being sued for false imprisonment

[dl2dp2]

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on CL now, middle aged man, likely borderline/antisocial spectrum, polysubstance abuse, came in with a suicide attempt of high lethality overdose, MICU, the whole works. recanted story 3 days later, "you didn't do any re-evaluation", calling malpractice lawyer for our decision for involuntary commitment.

very very unpleasant.

does anybody actually gets sued for false imprisonment?

 

[Doctor Bagel]

Jeez, that sounds stressful. I wouldn't worry too much about it, though, until this guy finds a malpractice lawyer who will take his case, which might very well never happen. I'm not at all familiar with the laws where you practice (or with any particulars about these types of suits), but I'm thinking your risk for keeping him is much lower than your risk would have been had you let him go and he attempted again.

And, again, you're likely still not going to get sued. 🙂

 

[IAmAUser]

.

 

[notdeadyet]

Where's the involuntary part? Did he try to leave and was required to stay? Was a 5150 or 5250 in place? As long as your local involuntary commitment paperwork was filed and hearings offered, I wouldn't sweat it. If they weren't...

 

[whopper]

does anybody actually gets sued for false imprisonment?

Yes. Think about it. If you keep someone in the hospital against their will inappropriately, you're violating their Constitutional rights. This is one of the most highly protected rights in the Constitution. Several of the landmark cases in forensic psychiatry are based on previous lawsuits in this area.

One thing that may ease your calm is in many malpractice cases, the lawyer representing the plaintiff realizes there's really no case and tells the plaintiff to drop it.

 

[dl2dp2]

Where's the involuntary part? Did he try to leave and was required to stay? Was a 5150 or 5250 in place? As long as your local involuntary commitment paperwork was filed and hearings offered, I wouldn't sweat it. If they weren't...

Yes and yes.

The issue is that when the patient is followed on the CL service, he can't leave the hospital when he is waiting for a bed, and a bed is often not immediately available--sometimes not for days. So we have this lala-land when he can't get a hearing until he gets to the inpatient unit but he can't get there because there's no bed. Not unlike the lala-land of gitmo and illegal alien jail.

Whooper, do u mind giving a few pointers in terms of dos and donts in management of character pathology and involuntary hospitalization? (i.e. what are these landmark cases?)

 

[whopper]

The landmark cases, I wouldn't worry about these because the existing laws in your state are already there in response to these laws. That is unless you do want to read up on these cases because you have an academic interest in them.

Whooper, do u mind giving a few pointers in terms of dos and donts in management of character pathology and involuntary hospitalization?

This all depends on the wording in your state.

Here's Ohio's

As used in the Ohio Revised Code (ORC):
A.Mental Illness means a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life.
B.Mentally ill person subject to hospitalization by court order means a mentally ill person who, because of his illness: 1.Represents a substantial risk of physical harm to himself as manifested by evidence of threats, or attempts at, suicide or serious self-inflicted bodily harm; (immediate danger to self) or
2.Represents a substantial risk of physical harm to others as manifested by evidence of recent homicidal or other violent behavior, evidence of recent threats that place another in reasonable fear of violent behavior and serious physical harm, or other evidence of present dangerousness; (immediate danger to others) or
3.Represents a substantial and immediate risk of serious physical impairment or injury to himself as manifested by evidence that he is unable and is not providing for his basic physical needs because of his mental illness and that appropriate provision for such needs cannot be made immediately available in the community; (immediate danger to self because can't provide own basic needs) or
4.Would benefit from treatment in a hospital for his mental illness and is in need of such treatment as manifested by evidence of behavior that creates a grave and imminent risk to substantial rights of others or himself.

Remember, the wording in laws do not reflect the wording of the DSM. A disorder of thought in the law could include schizophrenia. Get it? A disorder of mood could include in the legal sense a severe anxiety disorder even though in the DSM IV, that's not a mood disorder. The laws are written in English, not in medical jargon.

You need to look up the laws in your state. By the laws above, most people agree that most personality disorders will not lead to involuntary hospitalization, though severe borderline PD could be an exception. The law allows for involuntary commitment of someone with a "disorder of mood" but most people would agree that in borderline PD, it's a disorder where the mood is affected and could make one dangerous.

 

[sunlioness]

Yes and yes.

The issue is that when the patient is followed on the CL service, he can't leave the hospital when he is waiting for a bed, and a bed is often not immediately available--sometimes not for days. So we have this lala-land when he can't get a hearing until he gets to the inpatient unit but he can't get there because there's no bed. Not unlike the lala-land of gitmo and illegal alien jail.

Yikes. In my previous state, the hearing usually had to be held within 72 hours regardless. I believe there were contingencies in place for people who weren't medically stable enough to have them, but not having a bed wouldn't cut it. In those situations, folks actually got wheeled onto our unit to have their hearings at the appointed time and then wheeled back off again. It was pretty nightmarish for our social worker when that happened.

 

[whopper]

In my state as well, if someone's 72 hour hold is started on a medical floor, it starts. It's not supposed to be delayed until they get to the psychiatric unit.

In fact based on what you're telling us, I'm suspecting maybe the patient's 72 hours should've started on the medical floor but the medical people didn't know it because this isn't their usual arena, messed up, and perhaps this person's civil rights were violated. I'm just speculating, but I've seen that happen on the medical floor--them not knowing how this system works and then not doing something they were supposed to do. Someone in the hospital needs to be on top of this because I can tell you if the person's rights were not held, this can lead to some serious moolah going to the plaintiff with people being fired in the hospital.

If psychiatry, via the C&L, recommended this patient stay in the hospital, the patient changes his mental status significantly and the MICU doctor doesn't reorder a consult, the psychiatry C&L will likely have protection given that you're not supposed to reevaluate the patient unless asked in most cases, but then the MICU doc could be left holding the bag.

 

[dl2dp2]

Thankfully this wasn't an issue. The patient didn't submit his letter until a few days into his medical admission, but was placed on 1:1 for suicidality throughout. The involuntary paperwork was immediately put in place right after by the CL team, and in my state you can hold people for up to 60 days, but a court hearing must occur at the next court date, which is usually within a week.

Unfortunately I was one of the 2 MDs who put in the involuntary certification, which the patient interpreted as "it was your decision to lock me up." The other one was the fellow. The documentation is (hopefully) ok--I was the resident.

The involuntary admission per se is slam dunk--he has all the risk factors and potentially MDE vs. an acute episodic exacerbation of BPD. I'm sure this case, if actioned, can't go very far. But even then it's annoying to have to answer to it, and it'll be this big dark spot on my record before my career even got started--tell me I'm paranoid. Maybe I'll present it at Chief of Service to have the senior people on the team to review it.

In fact based on what you're telling us, I'm suspecting maybe the patient's 72 hours should've started on the medical floor but the medical people didn't know it because this isn't their usual arena, messed up, and perhaps this person's civil rights were violated. I'm just speculating, but I've seen that happen on the medical floor--them not knowing how this system works and then not doing something they were supposed to do. Someone in the hospital needs to be on top of this because I can tell you if the person's rights were not held, this can lead to some serious moolah going to the plaintiff with people being fired in the hospital.

 

[dl2dp2]

The other wrinkle is that how does the case law reflect the active influence of substance? The patient's complaint hinges on the fact that his supposed report of suicidality was made under the influence of substances, which renders it inaccurate. However, per my service chief if you made a report of suicidality you cannot recant it under any circumstances.

I have also seen this in the ER, where suicidal remarks made under the influence of alcohol or drugs were not taken as seriously and the patient gets discharged immediately after the drugs wear off. However, I think if anything the literature suggests that these people have the HIGHEST risk of suicide. Furthermore, inpatient units don't want them because they have only a substance induced mood disorder. MICA beds are very limited (as such in this case). You can't force people into rehab. What gives?! Can you involuntarily hospitalize these people??? They deny SI when sober!

 

[sunlioness]

In my old state (PA), if people were suicididal and drunk then technically it wasn't supposed to count. However, I've seen that fudged many times by both docs and the judge for people who really were judged to be a danger.

 

[Doctor Bagel]

Thankfully this wasn't an issue. The patient didn't submit his letter until a few days into his medical admission, but was placed on 1:1 for suicidality throughout. The involuntary paperwork was immediately put in place right after by the CL team, and in my state you can hold people for up to 60 days, but a court hearing must occur at the next court date, which is usually within a week.

Unfortunately I was one of the 2 MDs who put in the involuntary certification, which the patient interpreted as "it was your decision to lock me up." The other one was the fellow. The documentation is (hopefully) ok--I was the resident.

The involuntary admission per se is slam dunk--he has all the risk factors and potentially MDE vs. an acute episodic exacerbation of BPD. I'm sure this case, if actioned, can't go very far. But even then it's annoying to have to answer to it, and it'll be this big dark spot on my record before my career even got started--tell me I'm paranoid. Maybe I'll present it at Chief of Service to have the senior people on the team to review it.

One, has paperwork actually been filed against you? If not, you might avoid this whole black mark thing. Even if something is filed, you're right in that it'll be something to answer about probably forever, but I doubt the implications will go beyond that.

Two, I'm wondering if this is a good reason to have the primary team place the hold paperwork rather than the CL team because you're not actually the provider, so why should you be on the hook? I know we've done it both ways, but this might make me rethink my practice.

Three, involve your program in this to make sure you're getting as much help as you can. You made the right decision in putting this guy on a hold, but it's stressful anyway.

Four, that's kind of ridiculous that patients rights aren't protected while they're waiting for a bed even if they're held against their will. Honestly, I would like a court to look at that, but I don't want your name attached to it. The legal department of your hospital should probably weigh in on this.

Sounds like a good M&M. 🙄

 

[Ibid]

Four, that's kind of ridiculous that patients rights aren't protected while they're waiting for a bed even if they're held against their will. Honestly, I would like a court to look at that, but I don't want your name attached to it. The legal department of your hospital should probably weigh in on this.

One solution to this is to create a bed on paper that does not exist as an actual physical bed. (psychiatrists will be uniquely able to cope with this situation imo)

Its done in the UK to cope with hospital transfers when multiple hospitals are involved as well. It enable the patient to be discharged from one bed into another and on to a third without actually having to travel and touch base with the middle bed. The legal status of the person in the "paper" bed will be the same as the person with an actual physical bed.

It has to be that way. Is it a bed if it doesnt have blankets and pillows? Are you illegally detained if your physical bed is short of sheets? I'm being silly now....unless anyone wants a discussion on the true nature of beds....

The answer to the question how many beds in your hospital is surprisingly large.

 

[whopper]

Four, that's kind of ridiculous that patients rights aren't protected while they're waiting for a bed even if they're held against their will. Honestly, I would like a court to look at that, but I don't want your name attached to it. The legal department of your hospital should probably weigh in on this.

If this is the legal situation in your state, and this is occurring to your patient, I'd get a patient's right advocate involved. This way will address any unfair inssues to the patient while also demonstrating that you are sensitive to their situation of being held against their will and trying to do the right thing.

 

[Apollyon]

The answer to the question how many beds in your hospital is surprisingly large.

Are you in the US or UK, though? (As I am not a consistent regular on the psych forum, if you've mentioned it in the past, I am not aware; if so, apologies.)

In the US, hospitals are licensed by states for specific numbers of beds, which, by extension, limits the number of patients. Whether those are actual or virtual beds, that is the limit. One can't conjure magically as many beds as one wants solely to meet regulatory demand. The answer isn't surprisingly large. Examples include 1124 at Duke, 613 at Stanford, 977 at Columbia-Presbyterian, 912 at Bellevue, 1171 at Mt. Sinai, and 850 at Weill Cornell. This is not to say that this can't be exceeded at times when the surge capacity is occupied, but, if the numbers remain high in general, the hospital has to either make arrangements for more staff and facilities, or redistribute those patients.

 

[Ibid]

Are you in the US or UK, though? (As I am not a consistent regular on the psych forum, if you've mentioned it in the past, I am not aware; if so, apologies.)

In the US, hospitals are licensed by states for specific numbers of beds, which, by extension, limits the number of patients. Whether those are actual or virtual beds, that is the limit. One can't conjure magically as many beds as one wants solely to meet regulatory demand. The answer isn't surprisingly large. Examples include 1124 at Duke, 613 at Stanford, 977 at Columbia-Presbyterian, 912 at Bellevue, 1171 at Mt. Sinai, and 850 at Weill Cornell. This is not to say that this can't be exceeded at times when the surge capacity is occupied, but, if the numbers remain high in general, the hospital has to either make arrangements for more staff and facilities, or redistribute those patients.

UK. It's not regulatory demand. Rather it is putting the need of the person first that drives this. In this case giving clarity to their legal status.

Paper beds are created all the time for hospital transfers. If a patient needs to be admitted while they are a long way from home but the local hospital has no physical beds they may admit them to a hopital down the road.

The patient down the road remains the patient of the admitting hospital. When the time comes for them to go home there is no point in the patient traveling to the origninal hospital to be discharged from there. (NOTE: This situation is caused because the hospital down the road wont transfer the patient to any hospital other than the one they came from) Better the patient is transferred on paper but actually travels straight to the hospital/home where they live.

In the UK Dr.s recomend to the hospital managers that a patient be detained. The nurses on the ward accept the patient on behalf of the hosptial managers. The managers (in this case) are an independent set of non execs on the hospital board. They are appointed by a Secretary of State who is part of Her Majestys (The Queens) Government. Non execs have the power to discharge patients without reference to the Doctors but it hardly ever happens. But they can because they are the essentially the representative of the Queen.

In the UK the citizens are actually subjects of the Queen and the Queen has a duty towards all her subjects. In theory all this power comes from God, the divine right of Kings. Hence the Queen can pull rank on Doctors who just think they are gods.

Yep. Its a different system. But it works and everyone seems to love it.🙂

EDIT: Letters to the Queen complaining about paper beds are likely to get a polite response but in the end one will make as many paper beds as one wants.

 

[Apollyon]

EDIT: Letters to the Queen complaining about paper beds are likely to get a polite response but in the end one will make as many paper beds as one wants.

Do people actually do that - like, write a letter to "HM the Queen, c/o Buckingham Palace" (or Kensington, or Balmoral, or Windsor Castle, or wherever HRH might be at the moment)?

Or, alternately, I would guess that a person could write a letter addressed strictly to "The Queen" and put it in post, as the Royal Mail operates at the monarch's pleasure, and it is the express duty of the RM to do the Queen's bidding (although my nominal research into the Royal Mail is that it's more a state-owned enterprise, but due to be privatized 90%, so maybe I'm all wet).

 

[Ibid]

Do people actually do that - like, write a letter to "HM the Queen, c/o Buckingham Palace" (or Kensington, or Balmoral, or Windsor Castle, or wherever HRH might be at the moment)?

Or, alternately, I would guess that a person could write a letter addressed strictly to "The Queen" and put it in post, as the Royal Mail operates at the monarch's pleasure, and it is the express duty of the RM to do the Queen's bidding (although my nominal research into the Royal Mail is that it's more a state-owned enterprise, but due to be privatized 90%, so maybe I'm all wet).

Not at all....you are exactly right!

http://www.royal.gov.uk/hmthequeen/contactthequeen/overview.aspx

You can write to Her Majesty at the following address:
Her Majesty The Queen
Buckingham Palace
London SW1A 1AA
If you wish to write a formal letter, you can open with 'Madam' and close the letter with the form 'I have the honour to be, Madam, Your Majesty's humble and obedient servant'.

This traditional approach is by no means obligatory. You should feel free to write in whatever style you feel comfortable.

The Governement is HRH's. She has advisors who advise her after the general election as to who call to form a government. Someone actually called D. Cameron and said please come to the Palace at 3:45 sharp. He turns up and she says something to the effect of try and form a government. If he cant or cant form a coallition she asks someone else and so it goes on. In the end though it is her government.

The Queen opens parliment and reads out the speech saying what the governemt will do. Obv its all agreed in advance but in theory she could object to anything and they wouldn't put anything in it that would embarass her.

The whole civil service works for the Queen. The Courts are her Courts. The State is hers as the Monarch so all nationalised industry is hers. (she has private possesions but its a very fine distinction and she rather oddly pays tax to herself on income from that 🙂)

All the armed forces swear an oath to her. They fight for the Monarch not for politicians.

Its an awsome amount of power that she never actually executes.

Pros and Cons really. Hereditary principle is an anachronism in 2012 but on the otherhand we show less deference to people like the prime minister who are etherial.

The Queen is almost universally loved as she lives in her guilded cage with a lifetime duty to serve her subjects. A duty which by all accounts she takes very seriously.

So people do write to the Queen all the time. Its a sort of stereotype to think of the detained patient writing to the Queen asking to be let out. There are no official figures for the number of letters from patients but I imagine she gets a few hundred of those a year, if not more. Most would go down the hospital manager route and then a legal appeal where they would have a solicitor and a barrister in the role of judge and so on.

 

[nancysinatra]

I wish we had a Queen. It would sure help to put some annoying and impertinent chief residents in their proper place.

How does a doctor get sued for malpractice for false imprisonment? Isn't that a criminal charge? Wouldn't you potentially go to jail if found guilty? To be guilty of malpractice means you have done something that is below the standard of care and harms the patient--it doesn't mean you flat out broke the law, does it?

Let's say I'm a psychiatrist, and I want my brother locked up for some reason. So I file commitment paperwork that's completely bogus, or I just shove them in the inpatient unit, write admission orders, and throw away the key. Is that "malpractice?"

 

[Ibid]

I wish we had a Queen. It would sure help to put some annoying and impertinent chief residents in their proper place.

I am sure she would take that as compliment! As I said she is almost universally loved by everyone and with pretty good reason I would say.

How does a doctor get sued for malpractice for false imprisonment? Isn't that a criminal charge? Wouldn't you potentially go to jail if found guilty? To be guilty of malpractice means you have done something that is below the standard of care and harms the patient--it doesn't mean you flat out broke the law, does it?

Malpractice and false imprisonment are seperate issues. Malpractice is an issue for a professional body.

In the UK a patient is not detained by the doctor. Ultimately the patient is detained by the state on the recommendation of two doctors and a social worker/apporved worker.

Standards for the deprovation of liberty are what this is about. I'm not sure of a good link here but this one is as good as any...
link

Let's say I'm a psychiatrist, and I want my brother locked up for some reason. So I file commitment paperwork that's completely bogus, or I just shove them in the inpatient unit, write admission orders, and throw away the key. Is that "malpractice?"

It would require the collusion of so many people there is not a realistic chance of that happening. No such thing as admission orders (in the UK at least), all two doctors and a social worker can do is recommend a detention to ward staff who accept on behalf of the managers and so on and so as above.

 

[michaelrack]

I wish we had a Queen"

Dd

 

[nancysinatra]

I am sure she would take that as compliment! As I said she is almost universally loved by everyone and with pretty good reason I would say.

Universal is right! She is admired and beloved even here. I would absolutely love it if she would visit my residency program and bestow some of her regal benevolence on this place, as we desperately need it, but I doubt that's going to happen. If she ever did come, some of my fellow residents could use a tip or two about proper attire.

Malpractice and false imprisonment are seperate issues. Malpractice is an issue for a professional body.

In the UK a patient is not detained by the doctor. Ultimately the patient is detained by the state on the recommendation of two doctors and a social worker/apporved worker.

Standards for the deprovation of liberty are what this is about. I'm not sure of a good link here but this one is as good as any...
link




It would require the collusion of so many people there is not a realistic chance of that happening. No such thing as admission orders (in the UK at least), all two doctors and a social worker can do is recommend a detention to ward staff who accept on behalf of the managers and so on and so as above.

The laws for commitment are different in every US state. In my state it's actually relatively easy to admit someone involuntarily. Not so easy that I could easily imprison my numerous enemies, but still...

 

[whopper]

How does a doctor get sued for malpractice for false imprisonment? Isn't that a criminal charge? Wouldn't you potentially go to jail if found guilty?

Depends. The police usually don't get involved unless the situation is acute and clearly dangerous. E.g. if a patient called the police while in the hospital, the police might just ignore them. The police often-times don't see their jobs as being that of a lawyer. They'll get involved if they get a call that someone is being beaten up. If they get a call of "get me out of the hospital," they'll likely just refer the person to the patient rights advocate.