Jump to content
2019 Nursing Salary Survey Read more... ×

Holding voluntary patients - illegally?

Psychiatric   (3,491 Views 61 Comments)
by SoCal student SoCal student (Member)

1 Like; 2,374 Visitors; 48 Posts

advertisement

You are reading page 4 of Holding voluntary patients - illegally?. If you want to start from the beginning Go to First Page.

bgxyrnf has 10 years experience.

6 Likes; 10,640 Visitors; 1,208 Posts

I can't imagine a jury would ever find me liable for not opening the doors in this case. I think they'd find issues with the hospital's policies and training.
I can imagine it quite easily. By refusing to unlock the door, you are imprisoning this person against their will. Unless you can justify it based on the patient's evident lack of capacity, it's easy to envision a jury entering a judgment against you.

Were I empaneled, I'd be 1/12 of the vote.

Share this post


Link to post
Share on other sites

47 Likes; 2 Followers; 102,784 Visitors; 14,620 Posts

I've searched the Nevada statutes and could not find an answer. I haven't asked everyone in my facility as I'm not keen on being marked as anything (even if for a valid reason). I have asked a number of people and, no, they do not know the answer. Figured I'd ask here first before going to the nursing board, dept. of mental health, etc.

Yes, I've worked as a psych nurse both privately and publicly in NV for 6 years. Why don't I know the answer? Ninety-nine percent of my admissions have gone along with the process rather easily. There have been a few instances that escalated to the point of calling a house sup/doc/admin immediately and those patients were discharged quickly. Still, that didn't answer my question of whether we were, up until that point (after the pt. requested AMA), falsely imprisoning them.

Knowing the legal requirements, etc. is important. I agree. In this case, I would assume with false imprisonment being both a tort and a felony, that the law would be fairly identical or at least extremely similar across the entire country.

I am very well-versed in our state's process of initiating a legal hold, certifying it, petitioning patients for court, etc. Most nurses in my facility come to me when they have questions regarding this process. But let's not act like every nurse knows every law. This particular, nuanced question was apparently never important enough to be taught in nursing school (in NV), at various orientations/in-services, etc.

Not a big fan of being accused of some sort of negligence for seeking out the answer to a question that no one seems to know the answer to.

Again, I assume a patient would have every claim to false imprisonment in the same circumstance nationwide. Given that, why can't anyone here answer completely in the affirmative? Maybe because there is confusion and we're nurses, not lawyers.

In NV, various people can initiate a legal hold (LSW, RN, MD, police officer) and it then must be certified by a psychiatrist or psychologist. I've initiated many legal holds.

We do the same as well - try everything we can to talk a patient into staying - which usually works.

I totally agree with you. Especially if you get a particularly litigious patient. I'm not touching them until I need to. But I'm also at this point not unlocking the doors. I can't imagine a jury would ever find me liable for not opening the doors in this case. I think they'd find issues with the hospital's policies and training.

Still, I'd love to have the law on my side and be able to justify any of my actions in real time.

Unless you work in a completely involuntary, locked facility, I don't think there's a difference - that's my point. I would think a voluntary patient in my hospital would have every single right (in terms of AMA) that a voluntary patient in a medical setting would. The only difference is the doors are locked. So they can't just walk out. My hunch is any lawyer worth their salt could easily make a false imprisonment claim if such a patient was not allowed to walk out of a facility for any significant amount of time.

These are state laws; there is no national standard. There's significant variation among states, as the various contributors to this thread have shown.

Good luck with your search.

Share this post


Link to post
Share on other sites

Meriwhen is a ASN, BSN, RN and works as a Psychiatric sheep...er, nurse.

38 Likes; 2 Followers; 2 Articles; 58,865 Visitors; 7,837 Posts

Absolutely.

Unless the patient lacks capacity, autonomy and self-determination rule supreme.

They're patients, not prisoners...

I never said they were prisoners. I just didn't know if there were any differences in how these things worked in a non-psychiatric setting. It may seem a silly question to you, but remember that 98% of my nursing has been in psych settings. I'm used to working in the "it's a whole other ballgame" world.

And I've learned that essentially, there's not really that much difference.

Share this post


Link to post
Share on other sites

245 Likes; 1 Follower; 13,040 Visitors; 1,364 Posts

Totally. And that is my ultimate question. What is the state's legal precedent?

Yea, my employer would fire me if I opened the doors. And it's very unlikely that a patient would come after me personally for liability if I followed policy and, went up the chain.

Still, I want to know my patients' rights within the law so I can effectively advocate for them. I'm sick of sycophants trying to skirt responsibilities and/or make more money for the admins by dismissing patients. If voluntary patients who just happen to be in a locked facility wish to leave AMA and, by law, have the right to be let out of the hospital immediately, I want to know that so I can advocate for them.

You really, really need to learn the law in your state.

In my state, you absolutely cannot let a voluntary psych patient go without a discharge order. Because psych voluntary is not the same as being on a medical unit voluntarily. It's "voluntary" but it's not total freedom to walk out the door. Once the pt expresses they want to leave the doc has 72 hours by law to either discharge or petition involuntary status. The state requires 72 hours, but my facility goes with 48 hrs. If you were to let that pt go in my state you are neglecting your pt. Period. Involuntary patients don't get to sign an AMA and give 72 hours notice at all. They instead go to court every 2 weeks, which is held in the hospital.

But if detox is not psych voluntary then yeah you are in a weird gray area because your unit is locked. It could be to protect cognitively impaired pts but that doesn't mean everyone meets that criteria. So you need to find some stuff out.

If I were you I would be calling my facility legal dept and asking them to give me the low down on what I need to do when a pt tells me to open the ******* door.

Good luck.

Share this post


Link to post
Share on other sites

1 Like; 2,374 Visitors; 48 Posts

I can imagine it quite easily. By refusing to unlock the door, you are imprisoning this person against their will. Unless you can justify it based on the patient's evident lack of capacity, it's easy to envision a jury entering a judgment against you.

Were I empaneled, I'd be 1/12 of the vote.

Maybe I worded it wrong.

Sure, you could find me liable. But, if you're a patient that was falsely imprisoned and you're suing for damages, do you go after the RN or the hospital that enacted policies that, when followed by staff, resulted in the false imprisonment.

As this thread shows, there is a lot of confusion and disagreement in this scenario and I doubt an attorney would waste time going after a nurse that, following established practices and policies of their facility, didn't unlock a door. They would go after the facility or umbrella company.

And while I'm asking all of this to better advocate for my patients, I also stated above that I would not (and have never) unlocked a door for a patient that hadn't already been discharged by the physician.

Sorry, but I think, in a case like this, if you were to vote against the nurse....

I would hope for your sake that you don't find yourself in a suit where, while trying to do no harm, you may not understand the nuances of an uncommon occurrence.

Share this post


Link to post
Share on other sites

245 Likes; 1 Follower; 13,040 Visitors; 1,364 Posts

Since no one who's come along so far is familiar with the law in Nevada, none of us can answer that specific question for you. As I said earlier, if no one at your facility is familiar with the state rules/regs on this question (which I find hard to believe), the state department of mental health can advise you. Have you spent your six years working in psych in Nevada, specifically? If so, how is it you don't already know the answer? Is this the first time this question has come up in your career? Knowing the legal requirements of admission and discharge in psychiatric settings in the state in which you're practicing is important.

Agree with elkpark here. Psych nurses know this. Maybe not when they are brand spanking new, but in 6 years you would understand this.

Share this post


Link to post
Share on other sites
advertisement

1 Like; 2,374 Visitors; 48 Posts

You really, really need to learn the law in your state.

In my state, you absolutely cannot let a voluntary psych patient go without a discharge order. Because psych voluntary is not the same as being on a medical unit voluntarily. It's "voluntary" but it's not total freedom to walk out the door. Once the pt expresses they want to leave the doc has 72 hours by law to either discharge or petition involuntary status. The state requires 72 hours, but my facility goes with 48 hrs. If you were to let that pt go in my state you are neglecting your pt. Period. Involuntary patients don't get to sign an AMA and give 72 hours notice at all. They instead go to court every 2 weeks, which is held in the hospital.

But if detox is not psych voluntary then yeah you are in a weird gray area because your unit is locked. It could be to protect cognitively impaired pts but that doesn't mean everyone meets that criteria. So you need to find some stuff out.

If I were you I would be calling my facility legal dept and asking them to give me the low down on what I need to do when a pt tells me to open the ******* door.

Good luck.

Would you mind pointing me precisely to your state's law that cites this?

If you can't, you're pretty much in the same boat as me.

Agree with elkpark here. Psych nurses know this. Maybe not when they are brand spanking new, but in 6 years you would understand this.

Psych nurses, at least in my state (the sample of co-workers I've asked - the only ones I have asked before asking here), do not know the answer to this. They understand how a legal hold works. They understand how an AMA works. No one has been able to point me specifically to the state law that outlines the patient's rights in this situation.

So I guess that makes me what? Neglectful? Ignorant? Sounds more like the confusion and lack of an easy, straight-forward answer is more a systemic issue than an individual one (me, being a psych nurse of 6 years that "doesn't understand this.").

Share this post


Link to post
Share on other sites

MunoRN has 10 years experience and works as a Critical Care.

44 Likes; 63,207 Visitors; 5,929 Posts

I know that you can't force anyone to undergo medical treatment unless there's a court order. We regularly deal with patients who will take psych meds willingly but refuse the non-psych ones even if it's obvious that they need them. But back to the main topic...

I've done my fair share of AMAs and they've been after the patient has talked to the doctor or I called the MD for the order. But are you saying that a med-surg patient can just walk off the medical floor without any form of discharge order (either in person or given via phone) from the MD? Basically just elope? I wonder what the legal and financial (insurance) ramifications would be for that.

I'm not being facetious in asking--I've never worked on a medical floor. I've only consulted.

I can tell you (in my experience anyway) that 98% of the time, that medical staff is not going to drop everything to call the MD at 0300 when the med-surg patient says, "I want to go." No, they're going to do everything possible first to convince that patient to hold off on leaving until the patient can see the MD, especially in today's litigation-happy world. I know this because more than once I've been called over to that medical floor to do a consult to see if they have any case for placing the patient on any form of psych hold (answer: usually not). And while I'm there, I've also seen staff do a hard sell on the patient to get them to stay. It's not as though they're packing up the bags.

But would the MD be contacted for a discharge order via phone, or do they leave sans order?

It should be noted that physician "orders" are more accurately described as "advice", and the discharge order/advice is part of the medical advice that the patient is going against when they leave AMA, but they certainly have every right to do so unless they have or can be immediately determined to be incapable of making medical decisions. Contrary to popular belief, insurance will still cover hospital stays when the patient leaves AMA, and there are no legal repercussions for the patient for leaving AMA. As my facility discovered, there are however serious legal risks to attempting to hold a patient where no legal basis for a hold exists, aside from potential loss of license, there are serious legal consequences (one of nurses was looking at charges that carried a 5-10 year sentence until charges were dropped).

Share this post


Link to post
Share on other sites

MunoRN has 10 years experience and works as a Critical Care.

44 Likes; 63,207 Visitors; 5,929 Posts

As far as I can find, this is the State of Nevada statute regarding a voluntary mental health admit that wants to leave, as with many of these statutes it's as clear as mud:

Any person admitted to a public or private mental health facility as a voluntary consumer must be released immediately after the filing of a written request for release with the responsible physician or that physician's designee within the normal working day, unless, within 24 hours after the request, the facility changes the status of the person to an emergency admission pursuant to NRS 433A.145. When a person is released pursuant to this subsection, the facility and its agents and employees are not liable for any debts or contractual obligations, medical or otherwise, incurred or damages caused by the actions of the person.

There are at least three different ways of reading that. One is that if the request to be released is made during the "normal working day" then they must be "immediately released", another is that they must be released in the same "normal working day" in which the request was made, although the 24 hour window for changing their status to non-voluntary / "emergency" makes that confusing.

Just based on the basic rules of grammar, it seems to say the patient must be released immediately if their request is made within the normal working day. To read it as allowing the patient to be released later in the day would require an additional comma that isn't in the statute.

Share this post


Link to post
Share on other sites

Meriwhen is a ASN, BSN, RN and works as a Psychiatric sheep...er, nurse.

38 Likes; 2 Followers; 2 Articles; 58,865 Visitors; 7,837 Posts

Absolutely.

Unless the patient lacks capacity, autonomy and self-determination rule supreme.

They're patients, not prisoners...

You know, I just realized that it's usually ME saying this to people, not the other way round :LOL:

Share this post


Link to post
Share on other sites

1 Like; 2,374 Visitors; 48 Posts

As far as I can find, this is the State of Nevada statute regarding a voluntary mental health admit that wants to leave, as with many of these statutes it's as clear as mud:

There are at least three different ways of reading that. One is that if the request to be released is made during the "normal working day" then they must be "immediately released", another is that they must be released in the same "normal working day" in which the request was made, although the 24 hour window for changing their status to non-voluntary / "emergency" makes that confusing.

Just based on the basic rules of grammar, it seems to say the patient must be released immediately if their request is made within the normal working day. To read it as allowing the patient to be released later in the day would require an additional comma that isn't in the statute.

With the exception of the probably purposely confusing run on sentence, this is pretty much exactly what I was looking for. I really appreciate you finding it!

Can you tell me the source of that passage?

Thanks!

Share this post


Link to post
Share on other sites

MunoRN has 10 years experience and works as a Critical Care.

44 Likes; 63,207 Visitors; 5,929 Posts

With the exception of the probably purposely confusing run on sentence, this is pretty much exactly what I was looking for. I really appreciate you finding it!

Can you tell me the source of that passage?

Thanks

Bad Request

Despite saying "bad request" the link seems to work, if not here's the main page:

NRS: CHAPTER 433A - ADMISSION TO MENTAL HEALTH FACILITIES OR PROGRAMS OF COMMUNITY-BASED OR OUTPATIENT SERVICES; HOSPITALIZATION

Go down to and click "NRS 433A.140"

Share this post


Link to post
Share on other sites
×