How a Leading Chain of Psychiatric Hospitals Traps Patients

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Yeah. While I don't think the NYTimes is what it once was and has started leaning a little too far leftward to be considered truly unbiased and centrist, I don't think they're outright lying. Unless someone in that hospital contaminated the heck out of that judge's cornflakes and the judge is getting back in a dirty, unethical way, that hospital's done enough money-grubbing greedy hog stuff to get on someone's radar.
Yeah and hard data like rates of cases dismissed aside, you have the workers themselves effectively whistleblowing. They might be lying or real Florence Nightingales clutching their pearls at how the sausage is made... ime when both former/current employed docs and aux staff both agree the heathcare employer is crooked crooked and not just standard greedy, usually there's fire under that smoke.

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Sorry if you answered this already but how does the involuntary proceedings go if psychiatrist doesn't go to court? Thank you.

At least in my state this is done with a hearing officer who generally comes to the unit in question on a fixed schedule, no judge involved. Only goes to court if someone needs ECT and can't actively consent ou have an advanced directive asking for ECT and you're catatonic? Too bad, can't do it without a court order.
 
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At least in my state this is done with a hearing officer who generally comes to the unit in question on a fixed schedule, no judge involved. Only goes to court if someone needs ECT and can't actively consent ou have an advanced directive asking for ECT and you're catatonic? Too bad, can't do it without a court order.
Wait if someone has malignant catatonia, they would let the person die while waiting for a court order?
 
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Wait if someone has malignant catatonia, they would let the person die while waiting for a court order?

PA law is unfortunately very clear that you cannot administer ECT to someone without their consent without a court order. It is literally the only medical treatment this is true of. The courts are pretty good about expediting cases like this (it's done through Orphan's Court for some reason) but yes, this could definitely happen. Even if there's a durable medical power of attorney for someone who is saying yes please.
 
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PA law is unfortunately very clear that you cannot administer ECT to someone without their consent without a court order. It is literally the only medical treatment this is true of. The courts are pretty good about expediting cases like this (it's done through Orphan's Court for some reason) but yes, this could definitely happen. Even if there's a durable medical power of attorney for someone who is saying yes please.

That's crazy. I've heard Florida is much more lax, which make the hospital previously mentioned even more sketchy that most of their court cases are overturned. In Florida you could come in on a Tuesday morning, have a Baker Act petition filed later that day, go to court Wednesday with an ECT petition and start ECT involuntarily on a Friday. For all its perceived flaws, Florida does mental health court right.
 
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Wait if someone has malignant catatonia, they would let the person die while waiting for a court order?

PA law is unfortunately very clear that you cannot administer ECT to someone without their consent without a court order. It is literally the only medical treatment this is true of. The courts are pretty good about expediting cases like this (it's done through Orphan's Court for some reason) but yes, this could definitely happen. Even if there's a durable medical power of attorney for someone who is saying yes please.
So what happens if a doc does the reasonable thing and does it anyway to save a life? I've generally been told in such situations, if it shakes out when it gets to the judge, and they find at the time the judgement would have been to issue the order and you proceeded based on good faith belief it would be and saving a life, that you're not going to face negative legal consequences. How often does that happen? Seems like the real danger would be inaction and let the patient die.

Of course, that's how obstetric care was supposed to work under the abortion bans....

I dunno. I've had discussions with ethicists and lawyers that make me think some of the time docs are being more chicken**** sometimes than is actually necessary. But I get it. No one wants to go to jail or lose their career. Certainly not for doing the right thing.
 
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**** man a lot of things under the law get tolerated if it was really a reasonable thing to do under a life or death scenario.

The older I get the more pissed life makes me.
 
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PA law is unfortunately very clear that you cannot administer ECT to someone without their consent without a court order. It is literally the only medical treatment this is true of. The courts are pretty good about expediting cases like this (it's done through Orphan's Court for some reason) but yes, this could definitely happen. Even if there's a durable medical power of attorney for someone who is saying yes please.
I mean we had a neuropsychiatrist come-in on a Saturday (when they weren't on call), take the ECT equipment up to the ICU (which is a wildly different spot of the hospital) and get the team in to ECT someone emergently to save their life. There is no way the courts are getting that done. It's wild to me that person would just be dead if they lived in PA. This antipsychiatry codified into law is so absurd, it reads like something a scientologist would write. I even like PA as a state :cryi:.
 
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I mean we had a neuropsychiatrist come-in on a Saturday (when they weren't on call), take the ECT equipment up to the ICU (which is a wildly different spot of the hospital) and get the team in to ECT someone emergently to save their life. There is no way the courts are getting that done. It's wild to me that person would just be dead if they lived in PA. This antipsychiatry codified into law is so absurd, it reads like something a scientologist would write. I even like PA as a state :cryi:.
Malignant catatonia is pretty rare. But I guess a "person would just be dead" in a lot of areas if they really need ECT. There's no ECT available within 150+ miles of Memphis TN.
 
Malignant catatonia is pretty rare. But I guess a "person would just be dead" in a lot of areas if they really need ECT. There's no ECT available within 150+ miles of Memphis TN.
Being in an area without care is a lot different than legislation leading to someone dying through no fault of their own. I'm saddened that would be your point of comparison.
 
Malignant catatonia can be treated with meds. It's indeed very rare, but there are many, many areas of the country where ECT is even more rare. The whole country isn't like the Northeast where you can get it at the drop of a hat.
 
Malignant catatonia can be treated with meds. It's indeed very rare, but there are many, many areas of the country where ECT is even more rare. The whole country isn't like the Northeast where you can get it at the drop of a hat.
The patient was on an IV ativan drip and had worsening autonomic instability that was worsening despite the intensivist interventions.
 
Malignant catatonia can be treated with meds. It's indeed very rare, but there are many, many areas of the country where ECT is even more rare. The whole country isn't like the Northeast where you can get it at the drop of a hat.

Not even just that. There are smooth brains like Scientologists pushing to force the last two companies that make the ECT devices out of business.
 
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Malignant catatonia can be treated with meds. It's indeed very rare, but there are many, many areas of the country where ECT is even more rare. The whole country isn't like the Northeast where you can get it at the drop of a hat.
I have had 5 cases of malignant catatonia which is probably more than most psychiatrists will see in their lifetime but doing neuropsych at an academic center for some yrs you get an enriched population. It cannot usually be treated with meds (I've tried everything including IV benzos, IV valproic acid, zolpidem, IV barbiturates, memantine, amantadine, abilify, clozapine etc). 4/5 of those patients died even with ECT. Unfortunately, it is very hard to get ECT quickly on incapacitated pts where I am so there was a delay in getting treatment and we will never know if those patients would have survived otherwise. One of the patients went into cardiac arrest while getting ECT.

The condition is almost certainly under diagnosed as well. I used to teach the neurologists and hospital medicine docs on catatonia so they were much better at picking up cases of catatonia than most places.
 
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I have had 5 cases of malignant catatonia which is probably more than most psychiatrists will see in their lifetime but doing neuropsych at an academic center for some yrs you get an enriched population. It cannot usually be treated with meds (I've tried everything including IV benzos, IV valproic acid, zolpidem, IV barbiturates, memantine, amantadine, abilify, clozapine etc). 4/5 of those patients died even with ECT. Unfortunately, it is very hard to get ECT quickly on incapacitated pts where I am so there was a delay in getting treatment and we will never know if those patients would have survived otherwise. One of the patients went into cardiac arrest while getting ECT.

The condition is almost certainly under diagnosed as well. I used to teach the neurologists and hospital medicine docs on catatonia so they were much better at picking up cases of catatonia than most places.

5 in a lifetime? We see at least one a month at our quaternary center. Unless you're defining only non med responsive catatonia as malignant. Agree ECT is clutch, we end up needing to do that probably 1-2x/ quarter. Fortunately we have fairly easy access to ECT.
 
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5 in a lifetime? We see at least one a month at our quaternary center. Unless you're defining only non med responsive catatonia as malignant. Agree ECT is clutch, we end up needing to do that probably 1-2x/ quarter. Fortunately we have fairly easy access to ECT.
Uh, malignant catatonia has a pretty specific definition (life threatening dysautonomia) and it doesn't really have anything to do with med-responsiveness. Since I've been doing primarily non-ER consults (about a year) at our ~1,000 bed hospital we've seen 1 definite case and one other questionable case (dysautonomia, but not necessarily immediately life-threatening). Fortunately, both patients received ECT and survived, but we see a TON of catatonia (at least a case a week) and it rarely gets to the point of being malignant catatonia.

In my state ECT is considered "psychosurgery", so we cannot perform it without a court order with the exception of situations in which a patient fails ICU level care and requires ECT to sustain life. Which means the ICU team deems ECT medically necessary (usually after consulting us) for the patient's immediate survival.
 
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