Telephone order to sign patient to voluntary?

[janikc]

Hey guys,

For those who work in a psychiatric inpatient unit, have you ever heard of patients coming in on a CON and then the nurses assessing the patient and calling the provider for a telephone order to sign the patient to voluntary status? Without them being seen by a psychiatrist or NP? I have emailed the BON and they said they cannot comment on the legality of this and that it is acceptable for an RN to assess a patient and call a doctor for orders (well duh). They don't seem to understand that a CON is a legal document and I don't think it is within an RNs scope of practice to sign them over voluntary without psych eval. Sure, we are getting a telephone order to do so. But it's based off of an RN's assessment. Oh and this is just on uninsured patients. You know, the ones facilities get state funding for. Does this sound normal to anyone? If it does or if anyone else has heard of this please let me know, we are at a loss for what to do. Management is pushing it and the BON isn't backing us up.

Thanks!

[VegGal, BSN, RN]

Following.

[verene, MSN]

Per: TN Code § 33-6-404 (2018) Certificate of need for emergency treatment and transportation

IF

(1)

(A) a licensed physician, psychologist, or designated professional takes a person into custody under § 33-6-402, OR

(B) a person is brought to the physician, psychologist, or designated professional for examination under this section,

THEN

(2) the physician, psychologist, or designated professional shall immediately examine the person and decide whether the person is subject to admission to a hospital or treatment resource under § 33-6-403, AND

(3) (A) IF

(i) the person is not subject to admission, THEN

(ii) the physician, psychologist, or designated professional shall release the person, AND(B) IF

(i) the person is subject to admission, THEN

(ii) the physician, psychologist, or designated professional shall complete a certificate of need for the emergency diagnosis, evaluation, and treatment showing the factual foundation for the conclusions on each item of § 33-6-403, AND

(iii) the physician, psychologist, or designated professional shall assess the person's clinical needs and need for physical restraint or vehicle security and determine the mode of transportation to the hospital in consultation with the mandatory pre-screening agent, other mental health professional familiar with the person, or a knowledgeable family member, AND

(iv) if admission is sought at a state-owned or operated hospital or treatment resource, the physician, psychologist or designated professional shall verify that the state-owned or operated hospital or treatment resource has been contacted and has available suitable accommodations, acknowledging such verification in writing.

Per TN Code § 33-1-101 (20) (2018)

(20) "Qualified mental health professional" means a person who is licensed in the state, if required for the profession, and who is a psychiatrist; physician with expertise in psychiatry as determined by training, education, or experience; psychologist with health service provider designation; psychological examiner or senior psychological examiner; licensed master's social worker with two (2) years of mental health experience or licensed clinical social worker; marital and family therapist; nurse with a master's degree in nursing who functions as a psychiatric nurse; professional counselor; or if the person is providing service to service recipients who are children, any of the above educational credentials plus mental health experience with children;”

Additionally the CON form seems to indicate that second evaluation MUST be completed by a physician and MUST be completed either face-to-face or telehealth examination. (see form: https://www.tn.gov/content/dam/tn/mentalhealth/documents/MH-5542_Form.pdf)

Now I'm not a legal professional and can't offer legal advice, but I strongly suggest taking the above information to your organization's physicians and your organization's legal team for review.

Additionally, because involuntary commitment is a legal matter, you may seek clarification from the regulatory body which oversees rules and regulations pertaining to mental health, which in TN is Department of Mental Health and Substance Abuse Services: https://www.tn.gov/behavioral-health/mental-health---substance-abuse-law.html