OK, I'll admit this thread exists primarily as a way for a frustrated sister of a guy with schizoaffective disorder to vent, but I do have some questions as an M4 applying to psychiatry if you're willing to wade through everything else.
I'll try to make a long story short. My brother had been fairly stable living in a secured residential facility for about a year, where I visited him frequently. I am sure he would have happily signed a release of information form for me during that time but I never thought to ask him. So when he decompensated to the the point of needing acute psychiatric hospitalization he effectively disappeared off the face of the earth. No call was made to my mother, who was listed as his emergency contact but also had neglected to ask him to fill out a ROI. All we knew was that he was no longer in his home and the staff members we spoke with were too concerned about a HIPAA violation to give us any information whatsoever. We didn't know whether he was alive or dead, and could get no information from any of the psych wards/hospitals in town. Thank god he eventually called from one of them, after several days of treatment.
I understand the staff at his residential treatment facility and the psychiatric hospital were concerned about HIPAA violations, but really? Is this how things are done? No effort by anyone on either side of that handoff to contact the family of a person in crisis. I don't know for a fact whether they asked him if they could call us and he said no, but even if he had refused, he was apparently floridly psychotic; at what point do you not put that decision in the patient's hands? If he had been in a coma they would have called his emergency contact. He was conscious but certainly incapacitated by illness. If a facility is going to be such sticklers about having release of information forms on file before releasing any information about a resident's whereabouts, doesn't that put the onus on them to encourage residents to sign these forms when they're stable in order to prevent situations like this? This can't be how this is supposed to work.
Furthermore, in the interest of informed medical decision-making, isn't it incumbent on someone on his treatment team at the hospital to make an attempt to contact family members who may have critical insights to offer, for example which medications he has tried, which have worked, which haven't, which he has had (potentially serious) adverse reactions to? This particular psychiatric hospital may be worse than most in this regard, perhaps owing to the lack of licensed clinical social workers, whose role is (poorly) filled by inexperienced and undereducated "discharge planners".
On a personal level, is there a way for me to prevent this from happening again, short of having a guardian appointed? He doesn't want one and usually doesn't need one, so I wouldn't feel right about pushing for it. Should we have filed a missing persons report with the police? We strongly suspected he was in a local psych ward but had no way of knowing for sure. Would that have saved us days of anxiety and uncertainty?
If you made it this far, thanks for reading. Feel free to tell me I'm overreacting, or being naive and idealistic. I'm looking for an outside perspective on this situation, which I am obviously too close to to be objective about. I'm also trying to figure out what my role as a psychiatrist will be in trying to spare families the hell we went through. I'm starting to think my HIPAA compliance will be on a case-by-case basis; if I get sued doing what I think is in the patient's best interest, so be it. What's your policy?
I'll try to make a long story short. My brother had been fairly stable living in a secured residential facility for about a year, where I visited him frequently. I am sure he would have happily signed a release of information form for me during that time but I never thought to ask him. So when he decompensated to the the point of needing acute psychiatric hospitalization he effectively disappeared off the face of the earth. No call was made to my mother, who was listed as his emergency contact but also had neglected to ask him to fill out a ROI. All we knew was that he was no longer in his home and the staff members we spoke with were too concerned about a HIPAA violation to give us any information whatsoever. We didn't know whether he was alive or dead, and could get no information from any of the psych wards/hospitals in town. Thank god he eventually called from one of them, after several days of treatment.
I understand the staff at his residential treatment facility and the psychiatric hospital were concerned about HIPAA violations, but really? Is this how things are done? No effort by anyone on either side of that handoff to contact the family of a person in crisis. I don't know for a fact whether they asked him if they could call us and he said no, but even if he had refused, he was apparently floridly psychotic; at what point do you not put that decision in the patient's hands? If he had been in a coma they would have called his emergency contact. He was conscious but certainly incapacitated by illness. If a facility is going to be such sticklers about having release of information forms on file before releasing any information about a resident's whereabouts, doesn't that put the onus on them to encourage residents to sign these forms when they're stable in order to prevent situations like this? This can't be how this is supposed to work.
Furthermore, in the interest of informed medical decision-making, isn't it incumbent on someone on his treatment team at the hospital to make an attempt to contact family members who may have critical insights to offer, for example which medications he has tried, which have worked, which haven't, which he has had (potentially serious) adverse reactions to? This particular psychiatric hospital may be worse than most in this regard, perhaps owing to the lack of licensed clinical social workers, whose role is (poorly) filled by inexperienced and undereducated "discharge planners".
On a personal level, is there a way for me to prevent this from happening again, short of having a guardian appointed? He doesn't want one and usually doesn't need one, so I wouldn't feel right about pushing for it. Should we have filed a missing persons report with the police? We strongly suspected he was in a local psych ward but had no way of knowing for sure. Would that have saved us days of anxiety and uncertainty?
If you made it this far, thanks for reading. Feel free to tell me I'm overreacting, or being naive and idealistic. I'm looking for an outside perspective on this situation, which I am obviously too close to to be objective about. I'm also trying to figure out what my role as a psychiatrist will be in trying to spare families the hell we went through. I'm starting to think my HIPAA compliance will be on a case-by-case basis; if I get sued doing what I think is in the patient's best interest, so be it. What's your policy?
