Legal Issues

ddunnrn · Jul 31, 2012

I don't think Allnurses is meant to be the place for dispensing legal advice, but speaking in general, a court order of some sort is generally required to detain a person for any reason. The implementation varies from state to state. Here in PA, a medical involuntary commitment is very difficult to obtain, and the standard is even more restrictive than the mental health commitments. I once tried to obtain a medical commitment on a severe diabetic with inappropriate behavior who was refusing treatment and wanted to leave, and I was on the phone with a judge 5 hours to get an order just for a finger stick blood sugar test. The rules are there to protect the rights of the individual, but sometimes they can hinder appropriate medical treatment.

elkpark · Jul 31, 2012

Someone can be detained in a hospital (med-surg) if it is determined by someone qualified/credentialed to do so that the individual does not have the mental capacity at the present time (because of an acute impairment, which might include being s/p an overdose) to make a decision about leaving. Capacity is an issue that has nothing whatsoever to do with, and entirely separate from, involuntary commitment.

However, an individual's capacity to make a particular healthcare decision is a very flexible, individualized matter, and can change from hour to hour (if not moment to moment). I would think a facility could easily get into some kind of legal trouble if it had a blanket policy that no one with X diagnosis/scenario (like s/p drug overdose) is allowed to choose to leave.

tinasueb73 · Aug 1, 2012

I appreciate the responses. I simply wondered with the economy and the influx of patients that are often seen with these types of problems, how to protect my license. Patients have a right even though it may not be what we think is best, there is simply that fine line...

Orca, ADN, ASN, RN · Aug 1, 2012

Can a patient be detained in any facility without a involuntarily committment certificate or if a patient is a suspected "overdose", is it within our guidelines to attempt to keep someone hospitalized if they do not want to be?

Generally speaking, a patient must be a clear danger to him/herself or others to be detained, and the doctor must initiate emergency detention order proceedings for this to happen.

Several years ago I was involved in a situation in which there was a dispute when a patient wanted to leave my mental health unit. The patient called his attorney, who came to visit him. The attorney demanded the immediate release of the patient, which I told him I did not have the authority to do without a physician order. He threatened to have me arrested. In the meantime, the patient's psychiatrist came to the unit for rounds. He got into a heated argument with the lawyer, which I had to ask them to take to a private area to keep from disturbing the other patients. Meanwhile the patient - who was the most calm and rational of all the principals in this - apologized to the staff for what the situation had degenerated into. The house supervisor came by and she was worried about the situation, but I told her to just continue her rounds and I would call her when the dust settled. Finally I called our unit medical director - a more experienced and level-headed individual than the one fighting with the attorney, and a veteran psychiatrist himself. He asked me if I believed the patient qualified for an emergency detention order, and I told him "no". He asked me to bring the other psychiatrist to the phone. They talked it out, and the patient was allowed to leave AMA.

It was a lot crazier than it needed to be. I never understood the attending psychiatrist's obsession with keeping the patient on the unit regardless of what the patient wanted, because he wasn't dangerous.