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Anyone Know About Rights vs Hospital Rules?

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stillhere09 posted 3/28/2013 19:49 PM

Someone close to me had to put her H in hospital mental ward. He agreed to go. They are happily married; it's just that he has problems. Now she is afraid that they can do whatever they want to with him, and she will have no legal right to stop them. Does she have any rights, and if she doesn't, does he?

jo2love posted 3/28/2013 19:51 PM

(((Still, friend, & H)))

I'm sorry, I don't have an answer. Sending mojo and prayers.

Mama_of_3_Kids posted 3/28/2013 20:02 PM

I do not work mental health, but from what I remember from college, if he was voluntarily admitted (which sounds like is the case), they cannot do anything against his will unless he is a danger to himself or others. Tell the wife to get a copy of the Patients Bill of Rights; it will help to give insight on the subject.

(((Friend & H)))

jrc1963 posted 3/28/2013 20:44 PM

I don't know for sure either, but I was going to say what Mama said...

Unless he's a danger to self or others I believe they have to have patient consent, even in a mental health "ward"

stillhere09 posted 3/28/2013 21:16 PM

Thank you all for your responses. He did sign himself in. It was voluntary. He hears voices, though.

The issue she has is this: They give him Depacote, and it is giving him painful side effects. One possible side effect is Hepatitis. This, understandably, worries her. All she wants is for the Dr. to switch to a safer med, but he refuses to even talk to her, using the excuse he's too busy or it isn't necessary to talk to her. I think communication with the spouse of such a person would be considered very necessary.

She did finally get to talk to him for a few minutes, and he said the Depacote is working, so he isn't going to switch because he needs it. It does help his mental state, but the side effects are so very risky and painful and keep him up all night.

[This message edited by stillhere09 at 9:18 PM, March 28th (Thursday)]

Mama_of_3_Kids posted 3/28/2013 21:43 PM

Unfortunately, Psychotropic Meds can take up to two weeks to work. While the SE of Depakote are not fun, these symptoms may or may not be related to the Depakote (it could be related to the mental state or many other things). The insomnia could, again, be related to mental state vs the medication (esp if he is bipolar). I, however, do not agree with the Dr claiming he's too doctor should ever be too busy for a patient (I can understand the Dr being busy at that moment, but they need to take time to get back to the patient about their concern).

sad12008 posted 3/28/2013 21:56 PM

It's a plus he went in on a voluntary basis....a BIG plus. Depakote seems to be a standard operating procedure for stabilization; I've read it is supposed to act fast. What is your friend's H's status relative to regular psychiatric help? Does he already have a doctor-patient relationship with someone? Was he already on meds? If he does have a pdoc already, the treating pdoc @the mental ward should contact him or her....not to say there's any guarantee....however, that's how it's "supposed" to go.

It is scary as hell to be in the position your friend is in. Sending her strength. Sending you a PM.

betrayed5years posted 3/28/2013 22:07 PM

Stillhere09....Just a thought that doctors are paid by their patients for their knowledge/services. Your friend's husband has the right to "select" his own doctor. If your friend does not have a Power of Attorney that includes Medical Decisions, it may be a good thing to have. Some states recognize spouses and some states do not...AZ is one that can chose not to allow a spouse to make medical decisions in time of emergencies/incapacity. The hospital he is in should be able to give some guidance on state laws.

Know your legal rights---and the power one has to "fire" a doctor. They are hired help though we have chose to treat them like a super special person and they are not.

stillhere09 posted 3/28/2013 22:16 PM

He seemed fine for the 6 years of their M. This is a young childless couple who have always been very close and very happy together. Near the beginning of this month, she said he began talking strangely, saying things that made no sense at all. He is not bi-polar, and definitely not NPD. Very gentle, even timid nature.

Since this is an anon site, I may as well be blunt. He said he heard voices in his head. They were telling him he was going to die and ordering him to kill himself. It scared him. It scared her. She thought he should go to the hospital, and he thought so, too. She took him right away. They wouldn't let her visit him for 3 days. Torture for them both. He was in for 9 days. He came home, voices gone, all seemed well.

He's been home for a couple weeks and on Dr.'s recommendation, has just been weaned off Depakote. Today the voices began again, although nothing violent or drastic. He went to an appointment today at p-dr. that was assigned to him while in the hospital. Of course, since he was having an episode when he arrived there, she came to the waiting room, talked to him, and had her take him straight to hospital, so he is there again.

Now they are saying that he can't have visitors AGAIN! And, again, he's on Depakote. Back to sleepless nights, pain, and the worry over him contracting hepatitis.

My 2 questions are:
Can she insist they use a less dangerous drug?

Does she have the authority to transfer him to a different hospital if they refuse?

(Or does he have the authority to transfer himself, since he signed himself in?)

stillhere09 posted 3/28/2013 22:42 PM

betrayed5years, I didn't see your post till after I wrote my last one.

thanks so much for the info. I knew that we can select our own doctors, but I wasn't sure if that was still the case with a mental patient.

Mama, jrc, sad, thank you!

I will find the Patients Bill of Rights for our state.

betrayed5years posted 3/28/2013 23:14 PM

Just finished talking with Spouse who is in medical field. A volutary admission can refuse any medication..their right to control their life.

Doctors are only human that have the degree that says they can "practice medicine" and that is what most doctors practice. We are the "patients" who have to have lots of patience for those doctors that need more practice. One of my best doctors told me that sick people are called "patients" just for that reason, and it sure makes sense to me.

Tell your friend she has lots of support for her and her ill husband!!!

SouthernGal posted 3/28/2013 23:21 PM

First and perhaps most importantly the likelihood of depakote causing liver failure in an adult is very slim. The side effect is exceedingly rare to begin with and when it does occur it occurs most often in children under 2 who are being treated for seizures. So unless he has a history of alcohol abuse or a metabolic disorder this is a very low priority risk.

Second all medications have side effects. It boils down to benefit v risk. Depakote is a highly effective, and relatively quick acting and efficacious medication. The benefit likely outweighs the risk.

Third, looking through my texts and various sources I don't find any indication that the kind of pain you're vaguely describing, third-hand no less, is attributed as a side effect of depakote. Given that he has some clearly serious mental health issues it is very likely that the effects he is reporting are either being misunderstood/overly dramatized by his wife, are not the result of the depakote, or are psychosomatic.

Even in an involuntary committal the patient has the right to refuse to take meds or accept treatments. In order to override the patient's rights there must be a court order and those are not easy to get. Judges tend to be pretty leery of stripping patients of their rights.

However, those are his rights to exercise and not hers. As long as he is conscious and mentally competent they are his decisions to make from a legal standpoint. A Durable Power of Attorney assigning a Healthcare Surrogate is only a viable document in cases where the patient is unable to make decisions for his/herself - for example is the patient is comatose or has been ruled incompetent by a court.

Additionally, as hard as this is to hear about someone we love, patients in mental health crises and who are undergoing in-patient treatment and drug therapies with heavy-duty psych meds are notoriously unreliable. They say things that are simply not true or accurate either because they want to ger out of the facility or because the meds blur the lines of reality for them, or because the meds are not working yet. There is a very real possibility that not everything her husband is saying is factually true.

I am not saying that docs never make mistakes ... But if I believed every psych patient who told me their meds caused them pain, that they were being held against their will, that their nurses beat them, that their drugs were tainted, etc. I would have had to believe that every patient in the facility was the victim of a huge conspiracy to do harm.

When she speaks to her husband's doctor I would suggest that she remain calm and ask questions rather than putting the doc on the defensive because there is every possibility that her husband's version of the truth may differ from the actual truth.

[This message edited by SouthernGal at 11:29 PM, March 28th (Thursday)]

5454real posted 3/28/2013 23:31 PM

I just want to add that it is the patients right, and I stress patients right to determine treatment. Different facilities have slightly differing policies regarding spouses, but if H is deemed mentally competent, it probably will all have to go through him. The Dr. cannot legally divulge information without his patients consent. It would be up to H to give permission to divulge treatment and diagnostic info.

stillhere09 posted 3/29/2013 00:20 AM

betrayed5years, 5454real, thank you.

SouthernGal, thanks for the info on Depakote. Her H is dangerously underweight. He has had no drugs for several years, other than pot, which he FINALLY recently quit.

The pain I'm referring to is extreme, and in his joints to the point that he can barely walk, and only then tiny slow steps. The nurses all see it. It happens about an hour after taking the meds and lasts several hours. When he got home, it was the same until he weaned off depakote. The dr. said it was a normal side effect. He also has a lot of pain in his chest and stomach and it makes him nauseous. The dr. said this is a normal side effect as well that will lessen in time, (although it's my understanding that he'll be weaned off in less than a month.)He was unable to sleep at night because of it, and until he slept at night, they wouldn't release him. (This was probably a plus for his wife, I thought, but the poor guy!)

The side effects are not dramatized, as I was witness to it.

I don't believe the dr. is making a mistake, except for a great lack of communication, but he needs to at least consider a less dangerous drug or else explain why not. IMO, if the drug has even a slight risk of hepatitis, it is not worth it. If he contracts that, he gives it to her.

As to the info he is giving, you may be right; we have no way of knowing if what he says is accurate, as he is really bad off due to his condition (whatever it is) and the drugs they are giving him. However, the pain is very obviously real. He can eat extremely little, and is often doubled over. His eyes are glazed, and when his W asked him, "Well, did you tell the dr or nurse that you are in pain?" his answer was "no." He doesn't speak up for himself at all, to the point that he doesn't even give them needed info.

She has tried to give the nurses info that she gets from him, and they brush it off, I suppose because it isn't coming directly from him. So frustrating.

And heartbreaking for her. This is her H that she is very close to. When she speaks to nurse or dr. she is a bit timid herself, very calm tone of voice. Only after she leaves the hospital does she break down in tears.

She had what she thought was a normal H all this time.

Thanks for info on patients' rights.

SouthernGal posted 3/29/2013 00:35 AM

Depakote may in very rare cases cause liver failure or an inflammation of the liver (hepat = liver, itis = inflammation). But it does not cause Hepatitis A, B, or C. Those are viral diseases. The hepatitis or pancreatitis that can be caused by depakote are not viral or bacterial diseases and cannot be transmitted to another person. Your friend is in no danger. And again the risks are very small. Far smaller than the risk of a patient who is suffering command hallucinations harming himself. Again risks vs benefits.

Nothing in any of the resources I have available to me shoes generalized pain or joint pain as a side effect of depakote. I'm not saying he isn't in pain. I'm saying that it may very well not be caused by the depakote.

As an aside-

If her H isn't telling the nurses there isn't much that can be done. I can take medical history information from a family member and note in the chart where the info came from. I cannot, however, chart that a patient reports pain based on the say-so of a family member. And even less than that could I do something to treat the pain (even calling the doctor to report it) if the patient isn't telling me he is in pain. If he isn't speaking up there is only so much the medical staff can do.

[This message edited by SouthernGal at 12:43 AM, March 29th (Friday)]

newnormal posted 3/29/2013 07:21 AM

Southerngal is spot-on with her comments. I work in this field.

I want to add a few comments. Depakote can cause upset stomach, and if he is not eating much his stomach acid can certainly make him feel sick. But not joint pain. That is something else, maybe thyroid for example. Another reason not to worry about hepatitis from Depakote is that they do blood work that watches for anything starting. ... before it does any harm. But again, it's very, very rare and Depakote is the best drug.

However, there are other drugs to try like lithium or Trileptal. My question is if his main problem is voices, why are they not trying an antipsychotic like Risperdal, zyprexa or Seroquel? If I were hearing voices I would personally want to be on Haldol, but that's just my choice based on my medical history and choice of side effect risk. The patient will have these same choices.

Each state has its own privacy laws. In my state we cannot say anything to anyone unless the patient agrees and signs a consent forms. Visitation is only a few times a week when we have enough employees and security to make sure visitors are not bringing in weapons or drugs. I know that is not your friends intent, but we want to keep the other patients safe. I've seen family members being in letal tablets of drugs and all sorts of shanks, plastic so it got past the mental detectors. Harsh visitation? You bet. But we take our patients safety very seriously.

Lastly, some psychiatrists do not have the best bedside manner. But you can see that at any medical facility. The good news is that with the like it or not health care changes physicians are getting new found pressure to provide excellent bedside manner to patients and families. Their paycheck will depend on it.

Ok, ill get off my soapbox now and get to work. But I am so passionate about mental health. I want the best for our patients. They deserve better than the current system.

damncutekitty posted 3/29/2013 07:46 AM

The hospital that your friend's H is at should have a patient advocate. She should contact that person. It was my experience (when I was in a psych ward) that everyone there assumed I'd been in the system before and knew the routine. My family and I were all freaked out and really had no idea how the whole psych ward thing went and NOBODY explained anything to us. It was a terrible experience for me. (I mean, on top of having a nervous breakdown)

If he's gotten really bad she may need to get a temporary power of attourney or something. Really they can't tell her much because it's considered patient privacy. So unless it's been pre-arranged that she can hear confidential patient info then she.. can't.

tushnurse posted 3/29/2013 08:14 AM

I think this can vary state to state, but this what I can tell you.

The facility will/should always get permission to do anything invasive, this would include ECT. If she is his spouse and they deem him incompetent, then she should be the first go to person. Frequently nurses in facilities will go straight to the spouse for decision making on the medical side of things (this is a HUGE pet peeve of mine) You do not become incompetent because you are a patient, or have rec'd pain medication. If he is alert and oriented, and judgement is not impaired per the psych, and neuro guys he should be able to make his own decisions.

She should reach out to the Case Manager/ Care Manager/ or Social Worker if this is a legit concern. If they are adjusting meds, and not doing any invasive treatment, there is no need for consent on that.

I hope this helps. When he gets well she and he should fill out a Healthcare directive so she can be his legal decision maker if and when he is ever unable to make his own decisions.

I wish them luck.

why2008 posted 3/29/2013 10:37 AM

The hospital that your friend's H is at should have a patient advocate. She should contact that person. It was my experience (when I was in a psych ward) that everyone there assumed I'd been in the system before and knew the routine. My family and I were all freaked out and really had no idea how the whole psych ward thing went and NOBODY explained anything to us. It was a terrible experience for me. (I mean, on top of having a nervous breakdown)
If he's gotten really bad she may need to get a temporary power of attourney or something. Really they can't tell her much because it's considered patient privacy. So unless it's been pre-arranged that she can hear confidential patient info then she.. can't.

I was going to post the exact same advice, talk to the patient advocate.

Find out what kind of consent form or POA can give her access to her husbands doc.

Just because they are married does not mean that she is allowed to intervene in his medical treatment. It is in fact illegal to share patient info with the patients consent.

I am so sorry your friend and her husband are going through this.

Rollercoaster posted 3/30/2013 02:36 AM

However, there are other drugs to try like lithium or Trileptal. My question is if his main problem is voices, why are they not trying an antipsychotic like Risperdal, zyprexa or Seroquel?

What I was going to say.

From what you described it sounds more like schizophrenia or schizoaffective disorder than bipolar.

I wish doctors would be more willing to work with mentally ill patient's families. It would be so much more helpful to both the patient and the family.

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