meds over obj/consent for tx-BIG DIfferece??

Is your new NM new to psych? What she (he?) is advocating would be illegal in my state, and is probably illegal in yours. Gero psych clients don't lose their legal and civil rights just because they are old ... The previous procedure you describe is v. similar to the process I am accustomed to for legally forcing meds in my state. While a signature on a generic consent-to-treat form is a standard part of a voluntary admission, the client retains the right to refuse any medication or treatment once in the hospital (on any unit of the hospital, not just psych!). Once a client does refuse, then the process for legally medicating someone against his/her will can be initiated if necessary.

This issue came up over and over again when I worked as an acute psych surveyor for my state and the Feds (and psych units got in trouble with the state and the Feds for inappropriately medicating clients against their will). Have you talked with the NM about how she (he?) arrived at this position? (I often find it's helpful to reframe the question in situations like this. You may want to ask your NM whether she feels that, if she were in the hospital, it would be okay with her for hospital staff to give her any medication they wanted to, because she had signed a standard consent form on admission, and would it be okay with her if the hospital staff forcibly medicated her if she refused something ... Does she feel that she has a right to refuse medication?? Then why wouldn't your clients?) What do the medical director of the unit and the higher levels of hospital administration say? The hospital legal department can certainly advise y'all about the legal requirements in your state.

Best wishes for a difficult situation ...

yes he is new to psych, and is not real receptive to ?ing, if you know what i mean....as well as his superiors.....i was told by my nite supr. to "follow the chain of command" blah blah.....did that, got nowhere...... can i anonymously contact my state mental hygien legal svs. & have them look into it????

Never hurts to seek legal cousel. Do get copies of all the relavent hospital policies.

Do a search for "Protection and Advocacy" in your state. At one time every state was mandated to have such an agency. Things have changed somewhat now but you still might find something. Another thing you can do is search the statutes yourself, although depending on the state it can be difficult to make any sense of the mental health laws.

As others have said, it sounds like what you describe is illegal anyplace I've worked. There is a recent push to implement "Advance Directives for Psychiatric Patients" in some states, which some healthcare providers interpret as meaning, "Once you sign it, we can do whatever we want to you!" But that's a whole 'nother can of worms!

Hukilau, I don't understand how an "advanced directive for psych patients" would be used to do whatever they want to the patient. I mean, if the advanced directive states exactly what medications are well tolerated by the patient and which ones are to be avoided, then that is the guideline that the health care workers should follow. Or for instance, stating in the document that treating the undersigned in this or that way will make them much more agitated? Maybe I'm just too new at this and don't get it?

Do a search for "Protection and Advocacy" in your state. At one time every state was mandated to have such an agency. Things have changed somewhat now but you still might find something. Another thing you can do is search the statutes yourself, although depending on the state it can be difficult to make any sense of the mental health laws.

As others have said, it sounds like what you describe is illegal anyplace I've worked. There is a recent push to implement "Advance Directives for Psychiatric Patients" in some states, which some healthcare providers interpret as meaning, "Once you sign it, we can do whatever we want to you!" But that's a whole 'nother can of worms!

Hukilau, I don't understand how an "advanced directive for psych patients" would be used to do whatever they want to the patient. I mean, if the advanced directive states exactly what medications are well tolerated by the patient and which ones are to be avoided, then that is the guideline that the health care workers should follow. Or for instance, stating in the document that treating the undersigned in this or that way will make them much more agitated? Maybe I'm just too new at this and don't get it?

It is really great that you are thinking about these issues!

I believe most of what you stated above was, indeed, the intended use of the Mental Health Advance Directive. But the patient should still have the right to refuse medications, even if he previously agreed to it. That's the part that has been abused. In one state where I worked, an advocacy group went to another facility and had patients sign the AD, which then came with the patient to my hospital. During the interview, it became apparent that the patient had no idea what he had signed! And yet some staff were trying to say we could medicate him even if we had to restrain him to do so because he had signed a document that listed that medication as OK!

See the potential for abuse?

Your basic admission interview should cover what is most and least helpful to the patient when he is out of control.

Be aware that the rules are different for all restraint/involuntary treatment issues in med/surg. In a medical care setting medical/nursing personel can get away with much more than they can in a psych environment. It is, or was, routine to restrain a confused patient just to protect an IV line. It was a nursing decision and required minimal documentation. The doctor's order, if there was one, was something like, "light restraints prn for safety."

A geriatric unit is arguably more med/surg than psych.

Perhaps the rules are different from state to state. Where I work. Gero-psych is psych. Thus, the rules regarding restraints remains the same. In fact, once restraints are in place (any restraint) the patient is automatically 1:1.

In terms of refusing treatment, I am surprised your hospital does not have a number to call to report abuse/neglect. We have a number we can call and report any complaint. Your hospital must have a legal department. Also, surprised the docs are willing to go along with this practice.

yes he is new to psych, and is not real receptive to ?ing, if you know what i mean....as well as his superiors.....i was told by my nite supr. to "follow the chain of command" blah blah.....did that, got nowhere...... can i anonymously contact my state mental hygien legal svs. & have them look into it????

A licensed professional is always responsible for his/hers actions irregardless of instructions from management. I would seek clarification thru policy or written statement and try to work with hospital administration and risk management or the legal department to clarify the issues.

While sometimes called for, whistle blowing always has a backlash and should be considered as a last option

Good luck. Would love to hear how this plays out

Connate5