HB 1323: Does this worry you?

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I had to look this up after hearing a story about it on WTOP on the way home. Here is the HB1323 Summary. Emergency room doctors are apparently complaining about the current process where they have to call a designated psychologist for an independent evaluation before having a magistrate issue a Temporary Detention Order (TDO).

With all the weight that is being attached to this process and the extreme ramifications of TDOs in other bills that are a knee jerk reaction to the VT massacre, why the hell do we want to make it any easier to have someone ordered for treatment? After all, wasn't Cho orded to treatment under the current process?

As a side note, why (other than the insurance lobby) are we allowing by law those who are deemed a threat to themselves and others to be treated on an outpatient basis. Wouldn't we want to keep a threat to society contained?


I just had to rant to other intelligent folks that care.

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any emergency physician who has been trained to perform emergency psychiatric evaluations

Click to expand...

As the language in the bill does not address the level and extent of the training needed for an ER doc to qualify to perform emergency psychiatric evaluations, it is my guess that the doc would have to meet the same training qualifications as a non-ER doc currently possesses. Years of study in that field with a residency, if not also an internship. Too lazy to see what the AMA specifically says and what the State Board of Medicine requires for licensing in that specialty.

We should not speak too loudly of this, as the bill's supporters might catch on and amend it to "fix" that little issue.

In the meantime, We should, as you note, focus on the issue of "committing" folks to outpatient treatment. As you point out, if you are a danger to yourself, others, or substantially unable to care for yourself you need to be controlled. Showing up once a week for 55 minutes is not being controlled.

I'd like to see all the bills trying to deal with involuntary outpatient treatment get shot down based on the theory that a person has (with limited exceptions such as being a danger to others) the right - thanks to the Supreme Court - to refuse treatment. If nothing else, there is a good constitutional argument that if you are not bad off enough to be locked up they cannot force you to into treatment.

I do not recall off the top of my head the SCOTUS case from the 70's that resulted in the great deinstitutionalizationof MH wards, but basically it was decided on the issue of one either being a danger to others or not. SCOTUS said in essence you cannot have your cake and eat it too - if the person is no longer a danger you have to let them go.

Bottom line - it's "feel good" legislation.

stay safe.

skidmark

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http://www.inrich.com/cva/ric/news.apx.-content-articles-RTD-2008-01-12-0119.html

The Timesdispatch article today mentioned the physician's desire to bypass the local CSB but the wording of the bill does not allow for that:

"...and only after an in-person evaluation by an employee or a designee of the local community services board..."

Also,

"any recommendation from a physician or clinical psychologist treating the person, including any emergency physician who has been trained to perform emergency psychiatric evaluations"

It's just a recommendation from the MD, the CSB does not have to follow that. I don't see the need to further define the scope of the Emergency Physician as it already states that the recommendations from "a physician"- this would include any type of MD per this wording.

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I only worry when the voices in my head tell me to be worried.

In all seriousness, there are a lot of people out there that need significant mental health help. I am much more worried that there will not be funding to support the legislation.

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Funding and Inpatient Bed space are the biggest issues. All this talk of committing more people are going to jam up the Emergency Depts even further while inpatient beds are sought. I thought Mark Warner "fixed" these issues when they began to shuffle the psych resources to the communities instead of inpatient facilities years ago:banghead:?