What happens when a Physician is hospitalized?

[ryerica22]

I was just curious, what happens if a physician is placed on a hold and hospitalized? Do medical boards investigate upon discharge? Does it affect their ability to practice (if no substance abuse is involved)? I think in Medicine, there is a huge stigma about getting help for mental illness especially when you are in training, but I wonder how it would affect someone who is practicing?

On a related note, I always get questions from kids and parents about their ability to go to a good college or join the military based on their hospitalization, is this generally true? I would think it would be illegal to limit someones college potential, but I imagine the military would conduct its own evaluation.

Thanks

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[clausewitz2]

It will depend on the state but in general you would not report physicians who have been hospitalized upon discharge unless you thought that physician was impaired/dangerous and was attempting to return to work and not follow up with appropriate care. Most states have physician health programs, so even if you were going to report, it would be to the PHP not the medical board. I have treated quite a number of physicians with serious mental illness including those who have attempted suicide or seriously harmed themselves. I have never once reported them.

It should not affect a kid's chances of getting into college. However many elite colleges (e.g. stanford, yale, princeton) do discriminate in terms of return to college when there has been an LOA for mental illness (which is illegal and they have been sued or are being sued). The military does exclude those with a past history of psychiatric hospitalization.

Most law enforcement/intelligence agencies (and definitely the FBI/CIA/NSA) will also exclude applicants with involuntary hospitalizations. Also you will never be eligible for a commercial pilot's license, or even if you are taking a psychotropic medication other than Prozac or Zoloft (bizarrely).

 

[AnnoyedByFreud]

We avoid reporting and would only do so if we absolutely believed the healthcare professional would be dangerous if they continued to practice (this has never happened, so far). We had a healthcare professional who diverted meds for a suicide attempt and we still did not report (with our admins blessing). Our team's approach is that the negative ramifications reporting has on the career of a nurse or doctor would be horrible for their mental health, and so we need to have very good reason to believe this individual poses a threat to the public to ever go to the board.

 

[Crayola227]

How does this hold in the case of psychosis?

What if we're dealing with schizophrenia?

I apologize if this was addressed, I'm sort of wondering in the above cases if I could get some elaboration, but more importantly, just what *would* be the scenarios where the physician being treated hadn't harmed patients, but you were worried they might? What makes you worried to where you would report?

 

[NontradCA]

How does this hold in the case of psychosis?

What if we're dealing with schizophrenia?

I apologize if this was addressed, I'm sort of wondering in the above cases if I could get some elaboration, but more importantly, just what *would* be the scenarios where the physician being treated hadn't harmed patients, but you were worried they might? What makes you worried to where you would report?

You would need specific examples of how this would impact patient care, otherwise GL with that lawsuit.

 

[ryerica22]

Realized I forgot to follow up on this thread.

How does this law apply in California? For instance, lets say if a patient has severe Cluster B Personality Disorder (Borderline, Narcisstic and Antisocial), that is causing him to literally be an ass, be very paranoid/suspicious and be so bad that it is causing impairment in ability to sustain employment and be able to function with his family.

I feel like California is such a liberal state with their involuntary holds that there are too many patient's rights. Does the medical board find out about a hospitalization or 5150 hold? I would imagine that for someone with such severe personality traits, the board would see a hospitalization more favorably than an incarceration.

 

[justabanana]

The military only excludes people with juvenile psychiatric hospitalizations if the person tells the military about them or if they somehow find out. To my knowledge theres not some big database they can check (is there) and they certainly dont call around asking. I know a guy who had a couple psych hospitalizations in his early teens and ended up in the air force, even got a top secret clearance. He did his 4 years and was honorably discharged.

 

[WisNeuro]

The military only excludes people with juvenile psychiatric hospitalizations if the person tells the military about them or if they somehow find out. To my knowledge theres not some big database they can check (is there) and they certainly dont call around asking. I know a guy who had a couple psych hospitalizations in his early teens and ended up in the air force, even got a top secret clearance. He did his 4 years and was honorably discharged.

We had Vets in the VA all of the time who had disqualifying events or conditions in childhood. The military gives 0 f#cks when they are trying to meet their quotas.

 

[PsyDr]

NICS has involuntary holds as disqualifying events for gun ownership. Of course the VA thinks that federal law isn’t to be followed. And many states don’t provide for how physicians can follow federal law.

Medical boards care, but not very much. The big thing is your malpractice carrier. I’ve done many exams for such carriers.

 

[Mad Jack]

I was just curious, what happens if a physician is placed on a hold and hospitalized? Do medical boards investigate upon discharge? Does it affect their ability to practice (if no substance abuse is involved)? I think in Medicine, there is a huge stigma about getting help for mental illness especially when you are in training, but I wonder how it would affect someone who is practicing?

On a related note, I always get questions from kids and parents about their ability to go to a good college or join the military based on their hospitalization, is this generally true? I would think it would be illegal to limit someones college potential, but I imagine the military would conduct its own evaluation.

Thanks

They go in a database if they end up having a hearing that results in true involuntary commitment, and come time for license renewal they have to explain their stay and make a case for fitness. I have had to deal with this unfortunate situation once and it broke my heart

 

[Crayola227]

They go in a database if they end up having a hearing that results in true involuntary commitment, and come time for license renewal they have to explain their stay and make a case for fitness. I have had to deal with this unfortunate situation once and it broke my heart

seriously there's a database just for this?

is that for holds?

I've heard psychiatrists rec that someone go out of state for inpt tx, then again, that's voluntary

 

[Mad Jack]

You would need specific examples of how this would impact patient care, otherwise GL with that lawsuit.

If you've got a patient that is actively psychotic upon discharge, it's a pretty easy case to make. For instance an individual that believed they the chosen one, that had engaged in life-endangering behavior, that had violently resisted arrest, and that on discharge still adamantly believed they had done nothing wrong and that they had no mental illness but that had no active thoughts of harming themselves or others and could do their basic ADLs and thus there were no legal grounds to keep them inpatient... I mean, we're talking the sort of person who views cooking food in metal in their microwave as an "unconventional method but not incorrect" because it lights everything on fire and still cooks your food. You'd have a really difficult legal case if you didn't report this person to the board as reporting impaired physicians is mandatory and this individual is dangerous with a car let alone with a scalpel.

This is a hypothetical based on real world cases.

 

[Mad Jack]

seriously there's a database just for this?

is that for holds?

I've heard psychiatrists rec that someone go out of state for inpt tx, then again, that's voluntary

It's not just for this, it's for all patients involuntarily committed. You get added to NICS, which is part of every FBI background check, and is how individuals with a commitment history are screened out of military service, police careers, and firearm purchasing, but also how boards and employers can become easily aware of an involuntary commitment. Keep in mind that this only applies to involuntary commitments in which a formal legal hearing has been held and thus does not apply for pre-hearing involuntary holds that carry in duration (in my state at least, I don't know reporting requirements elsewhere). Also you're fine if you go looking for help, as this only applies to involuntary commitment.

 

[hallowmann]

It's not just for this, it's for all patients involuntarily committed. You get added to NICS, which is part of every FBI background check, and is how individuals with a commitment history are screened out of military service, police careers, and firearm purchasing, but also how boards and employers can become easily aware of an involuntary commitment. Keep in mind that this only applies to involuntary commitments in which a formal legal hearing has been held and thus does not apply for pre-hearing involuntary holds that carry in duration (in my state at least, I don't know reporting requirements elsewhere). Also you're fine if you go looking for help, as this only applies to involuntary commitment.

Which is why offering voluntary admission to such individuals is important, despite the coercive nature of that process (i.e. you need to come in, I can file on you or you can sign-in voluntarily, but if I file its going on your record). Personally I hate situations like this. Most physicians I've had to deal with at very least had the insight necessary to decide on voluntary admission.

 

[hallowmann]

seriously there's a database just for this?

is that for holds?...

Yeah, some rights are absolutely lost with mental health commitments, but this does not apply to holds. People can have holds placed on them for a number of reasons, but the point is just needing time for proper evaluations (and sometimes treatment if they become more amenable to it). The NICS includes commitments, not just holds (as far as I know in my state), i.e. what happens when the hold expires they still require involuntary hospitalization (or outpatient commitment).

 

[clausewitz2]

It's not just for this, it's for all patients involuntarily committed. You get added to NICS, which is part of every FBI background check, and is how individuals with a commitment history are screened out of military service, police careers, and firearm purchasing, but also how boards and employers can become easily aware of an involuntary commitment. Keep in mind that this only applies to involuntary commitments in which a formal legal hearing has been held and thus does not apply for pre-hearing involuntary holds that carry in duration (in my state at least, I don't know reporting requirements elsewhere). Also you're fine if you go looking for help, as this only applies to involuntary commitment.

Very state-specific. My state does not have a distinction between holds and commitments so a physician upholding the initial petition for commitment in advance of an actual hearing still goes to NCIS.

Reporting to NCIS is very inconsistent across the board and varies dramatically from state to state. It is more accurate to say there is a chance an involuntary gets put into a database but it is not an automatic process.

 

[Mad Jack]

Which is why offering voluntary admission to such individuals is important, despite the coercive nature of that process (i.e. you need to come in, I can file on you or you can sign-in voluntarily, but if I file its going on your record). Personally I hate situations like this. Most physicians I've had to deal with at very least had the insight necessary to decide on voluntary admission.

Unfortunately this is not always the case. I pushed for a voluntary, begged for one, but the insight was just that far gone. I do the same for police and military, but maybe one out of every ten has no insight and will not work with you to help themselves.

 

[Mad Jack]

Very state-specific. My state does not have a distinction between holds and commitments so a physician upholding the initial petition for commitment in advance of an actual hearing still goes to NCIS.

Reporting to NCIS is very inconsistent across the board and varies dramatically from state to state. It is more accurate to say there is a chance an involuntary gets put into a database but it is not an automatic process.

Over thirty states have some level of mandated reporting, it's pretty common

 

[hallowmann]

Unfortunately this is not always the case. I pushed for a voluntary, begged for one, but the insight was just that far gone. I do the same for police and military, but maybe one out of every ten has no insight and will not work with you to help themselves.

It happens, but there's not much you can do in those cases, you have to keep them, so you just move forward and do your job. The docs/resident cases are the ones that hit me hardest, too close to home. Its not a far stretch to see myself in their position if things go/went a bit different

 

[Mad Jack]

It happens, but there's not much you can do in those cases, you have to keep them, so you just move forward and do your job. The docs/resident cases are the ones that hit me hardest, too close to home. Its not a far stretch to see myself in their position if things go/went a bit different

I know that feel, I know that feel

 

[whopper]

We avoid reporting and would only do so if we absolutely believed the healthcare professional would be dangerous

Agree with pretty much what's been said except for this comment. Reasonable suspicion is far lower standard vs "absolute belief." The term itself "belief" is highly subjective.

If you have reasonable suspicion often-times that's when you report. Yes rules vary by state but one standard for all states are federal guidelines.

Also the original question wasn't specific and cuts into a lot of areas that could have multiple and very specific answers.

If a physician is involuntarily committed you bet it's going to affect at least their rep within the hospital if they work there. For this reason many health care professionals see a physician outside of their place of employment. If they are in a situation where they could be involuntarily committed often times attempts are made to put them in another facility outside of their employment if possible. This, however, may not be possible especially in more rural areas where the psych unit in question might be the only one available and the next one is hours away.

 

[ryerica22]

They go in a database if they end up having a hearing that results in true involuntary commitment, and come time for license renewal they have to explain their stay and make a case for fitness. I have had to deal with this unfortunate situation once and it broke my heart

Can the physician appeal the decision in California?

 

[Mad Jack]

Can the physician appeal the decision in California?

I'm not on California, don't know. Can't appeal in my state though

 

[ryerica22]

in california there is no reason why a physician would have to de facto disclose a history of psychiatric hospitalization. unfortunately california is one of the worst states to be a physician with mental illness. There is no official PHP (only a privatized one) so the medical board puts you on trial for being mentally ill. even if you are granted a license, it would be a probationary one such that it is unlikely you would be able to get privileges anywhere except an academic medical center.its easier to keep privileges once you get them even if hospitalized. I always try to keep physicians voluntary (I mean I try to keep anyone voluntary but california is not great for this as there is pressure to put everyone on a hold). There are some cases where mentally ill physicians should not be working, but it has nothing to do with diagnosis or need for hospitalization.

Wow, what a bummer. I am working in a clinic where there is a family doc who was on a hold in California issued by Police but was discharged from the ED by an ED doctor who just dropped the hold saying it was due to personality disorder. In california, can a non-psychiatrist discontinue a 5150? I find that pretty appalling.

 

[ryerica22]

it;s a complicated question. at my institution, only a psychiatrist or psychologist can discontinue a hold. however if an ED physician had completed the LPS training and was designated by the facility to drop the hold then they can do so. if the facility is not an LPS designated facility (i.e. doesn't have LPS accreditation - i.e. no involuntary psychiatric beds) the 5150 is void and so the ED physician has to let the patient go or a new 5150 has to be placed and the patient transferred to an LPS facility.

I see. on the second scenario, though, if the patient was just sent to the ED for medical clearance, isn't it the ED's job to consult psych or enlist case management to transfer the patient to an LPS accredited facility?

 

[Mass Effect]

There are some cases where mentally ill physicians should not be working, but it has nothing to do with diagnosis or need for hospitalization.

Can you elaborate on that? I assume you're talking personality.

 

[Jackie88]

There is no database the only thing that is reported is the firearm prohibition which does not come up on a doj/fbi LiveScan. It is only criminal. The only time it comes up if you are trying to purchase a gun or have to do a bof LiveScan for a firearms record review. Hospitalizations are confidential and any mental health records are confidential unless you are working for law enforcement or the military or are required to have a security clearance. Which these jobs require you to possess a gun. I’ve called the licensing board about this and they even told me mental heath records do not show up.

 

[Jackie88]

If everyone who was ever hospitalized for mental illness was not allowed to practice medicine we would literally no longer have any people to work in the medical field. All they want to know is that you have been rehabilitated and have progressed from that time in your life where you were hospitalized. But honestly I don’t even know how they would find out unless you told them yourselves.

 

[splik]

If everyone who was ever hospitalized for mental illness was not allowed to practice medicine we would literally no longer have any people to work in the medical field.

 

[abc2019]

how do you know whether or not a hold was placed on a pt in the ED?

 

[ryerica22]

how do you know whether or not a hold was placed on a pt in the ED?

There is usually a database where holds go to and sometimes that database may also go to the DOJ (depending on the state, I believe).

 

[Mass Effect]

There is usually a database where holds go to and sometimes that database may also go to the DOJ (depending on the state, I believe).

Please cite a source for this.

 

[FlowRate]

how do you know whether or not a hold was placed on a pt in the ED?

State specific.

In MA you look in their chart / electronic chart for a Section 12(a). It doesn't get reported to anyone outside of the hospital (except for receiving psychiatric facilities).

 

[splik]

There is usually a database where holds go to and sometimes that database may also go to the DOJ (depending on the state, I believe).

This is not true and certainly not in California. Only patients admitted to the psychiatric hospital/ward on a 5150 for DTS/DTO get reported to the DOJ re: firearm restrictions. Patients on a 5250 who are psychiatrically hospitalized will be reported in NICS re: firearm ownership. If you never are psychiatrically hospitalized (e.g. placed on hold by therapist/police officer/mobile crisis unit/in ER/medical or surgical ward and never make it to a psych hospital/ward then there is no record of it (except of course in the medical records). Of course the physician can report to DOJ if they dont meet the requirements as a means restriction intervention, but this is rare and not required by law (but may be good practice).

 

[abc2019]

Does the pt know they were put on hold? Does the pt need to be informed? ie sign consent form or anything? It seems like a violation of rights to put hold or report to a database, etc without the patient's knowledge.

 

[Mass Effect]

Does the pt know they were put on hold? Does the pt need to be informed? ie sign consent form or anything? It seems like a violation of rights to put hold or report to a database, etc without the patient's knowledge.

I am not familiar with any database like the posters above mention. As to psychiatric holds, yes, the patient knows (or should know), but no they don't have to sign anything. The point of a hold is because you feel the patient is too impaired due to mental illness to be safe in the community and they require psychiatric evaluation and/or admission.

 

[NickNaylor]

Does the pt know they were put on hold? Does the pt need to be informed? ie sign consent form or anything? It seems like a violation of rights to put hold or report to a database, etc without the patient's knowledge.

In our state, patients will find out one way or another if they’re placed in an involuntary hold. The county sheriff’s office will serve them with a copy of the involuntary hold order signed by a judge, so not telling them what’s going on isn’t a pragmatic option. I would make the argument that being open about what’s going on - even if the patient isn’t going to like it - is necessary.

 

[FlowRate]

In our state, patients will find out one way or another if they’re placed in an involuntary hold. The county sheriff’s office will serve them with a copy of the involuntary hold order signed by a judge, so not telling them what’s going on isn’t a pragmatic option. I would make the argument that being open about what’s going on - even if the patient isn’t going to like it - is necessary.

Probably one of the hardest (and most dangerous) parts of the job.

 

[splik]

In our state, patients will find out one way or another if they’re placed in an involuntary hold. The county sheriff’s office will serve them with a copy of the involuntary hold order signed by a judge, so not telling them what’s going on isn’t a pragmatic option. I would make the argument that being open about what’s going on - even if the patient isn’t going to like it - is necessary.

Indeed, to do otherwise would be both unethical and illegal.

 

[hallowmann]

Does the pt know they were put on hold? Does the pt need to be informed? ie sign consent form or anything? It seems like a violation of rights to put hold or report to a database, etc without the patient's knowledge.

In my state (and every state where I saw holds in med school), the patient is always informed by receiving a copy of the hold order and, if they've been filed on, the court date. This may be delayed after hours and on weekends to the next business day, but it typically happens quickly. The patient needs to be told, ideally before it happens. It coming as a surprise isn't the best way to build rapport or a therapeutic relationship, even if you're only going to see them inpatient.

Indeed, to do otherwise would be both unethical and illegal.

Exactly.

 

[abc2019]

What to do if a patient comes to the outpatient clinic who has a prior psych hospitalization and the patient and his family and even his psychiatrist who treated the patient while he was inpatient all claim there was not a hold placed on the patient but than upon reviewing the medical record, there was a hold placed on the patient when the patient was bought into the ER by police? Was this unethical and illegal and does the patient have the right to do anything regarding this?

 

[samac]

If everyone who was ever hospitalized for mental illness was not allowed to practice medicine we would literally no longer have any people to work in the medical field. All they want to know is that you have been rehabilitated and have progressed from that time in your life where you were hospitalized. But honestly I don’t even know how they would find out unless you told them yourselves.

Do you really think the majority of people working in health care have been hospitalized for mental illness?
I’m all for not tanking people’s careers for hospitalizations, but I would say from my limited experience I’ve only seen a few come through inpatient. Definitely not a majority.

 

[Merovinge]

Do you really think the majority of people working in health care have been hospitalized for mental illness?
I’m all for not tanking people’s careers for hospitalizations, but I would say from my limited experience I’ve only seen a few come through inpatient. Definitely not a majority.

It's a fleetingly small percentage of the total population and even smaller percent of physicians. That poster is not in psychiatry who you are quoting.

 

[Mass Effect]

What to do if a patient comes to the outpatient clinic who has a prior psych hospitalization and the patient and his family and even his psychiatrist who treated the patient while he was inpatient all claim there was not a hold placed on the patient but than upon reviewing the medical record, there was a hold placed on the patient when the patient was bought into the ER by police? Was this unethical and illegal and does the patient have the right to do anything regarding this?

You need to clarify "hold." The above posters are referring to a "hold" in an inpatient setting. You're referring to PD bringing the patient to the ED for a psych evaluation. These are two different things. One is a psych eval and one is a commitment. They have different requirements. For instance, a patient screaming in the street may be brought in by PD under a "hold" for a psych eval. When psych does the eval, they may not "hold" the patient for transfer to a psych hospital. And if they do, the inpatient team may not "hold" the patient as he/she may not be commitable.

In the case of committing someone or forcing someone to be transferred to a psych inpatient unit, you have to tell them. In terms of law enforcement bringing a patient to the ED for a psych eval, in a lot of cases, this type of hold is done so staff knows the patient can't discharge prior to psych eval. Whether the patient is told or not is up to the discretion of the ED unless the patient is asking to leave. I don't know of any law that suggests the patient must be told they can't leave if the patient isn't even asking to leave. Also, it would be unlikely that the patient wouldn't know if they refused to come to the ED. In your patient's case, he/she likely willingly came to the ED and a hold was placed pending psych eval. He/she saw psych. Psych felt he/she didn't meet criteria to be admitted involuntarily. But then the patient was admitted to a psych hospital voluntarily.

Your question is what to do. My question is about what?

 

[NickNaylor]

What to do if a patient comes to the outpatient clinic who has a prior psych hospitalization and the patient and his family and even his psychiatrist who treated the patient while he was inpatient all claim there was not a hold placed on the patient but than upon reviewing the medical record, there was a hold placed on the patient when the patient was bought into the ER by police? Was this unethical and illegal and does the patient have the right to do anything regarding this?

Most states give the police that power to detain people without warrant and bring them to a hospital for psychiatric evaluation if they believe they are a danger to themselves/others and that this may be due to a mental illness. You may or may not argue the ethics of the police having the power to do that, but it's the law. In my state, people can be detained in an ED setting for up to 72 hours without any meaningful judicial oversight.