Recently a mother took her fifty-year old son to County Memorial General, one of the largest hospitals in the region. She told the ER staff that her son had not taken his antipsychotic medication in some time and was making absolutely no sense and so on.
An ER doc saw her son briefly and then a psychiatric nurse evaluated him. The nurse requested that we see this gentleman. The nurse reported that this gentleman is grossly psychotic, not able to function , and so on...and not able to make an informed decision about treatment. (OK, you need to remember this part as I'll be referring to it later.)
We get there and agree with the nurse's assessment and start trying to find a TDO bed. (Do you all rememeber...TDO...Temporary Detaining Order?) OK. Hospital A would not take this gentleman because he has Medicare and the free-standing days are exhausted. Hospital B basically just doesn't want to be bothered. Hospital C has no beds. Now, hospital D...well, they seemed they would accept him; however, they jerked me around for over and hour and then declined.
Now, the ER staff knew we were looking for a bed. And, they are used to it sometimes taking more than a day to find one. Anyway, the next morning we found out the son left the ER. Nice. The hospital says this person must be detained and so on and the person is allowed to leave.
OK. Right up front, the hospital has no legal means to force this person to stay at the hospital; however, from a practical standpoint, knowing that the person needs emergency psychiatric care, the hospital could have at a minimum put a sitter in the gentleman's room. (Note, a sitter is just what it says...someone who stays with the patient and who can discourage them from trying to leave.)
I won't even go into the rest of what happened in this case... Quite unpleasant.
OK, same hospital, same ER staff.
A crackhead (don't get all riled up--my dictionary has this word) shows up and says, I'm going to kill myself if I don't get help. Now, keep in mind that using crack is against the law. Yep, it is. And furthermore, keep in mind that few crackheads work. Sooooo, where do the crackheads get the money to buy crack? Good question. I'll let you use your imagination on this one. Ever had your car broken into? Ever had your home burglarized? Ever been knocked on the head and awake to find you no longer have a wallet? Well, you get the idea.
OK. So this criminal comes to an ER, of course he has no money, and of course he'll never pay the hospital bill, demanding, yes, demanding that you provide him with room and board. Actually, they are extorting money from the hospital and the bill is ultimately paid by, guess who? Yes, ladies and gentlemen, for those of us who are silly enough to go out there and work, we're picking up the tab.
Additionally, most likely 90% of these...well.....anyway, are on probation or parole and yes, smoking crack does violate that.
Trust me on this one, over 95% of these folks do not want help in trying to quit using crack. Period. Nope, not going to debate it with you.
Why are they at the hospital? Out of money. Drug dealer after them. Court appearance coming up and they want sympathy or some such thing. The just stole the 5th TV from their family and got kicked out for the 99th time. They used their mom's ATM card and got caught. Or, they just want to take a break, you know, have someone bring them their food and give them a place to stay or hideout for awhile.
Now, this is the good one. I have never heard of a crackhead just outright killing themselves. Period! Yes, a handful may die because of too much crack and cardiac problems or some such thing. However, I've never heard of one to say, I can't get help and kill themselves. Please, if you know of one out there, let me know.
Remember the poor mentally ill fellow mentioned above. Yes, the one that left the hospital. Yes, the one the hospital didn't provide with a sitter. Good.
OK, now we come to another good part.
THE CRACKHEAD CRIMINAL WHO IS LYING ABOUT GOING TO KILL HIMSELF IS GIVEN A SITTER.
In a way it would be funny if it wasn't so pathetic and such a waste of money. Yes, you see them propped up on a gurney and we, yes ladies and gentlemen, we are paying for someone who will sit next to them. Hey, the last thing the old crackhead is going to do is leave!!!! They want that free (to them) room and board.
And, so it goes!!!!!!
Hey, I'm tired of writing this one....and getting a little ticked off.
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Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
We often hear people say the system is "broke." However, the problem is that there isn't a system.... Joseph Heller would be proud. Please note, what follows is from my, most likely, myopic viewpoint and I surely don't claim to have The Big Picture, if there is one. I am definitely at the bottom of the food chain looking up......
This is Emergency Services as its Defined on a Community Services Boards' Web Site
Emergency Services/Crisis Counseling is a State mandated program. This unit provides short-term crisis counseling and referrals to individuals on an emergency basis. Emergency and crisis response services include: telephone interventions; face-to-face assessments and evaluation (including pre-admission screening); psychiatric consultation and other clinical consultation about mental health, substance abuse, and special populations which include children, adolescents, geriatric, people with mental retardation, and individuals involved in the forensic system. Emergency Services/Crisis Counseling is staffed 24 hours a day, 7 days a week.
Everything on this website has been thoroughly examined, reviewed, evaluated, and ultimately approved by The Citizens’ Committee for the Advancement of Rational Thought and Actions in Virginia's Mental Health System….
Things Sure Aren't What They Used to be..Conditions Sure Have Changed
coming soon........
Think it's time to post the old First Amendment........ January 17, 2008
Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
Please Read: Important!
Any events that are mentioned or described here actually happened: however, of course the names of any citizens have been changed and the circumstances of the situation have been altered and modified so that they could never be identified.
Who am I and Where am I?
No way, Jose. I have enough problems. Let me just say that I am sure my part of the state is no different than what other folks are trying to come to grips with in Virginia.
I guess I'll just say that I have some idea of what's going on....and let it go at that.
I'm sure you can separate the facts from the opinions......
PS. OK. I'll fess up...yes, I work for an emergency services unit and have for a few years. My opinions are mine and surely I am not speaking for all of the other emergency services' workers throughout the state.
And, my opinions are based on the population that we see day in and day out.
I guess I'll just say that I have some idea of what's going on....and let it go at that.
I'm sure you can separate the facts from the opinions......
PS. OK. I'll fess up...yes, I work for an emergency services unit and have for a few years. My opinions are mine and surely I am not speaking for all of the other emergency services' workers throughout the state.
And, my opinions are based on the population that we see day in and day out.
The Temporary Detention Order (TDO)
The Temporary Detention Order (TDO).
In the Commonwealth of Virginia there is a provision that allows a person to be forced into a psychiatric hospital. Basically the code says, That if because of mental illness a person is imminently dangerous to themselves or others, or if because of mental illness a person is substantially unable to care for themselves, a magistrate may issue the order.
The magistrate will have a probable cause hearing at which time the emergency services' worker and sometimes a petitioner (note: a petitioner is a reliable responsible member of the community who has seen the behavior or heard the words) will give sworn testimony to support the issuance of the TDO. Some jurisdictions require a petitioner and some allow the order to be issued based only on the testimony of the emergency services' worker.
The TDO specifies where the person is and where they are going (to which hospital). It is an order that must be carried out by sworn officers; usually a sheriff's deputy or a police officer.
In the Commonwealth of Virginia there is a provision that allows a person to be forced into a psychiatric hospital. Basically the code says, That if because of mental illness a person is imminently dangerous to themselves or others, or if because of mental illness a person is substantially unable to care for themselves, a magistrate may issue the order.
The magistrate will have a probable cause hearing at which time the emergency services' worker and sometimes a petitioner (note: a petitioner is a reliable responsible member of the community who has seen the behavior or heard the words) will give sworn testimony to support the issuance of the TDO. Some jurisdictions require a petitioner and some allow the order to be issued based only on the testimony of the emergency services' worker.
The TDO specifies where the person is and where they are going (to which hospital). It is an order that must be carried out by sworn officers; usually a sheriff's deputy or a police officer.
What are the steps required to have a TDO issued?
- A police officer, citizen, hospital worker, friend, loved one, relative, requests an evaluation for a TDO
- Information is usually required that would indicate that the person may be meeting criteria
- A face-to-face evaluation is completed
- A screening form is filled out that provides information that supports the request for the TDO...after the evaluation, if the person is not meeting criteria, they are released
- If the person is meeting the criteria a willing facility must be found
- After a hospital is found, the information is presented to the magistrate
- The person is taken to the hospital by law enforcement officers
- At the hospital the officer signs/executes the TDO and turns over the patient to the hospital
Who can request an evaulation for a TDO?
With some exceptions, almost anyone can request an evaluation. Some folks think it must be a family member...not true. Any reliable and responsible citizen may make the request; however, they must have first-hand knowledge of "recent" events that would lead the worker to feel as though the person would meet the criteria. The person requesting the evaulation should be able to describe living conditions and in general overall mental status.