72-Hour Hell

Graham of Over My Med Body links to this account of a Stanford student suffering from depression who was held for 3 days against his will in a Stanford hospital psyciatric ward:

When sophomore “Neil Fisher” arrived at Vaden Health Center for a routine check-up on Friday, Oct. 29, he expected to see his doctor, pick up his prescription and be home in time for dinner. He had no idea that the appointment would end with him handcuffed in the backseat of a squad car or that he would be forced to spend the next three days at the locked inpatient psychiatric ward of Stanford Hospital.

Graham correctly notes that this is only one side to the story. 72-hour hold are commonly used in psychiatry as a means to keep people who may be a danger to themselves or others in protective custody. Primarily, it is used to hold people who are at risk for suicide.

This student complains that his hold was placed without warrant:

“This was my fourth trip to Vaden,” said Fisher, who was diagnosed with clinical depression several months ago. “I’m used to going. I didn’t think I’d be arrested.”

Fisher was not taken into custody on criminal charges but rather under code “5150,” the section of state law that requires physicians and peace officers to hold mental patients for three days, against their will if necessary, at a psychiatric treatment facility, if they believe the patient is a danger to himself, a danger to others or gravely disabled.

The process was briefly explained to Fisher on a one-page form given to him prior to his admission to H2, the acute inpatient psychiatry ward on the second floor of Stanford Hospital. Fisher said that he was wrongly placed into care and that the treatment he received — which he described as “grossly negligent” at times — left him worse off than before he was brought into custody.

Even if these holds are used very efficiently, it's bound to happen that one person is going to be improperly held. Lets see: physicians have almost unquestioned authority to place the holds, and they can be accused of malpractice if they fail to before a patient commits a crime or suicide. In the face of such power and incentive, what ae the odds that errors in judgement are made? And which direction is that error? I'm pretty sure that if this patient's side of the story is true, he is not alone.

According to Dr. John Brooks, the co-director of inpatient psychiatry at the veteran’s hospital in Palo Alto, the law was written precisely to allow professionals to make conservative judgments.

“The law is set up to protect the patient... The consequences of not treating a patient who actually commits suicide are much worse than treating a patient who may only be contemplating suicide,” said Brooks, who is also an assistant professor of psychiatry.

It's sounds like the guy didn't have a pleasant stay:

While Fisher conceded that there was little he could do to protest his doctor’s professional opinion after the fact, he remains troubled by his time at the ward, calling it “one of the worst experiences of my life.”

After entering H2, Fisher said he initially refused to cooperate with nurses on the basis that he had been wrongfully taken into custody in the first place. However, at about 2 a.m. he said, “I decided it was in my best interest to at least give the staff my medical information since I have asthma and high blood pressure.”

Two hours later he requested and received a prescription for Ventolin, a common asthma medication, after he said he began “heaving and feeling breathless.” The medication took three hours to arrive, he said.

“I’ve never been without an inhaler when I needed it for so long,” Fisher said. “It was pretty scary.”

...The second night of the stay was the worst, Fisher said. He asked a nurse for his “Family Guy” DVD, which had been confiscated upon his arrival. When he was denied, he began arguing with staff members, prompting them to send him to solitary confinement until 8 a.m. the next morning.

Fisher called the seven-hour experience “traumatic, to say the least. The room was all white, no contrast. It was half the size of a dorm room, and the windows were all boarded up.”

After spending a sleepless night in the isolation room, Fisher said he asked to see a doctor for stress-induced hypertension and was refused access.

“I was starting to get really stressed out and felt dizzy,” he said. “When I told the nurse about it, she wouldn’t let me see a doctor because she didn’t believe me.”

He saw a doctor about six hours later, shortly after his father arrived from outside the country; he had flown in to Stanford out of concern for Fisher’s situation.

Fisher was discharged on the Monday after his arrival. Just after his release, his blood pressure measured 150 110, unusually high for a 19-year-old. As he was preparing to leave he realized his shoes were missing — a fellow mental patient had stolen them.

“I had to stand out on the curb waiting for my ride in socks,” he said.

His shoes were recovered two days later, but another theft aggravated Fisher even more: “I went back to Vaden to pick up my bike, and it was gone. Somebody stole it. I guess because it was just sitting there for three days.”

It certainly would be nice to have a quote from the physician in this article, but it explains why there isn't, and you can read the statements given by the facility's spokesperson. Anyway, it is entirely possible that this guy said in his initial visit he had thought about suicide, and it's also possible that he became more violent then he leads on once he got to the unit. But if they can't hold these people without causing more psychological stress then they prevent, maybe the whole system needs to be re-evaluated. My experience in inpatient psychiatrics is all of two weeks, but I saw a handful of people in that short time who were on 72-hour holds for reasons I couldn't quite discern. I got the impression that any one of us "normal" people could hypothetically walk into a psychiatrist's office and say something to trigger a 72-hour hold. And if such occurred, I'm pretty sure a three-day stay locked in a psych unit would drive me nearer to crazy rather than further.

I remember one guy in my hospital who was held against his will because his ex-wife called the police and reported "suicidal thoughts." It turned out after one or two days that this was a lie and there were issues of child custody involved. I think it was hard to justify such power when these things can occur (if they occur often enough, which I suspect they might).

But here's the part that gets me:

Medical costs — which can be substantial for inpatient care — are another factor patients must deal with after their release. At a daily rate of $2,500, Fisher said his hospital bill totaled $7,500 for treatment he actively resisted.

“Luckily my insurance will cover most of it,” he said. “But what if I didn’t have insurance? How would I be able to pay for that?”

Because psychiatric care constitutes medical care, Dr. Brooks said the bill is the patient’s responsibility, regardless of the circumstances that brought him to the hospital. “That’s one unfortunate aspect of the U.S. healthcare system,” he said.

He compared a 5150 to another life-saving medical procedure: “Let’s say you have severe abdominal pain and a fever, and go to the hospital where you find out your appendix has to be taken out. Afterwards, you say, ‘Well, I don’t think I wanted it removed, even though I could have died otherwise.’ That doesn’t relieve you of the burden of paying for the operation.”

There's a huge difference between making someone responsible for the bill after an emergency procedure, and making someone respnsible for the bill after being held against their will. That seems pretty obvious to me. We don't bill prisoners for their stay in prison (though, that may not be unjustified), so how can they justify the bill for this guy. It seems that if the hospital or society in general had to pay for these, the pratice would fall under greater scrutiny. But under the present situation, with perverse incentives, and all costs accruing to the patient, noone questions psychatric care "for your own good."

Fisher will stop out for the remainder of the quarter, a decision that he said was partly induced by his experience at the ward and its aftermath. “I was so exhausted after I got home,” he said. “I missed almost a week of class.”

“I talked to my advisor and my dad about it; we thought [stopping-out] would be the best thing to do,” he said. “You know, start fresh next quarter.”

Fisher said he is considering pressing charges, but that he really just wants an apology from his doctor at Vaden and the H2 staff at Stanford Hospital.

“I want them to acknowledge that they made a mistake. I definitely wouldn’t want this to happen to another student.”

Makes me want to go read some Thomas Szasz.

Share this

Quite right. And seeing that

Quite right. And seeing that Neil is tossing around words like "grossly negligent," I'd be willing to bet he's already spoken to a lawyer.

Which is of course troubling. If the boy were to sue the psychiatrists and win, psychiatrists would be a the terrible dilemma, facing the possibility of malpractice nomatter what their decision.

For a case on point as to why psychiatrists, when in doubt, will always commit a patient, see Tarasoff v. Regents of University of California, 551 P.2d 334 (Cal. 1976). And see Estate of Morgan v. Fairfield Family Counseling Ctr., 673 N.E.2d 1311 (Ohio, 1997)(stating that a fear of undue confinement caused by the imposition of a duty to confine upon psychiatrists has no reliable statistical support.)

Although few people actively

Although few people actively realise it, or give it much thought for that matter, but those within the psychological and psychiatric professions wield considerable power, rarely is their judgement in a medical case questioned, they can often "recommend" measures that, under the current bureaucratic, rights trampling legal system, force all sorts of people into unecessary medical treatment. I believe that a large part of the reason is that, unlike within hard medical science, there are few clear objective standards by which to measure if an individual is truly in need of treatment or just behaves in an abnormal but otherwise harmelss way.It seems to me that much of the reasoning that psychologists and psychiatrists use for their conclusions is based on tenous findings and the worst part is that these conclusions are often the basis of very much tyrannical government laws. Examples abound:! The one in the above post, many thousands of school children and teenagers who have been forced on psychiatric drugs,even against their parents wishes for conditions such as "A.D.D", and all kinds of people forced into preemptive "care" for alleged disorders.

Tyranny of the APA, hah...

Medical imprisonment should

Medical imprisonment should never happen, ever, at all. It is purely enforcement of cultural taboos and norms, equivalent to a neo-mediaeval society medicalizing heresy, and is a crime against natural rights.

Without any comments from

Without any comments from the doctor who ordered the 72 hour detention for this patient -- I don't believe any real conclusion can be reached in this situation.

If this young man had gone home after his appointment and killed himself or someone else, there would be others talking of suing the doctor for incompetence.

By this patient's own account of his stay in the psych facility, he was a troubled, and uncooperative patient even when it came down to basics such as medical conditions that he would need treatment for while being held. 2 am and he decides to let the night shift know he needs an inhaler for asthma?

He sounds more like he needs a heavy dose of reality and not some attorney to try to sue the facility that tried to help him.

Diana

I think this case shows a

I think this case shows a too little-appreciated advantage of fee-for-service care and non-capitated provider compensation. Neil Fisher made the mistake, poor thing, of putting himself in the clutches of someone who didn't so much as see him as a valuable customer. I have a new appreciation of the value of going to a physician who--although he may not know me from Adam and may or may not really care about my wellbeing--can at least be depended on to want me as a repeat customer and as someone who will give favorable recommendations to family and friends. I will seek physicians who are dependent on the good graces of their patients for their livelihood.

Also, I'm not going anywhere

Also, I'm not going anywhere near Diana.

"Also, I'm not going

"Also, I'm not going anywhere near Diana."

LOL!

Seriously, though -- one of my more memorable patients was a 9yr. old who was rescued from a house fire. The only survivor of a large family. While cutting off the remains of her charred clothing I found a bullet wound. The girl was alert and calm, and looked at me with the biggest brown eyes as she said 'My Daddy killed my family.'

If only one of the people the father of those children had spoken to before he shot his kids and then set the house afire had been a health care professional, or a mental health professional there would have at least been a chance that event could have been avoided. If nothing else, a 72 hour detention would have given social services time to say listen, this man cannot be around these kids right now.

There would be 6 small brothers and sisters together, instead of the one who will no doubt have problems all her life because of one moment in time.

I have at least 100 such tales, and each is just as ugly as the next. Or, think about this -- what if *someone* had caught on to the 'Columbine kids' before the tragedy and they had been put under 72hr detention ? Don't condemn 5150 until you fully understand all that it is intended to safeguard.

Diana

Diana, I'm not sure I

Diana,
I'm not sure I understand your example. There was a system in place that could have held this man IF he had spoken to a healthcare professional, and IF he had announced his plan. But the fact that the system existed didn't stop him. How does this support the need for involuntary psychiatric holds? I would think that if he had spoken to ANYONE (shrinks, cops, relatives, strangers) the event could have been avoided. Also, from my understanding, there were signs that the Columbine kids were going down a bad road long before they took any lives, but nothing was done despite the system for psychiatric commitment being in place. I don't quite see how these two examples support the need for this system, since the system in place did nothing to prevent these two tragedies. It's hard to see how it could, unless people make a practice of announcing to the nearest mental health professional that they plan to commit an act of violence.

Something similar happened

Something similar happened to a friend of mine a while back. (Minus the part about being dunned for the imprisonment.)

What being on the periphery of the experience did for me was to reinforce my previous resolution to never, never, never, under any circumstances, reveal to a therapist any suicidal thoughts. There have been times when I *was* suicidal, and it would have been a good thing to be able to talk to my therapist about these feelings, but I couldn't take the risk of something like this happening. Ironically, I think if it did it might be enough to push me over the edge, in a vulnerable state.

That also ought to be food for thought. How many people kill themselves because they're afraid that if they seek help, they'll be locked up instead?

Lisa, The man who killed his

Lisa,
The man who killed his children *could* have been detained for at least 72 hours *if* he had discussed what was going through his head with a health care professional. It didn't need to be the exact plot that unfolded.

The same with Columbine. *If* the therapist the one boy had already been seeing[if I'm not mistaken here one of them was seeing someone?] had realized the seriousness of the situation, or not left it to the parents to deal with -- whatever it was that went through his head. Or the boy's parent's decided to admit him. The kid had bombs in the house.

Someone dropped the ball in each of these examples and didn't take advantage of 5150. I'm only saying that it [5150] exists for good reasons.

I don't know how much a 72

I don't know how much a 72 hour incarceration in the loony bin would have necessarily stopped the man from killing his kids eventually. Given the description, it looked like:

[a] there was precious little treatment or concern aside from keeping the person quiet and in a confined space and

[b] the experience is traumatic enough as to itself cause mental damage (a person put in for having one set of thoughts snaps while inside, is let out, and then instead of killing themselves, goes on a killing spree)

Neither of which are very good outcomes. With Columbine, would a 72-hour imprisonment have stopped them from killing? By itself, probably not. But in order to get the 5150 invoked, you have to already know there is a problem, which makes 5150 moot- the discovery of pipe bombs in the boy's house would be enough for an *actual* arrest, mental status being irrelevant at that point. Just like with 9/11 & many aspects of the PATRIOT Act, the reality of the ground was that the tragedy could have been stopped rather trivially in many points and simply wasn't. The problem was dropping the ball- if you don't drop the ball, you have other, non-tyrannical methods available to deal with the problem.

I can only see 5150 being useful in stopping a temporarily deranged person from trying to kill themselves, but even then its very sketchy.

5 monthes ago in wisconsin,I

5 monthes ago in wisconsin,I was held in a mental hospital against my will...and I never once intimated that I was suicidal, I admit that I was severly depressed, but not to the point where I was planning on killing myself. I was at that time in a very bad living situation, and after a friend who was supposed to help me move, got caught up in something and didnt return my calls, I freely admit, that all the sudden I felt like I was going to be in that situation forever, so I called the crisis center in green bay mostly for resources on how to get out of the situation I was in, and a little for someone to talk to, the woman I spoke with suggested that I come down and talk in person, I explained to her that my car was broke down,so she offered to send a cab, which arrived 2 hours later, when I got there, I was in a little bit of a better mental mood, but I explained my living situation, and that I was feeling like I had no way out of that(NOT MY LIFE) this woman did NOT listen to me, she asked me if I would admit myself into a kind of half way house, I told her there was no way I could, Im 32 years old, have two children to support, I had to work the next day, and my kids needed me, (and I admit I needed them) she then told me that if I didnt admit myself she would have me commited, I felt then that I had no choice, so I admitted myself, I was also told, several times that if I wanted to leave all I had to do was call adn someone would come down to reevaluate me, so after about 5 hours of sitting there, and talking to several of my friends, and one suggested that she come get me and we have a girl night, just sit in and talk and watch movies, I requested to talk to someone to go home, the lady was very rude on the phone, and then said she had to finish up some stuff but would then be there to reevaulate me, I was sitting in the car with my friend outside the place waiting, waiting and my friend heard her say this, after an hour of waiting, I finally told my friend to leave and Id call her, when they came, well they came all right with two officers, to commit me..I was extremely angry and upset, adn tried to explain that I DIDNT need to be there, did I need help?I admit I did, but did I need to be hauled in handcuffs in the back of a cop car to the county mental hospital?NO...I was upset about missing work, how many suicidal people are mad about missing work? I told her that what I needed was NOT to be locked away, but to be around the people that I love and that love me, and I needed to be able to go to work, I also told her that because of this I would lose my job, and then I would be more depressed because I wouldnt be able to feed my children.she didnt listen to a word I said, the officers did, because they were reluctant to handcuff me, and when we got there one of them made a comment "you must hate me dont you, I would if I were you"..I was also lied to again when the cops told me that I would see a doctor when i was admitted, and that htey would determine if I needed to be there, so I went in, I asked the intake nurse when i would see a doctor, she said "not til morning"..I was given a room, in which the sheets hadnt been changed from the previous person, and were completely stained with blood....in the morning when I asked to see a doctor, they told me, "the doctor doesnt come in until tomorrow"....in the time I was there, I recieved NO treatment, had NO counseling...no medications, noone even talked to me....I had to beg to be put on the list for the psychiatrist the following day, when she determined I shouldnt have been there in the first place..and was finally released. from this experience, I still feel mentally raped...I AM in counseling, that I started on my own..(after when filling out the forms to see my new doctor, I made sure they said "I am NOT suicidal" all over them.)but,as a result of what happened, I wasnt able to sleep, eat, or anything, I didnt even want to go anywhere...I lost my job...and had problems finding a new one.( I have since moved to washington)...that experience left me feeling even more messed up than I was when I went in..I started questioning my own sanity, and to be honest, there were points while I was in there, I was almost suicidal, just as a way to get OUT...I am more bitter towards the woman that signed the 72 hour hold, because I feel she didnt listen to a word I said...and I kept telling her, I could stay with friends or my sister for the weekend, and she kept telling me then I wouldnt get treatment, but in the end, I didnt recieve any treatment anyway, just a horrible experience...my sister and I are currently coming up with ways to either abolish the law, or to have it changed,so that if say a social worker admits you , you should be able to see a doctor within the first 24 preferable 12 hours of being admitted, to hopefully keep other people from what I went through, this law SUCKS
Hope from wisconsin transplanted to washington

ps and diana, if I HAD got treatment, maybe I wouldnt be so bitter, but.. noone ever even tried...and its my experience(I also do counseling) that suicidal people DONT worry about missing work, or how short their paycheck will be in two weeks as a result of missing said work.