the state or facility provides to hire psychiatrists, they have no choice in which facility they are sent to, no opportunity to control or mitigate their costs, no right to see a psychiatrist within a certain amount of time, are still charged a daily fee by the facility regardless of whether or not they have a psychiatrist on staff, are involuntary confined, and yet they still are responsible for paying for the full 72 hours even if they could have been released sooner.  I realize they were the ones that got themselves into the situation, but since they have no way of controlling or mitigating the costs, there should be some limit to how much they should have to pay.  Suppose they were charged $100,000 per day?  Would that be fair?  Would you just say, oh well, they were the ones who caused the problem, so whatever happens to them, its okay.  Perhaps there should be at least some maximum amount that citizens should have to pay in a situation like this.

    Also, there's a lot of details I can't post here because it would be way too long.  So while I respect people's opinions, there's only so much validity those opinions carry because they don't know all the merits of the case and all the aspects of the law.  But I do appreciate the input.

  • 08-26-2012 7:39 PM In reply to

    Re: Issues with recent M1 72 hour hold

    KevinD65:
    The patient has no control over how much funding the state or facility provides to hire psychiatrists, they have no choice in which facility they are sent to, no opportunity to control or mitigate their costs, no right to see a psychiatrist within a certain amount of time, are still charged a daily fee by the facility regardless of whether or not they have a psychiatrist on staff, are involuntary confined, and yet they still are responsible for paying for the full 72 hours even if they could have been released sooner.

    Then they have no business trying to commit suicide.

    KevinD65:
    Suppose they were charged $100,000 per day?  Would that be fair?

    A ridiculous question deserves a ridiculous answer: Fair is where you go on rides and eat cotton candy. Has nothing to do with medical treatment cost (or life for that matter).

    KevinD65:
    Would you just say, oh well, they were the ones who caused the problem, so whatever happens to them, its okay

    Exactly.

    KevinD65:
    Perhaps there should be at least some maximum amount that citizens should have to pay in a situation like this.

    And then the taxpayers take over? No thanks.

    KevinD65:
    So while I respect people's opinions, there's only so much validity those opinions carry because they don't know all the merits of the case and all the aspects of the law.

    True.

    And the answer to that is hire a lawyer who can review "all" the merits of the case and give you an expert legal opinion.

    You might see some lawyers posting tomorrow but I doubt that they'll be writing anything that fits what you want to see.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • 08-26-2012 7:53 PM In reply to

    • KevinD65
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    Re: Issues with recent M1 72 hour hold

    So the main thing I've learned through the 72 hour hold experience so far is a better perception of the law.  I've never been though this before, and didn't know what provisions the law made.

    What I thought before this happened was the condition of "imminent danger" was what started a 72 hour hold, and once the imminent danger was removed, they would release you.  But now I know that's not how the law reads.  "Imminent danger" is what gets you in (or "gravely ill" which isn't the issue in this case), and "no longer requires treatment or evaluation" is what gets you out, or the expiration of the 72 hour hold, assuming they don't try to short term certify you, which is another one of the 6 issues I mentioned at the beginning.

    So I just didn't understand the law when this first happened.  It has been educational for me.  I hope for my sake and my wife's sake that nothing like this ever happens again.  But if it does, I'll be a little better prepared next time.

    It's good for the general public to understand that if you make a legitimate, actual suicide attempt, you're going to be in for at least 72 hours, or possibly longer if you're short term certified.  They're not going to let you out earlier under any circumstances.  Now if it was only a suicide threat, or something like that, they might let you out sooner, but if you actually tried it, you're not getting out.  That was a realization that I just didn't have before this happened.

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