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Discuss.
Vaden doctor sends depressed student to psychiatric ward
By Jennie Kim
Senior Staff Writer
Monday, November 15 2004
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.
His experience highlights the delicate complexity of doctor-patient relations in psychiatric medicine, where doctors are sometimes forced to make judgments they can never be sure of and where doing nothing could, in itself, violate the Hippocratic Oath.
?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.
Stanford students are not uncommon at the ward, said medical director and assistant professor of psychiatry Dr. Rona Hu.
?At any given time there?s usually at least one Stanford student at H2, probably one-to-three, including both undergraduate and graduate students.?
Stanford Hospital?s psychiatry center, which includes H2 and separate outpatient facilities, ranked eighth this year in a national survey conducted by U.S. News and World Report.
H2 is a 16-bed locked facility that provides medical and social care for patients with mental disorders. Hu said that patients are usually sent by their doctors, peace officers or brought in by concerned friends and family members. On the written application placing Fisher into custody, Fisher?s doctor at Vaden cited ?statements (Fisher) made about increasing suicidal ideation? and ?inability to provide for (his) own food,? conditions which fulfilled two of the three possible criteria that necessitates enacting a 5150.
Fisher called the assessment, which followed a discussion of his school performance, sleep patterns and eating habits, a ?presumption rather than a valid conclusion.? Fischer said that at no time during the discussion did he explicitly tell his doctor he intended to commit suicide.
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.
?People are not terribly good at determining who will actually commit suicide,? he said. ?For example, there are patients who say they have no plan, but then you find out years later they had a loaded gun in their dresser all along but didn?t want to tell you about it.?
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.?
By state and federal law, hospitals are not allowed to release any information about specific patients being treated for mental disorders. However, healthcare workers can discuss general hospital procedure.
Hu said the staff asks for all medical records from each patient shortly after they enter the ward to prevent a situation like Fisher?s from happening.
?We ask what their medical conditions are and for a complete list of medicines they?re on so we have that medicine ready for them well ahead of time,? she said.
Hu said that the the typical wait time for medication varies. ?It may take longer to fill a prescription depending on the time of day. There are fewer people working at the pharmacy in the middle of the night,? she added.
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.?
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.?
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.?
If a patient is dissatisfied with treatment, Hu suggested three different options of recourse. The patient can leave specific feedback on a post-treatment survey; he or she can file a complaint with Stanford?s Ombuds Office, which acts as a mediator and is independent of Stanford Hospital; or the patient can take legal action against the hospital by requesting a free patient advocate to help file suit at the Santa Clara courthouse.
Hu empathized with patients who felt they were wrongly placed in the ward, and like Brooks, she said the primary goal of the 5150 law is to save lives.
?Nobody wants to be locked up for longer than necessary,? she said.
While Fisher has negative associations with the ward, he recognized its importance.
?A lot of people in there needed to be treated like children. I don?t doubt the fact that it?s an effective system overall, but there are flaws in that system that I can attest to.?
?I was a sane person going into an insane asylum ? I felt lucky in a way because I had a different perspective,? he added.
