Interface of legal and clinical issues in emergency settings

1. Interface of legal and clinical issues in emergency settings Kathleen Crapanzano, M.D. Office of Mental Health Medical Director

2. Documents in your packet • PEC subcommittee report • Louisiana Mental Health law regarding PEC’s, OPC’s • Copy of PEC, OPC form

3. Ways to enter the hospital voluntarily • Informal voluntary admission • Formal voluntary admission • Noncontested admission

4. Criteria to sign in voluntarily • Person realizes he/she is in a psychiatric facility • Person realizes he/she is making an application for admission • Person understands the nature of his/her status and provisions governing discharge or conversion to an involuntary status

5. Ways to get to the hospital involuntarily • By emergency certificate • By peace officer • Protective custody (OPC)

6. Info on PEC • Can be signed by physician, psychologist, or psychiatric nurse practitioner • Can be signed only after an “actual evaluation” of a person within 72 hours of the signing of the certificate • Can be signed if a person is deemed to be in need of immediate care and treatment because the person is gravely disabled, dangerous to himself, dangerous to others

7. More on the PEC • After admission on a PEC, the coroner will be immediately notified • Coroner is to examine a person on PEC within 72 hours and may extend the PEC for up to 15 days until a hearing is held

8. Peace officer • A peace officer may take someone into protective custody and transport him to a treatment facility for evaluation when he has grounds to believe the person is a proper subject for involuntary admission to a hospital • Upon arrival at treatment facility, the escorting peace officer is relieved of any further responsibility

9. Definition of “Treatment facility” • A community mental health center • A public or private general hospital • A public or private mental hospital • A detoxification center • A substance abuse clinic • A substance abuse inpatient facility

10. Protective Custody • Upon the request of a credible person, the coroner or a judge of a court of competent jurisdiction may order a person to be taken into protective custody and taken to treatment facility or coroner’s office for evaluation. • The order is valid for 72 hours, but the person must be brought to a treatment facility or the coroner’s office within 12 hours of being taken into protective custody. • In the event of an OPC, the second certificate is signed by a physician of the treatment facility

11. Questions regarding the use of OPC’s and PEC’s • If a person shows up in the emergency room on a PEC and is evaluated by ER doc who doesn’t believe the person to be suicidal, homicidal or gravely disabled, can he/she let that person go?

12. Questions regarding the use of OPC’s and PEC’s • Can the police pass up a private emergency room to bring a patient on OPC or PEC to a public emergency room?

13. Questions regarding the use of OPC’s and PEC’s • Are the police compelled to pick up people from MHC’s to bring to emergency rooms?

14. Questions regarding the use of OPC’s and PEC’s • Are mental health clinics required to serve as treatment facilities? • Can they refuse to serve as treatment facilities?

15. Questions regarding the use of OPC’s and PEC’s • Why do mental health clinics “dump” their PEC patients in ER at 4:30? • Why don’t mental health clinics try to find beds for people instead of sending them to ER’s?

16. Questions regarding the use of OPC’s and PEC’s • Why do MHC’s sometimes sign PEC’s on people when the people were willing to be admitted?

17. Questions regarding the use of OPC’s and PEC’s • What can ER’s do with people who are PEC’d but there are no hospital beds?

18. Summary • Problems occur at interface of mental health and emergency room, often related to PEC problems • Resources are limited on both sides • Local discussions with law enforcement, private hospitals, coroners, mental health, and LSU ER staff may be helpful