Molecule

Member
10+ Year Member
5+ Year Member
Feb 5, 2005
27
0
Status
Hi,

I have a question regarding holds (orders to forcibly hospitalize or treat) for psychiatric patients.

If one has a psychiatric patient who is clearly psychotic and unable to make their own decisions (but does not yet have a conservator), what do you do in the event of a life-threatening medical or surgical problem--that the patient is refusing treatment for?

Do "holds" exist for general medical problems?

I know that in California we can place a "5150" on a patient (3-day involuntary hold)--and we can further "Riese" a patient to treat them with psychotropic Rx's if the court upholds the medical decision...but I am not aware of any equivalent orders or court precedents for psychiatric patients with general medical issues that are acute and possibly life-threatening.

For instance, earlier in medical school, while on a Psychiatry C&L service, I had a psychotic woman who eventually managed to leave the hospital AMA despite an active pulmonary embolism. We could place a 5150 and probably Riese her, too...but our team was less sure about whether we could forcibly heparinize her to address her very dangerous P.E.

Any thoughts?

(Any resources you could point me to?)


Thanks!
 

john182

Member
10+ Year Member
7+ Year Member
Sep 16, 2004
117
1
Status
Molecule said:
Hi,

I have a question regarding holds (orders to forcibly hospitalize or treat) for psychiatric patients. This is specifically about California State laws--but I would be interested in hearing about other states as well.

If one has a psychiatric patient who is clearly psychotic and unable to make their own decisions (but does not yet have a conservator), what do you do in the event of a life-threatening medical or surgical problem--that the patient is refusing treatment for?

Do "holds" exist for general medical problems?

I know that in California we can place a "5150" on a patient (3-day involuntary hold)--and we can further "Riese" a patient to treat them with psychotropic Rx's if the court upholds the medical decision...but I am not aware of any equivalent orders or court precedents for psychiatric patients with general medical issues that are acute and possibly life-threatening.

For instance, earlier in medical school, while on a Psychiatry C&L service, I had a psychotic woman who eventually managed to leave the hospital AMA despite an active pulmonary embolism. We could place a 5150 and probably Riese her, too...but our team was less sure about whether we could forcibly heparinize her to address her very dangerous P.E.

Any thoughts?

(Any resources you could point me to?)


Thanks!
Over here involuntary detention is under the Mental Health Act, and it only allows detention under the MHA involuntary for treatment of a psychiatric disorder in which the patient represents a danger to him/herself or others.

There is a separate section of the law regarding Duty of Care in which a patient can be held for life-saving medical treatment without their consent. That decision is usally taken at a very senior level.

I suppose int he situation above perhaps she did represent an acute danger to herself due to lack of insight so she could be held here for treatment of that (no different than if she had a gun, wouldn't it be?).

Sometimes you get asked to "convince" someone that they need say a hemicolectomy but they refuse and we might get asked can they be "sectioned" (term for hold orders here) so to give the procedure.

I suppose it comes down to an adequate assessment of capacity to consent to treatment. Interesting dilemma........

Does 5150 have anything to do with Van Halen's album of the same name? I've never heard of 5150 except that before so it's maybe just conincidence. Or an idea of reference...........
 

Anasazi23

Your Digital Ruler
Moderator Emeritus
10+ Year Member
15+ Year Member
Feb 19, 2003
3,505
26
The innocent shall suffer...big time
Visit site
Status
Attending Physician
Basically I think you get a capacity evaluation, which paves the road to a competency hearing. Once that clears, and I know I'm skipping a lot in between, you can force medical/surg treatment. As far as the "hold" in the interim, I think it varies from state to state. If you find the patient to not have capacity (secondary to psychosis, delirium, etc.) as determined by a psychiatrist, you can hold the patient until the hearing, if they continue to refuse treatment. At least that's what I've seen in my hospital.
 

mdblue

Senior Member
10+ Year Member
5+ Year Member
2+ Year Member
7+ Year Member
15+ Year Member
Oct 17, 2003
199
1
Anasazi23 said:
Basically I think you get a capacity evaluation, which paves the road to a competency hearing. Once that clears, and I know I'm skipping a lot in between, you can force medical/surg treatment. As far as the "hold" in the interim, I think it varies from state to state. If you find the patient to not have capacity (secondary to psychosis, delirium, etc.) as determined by a psychiatrist, you can hold the patient until the hearing, if they continue to refuse treatment. At least that's what I've seen in my hospital.
If the pt lacks decisional capacity and if there is a life threatening emergency you can always treat the pt, even more w/ serious med/surg prob. However w/ the resolution of the crisis, you'll need a court order to continue tx.
Hope this helps