Preview: Dangerous patients ‘warehoused’ at local hospitals
SEATTLE -- Inside every community hospital in King County mentally ill patients are tucked into emergency rooms, put on medical floors, boarded in ICUs for days, weeks, even months.
It is so common hospital officials have a name for the practice.
“When I say warehoused, I am saying we can keep them dry and safe and on their meds, but we are simply not equipped to provide the other care that they need to get better,” said Swedish Vice President of External Affairs Dan Dixon.
The patients themselves are known as ‘psychiatric boarders.’ They are a result of too many psychiatric patients and not enough psychiatric beds at any given time.
“We have a public health crisis,” said Director of King County Mental Health Amnon Shoenfeld.
State law requires individuals who are gravely disabled or a danger to themselves or others to be committed or hospitalized for treatment against their will even if the hospital doesn’t have enough designated psychiatric space for them.
“Last year in King County, the Problem Solvers learned 3,000 people were committed, and more than 2,000 of them had to wait for help,” said KOMO 4 Problem Solver Michelle Esteban.
But what happens when one of those patients becomes violent and lashes out at hospital staffers around them?
It happens more than you may think.
Coming up tonight on KOMO 4 News at 11pm Problem Solver Michelle Esteban exposes the dangers and shares her shocking interviews with nurses who’s lives will never be the same after being attacked. Who is to blame and what can be done to protect patients and staffers? Watch tonight after Castle on KOMO 4 and decide for yourself.
Also please see http://www.drrichardhall.com/ethical.htm Â
Ethical and Legal Implications of Managed Care
Richard C. W. Hall, M.D. CourtesyClinical Professor of Psychiatry University of Florida, Gainesville
It would be interesting for you to also know  how our workers compensation program treats half of these injured workers.  The Workers comp. program  tries to deny treatment to half of these injured workers.  And the workers our not allowed to fight against it in a court of real law.  This adds insult to injury.  Not being able to sue our Dr.s in a court of law as individuals, and giving HMO's and Dr.s the ultimate power to be gatekeepers to the care, treatments, and resources, one receives, or does not receive in our health care system unchecked by the civil legal system creates an adversarial role between health care providers and patients, and gives free reign to HMO's and government programs to administer at will any austerity measures they see fit to put forth on the public.  Once again with out being able to be challenged in  a real court of civil law.  This adversary role is resulting in death of health care workers across this country.  Dr. in Orange county shot this week by an enraged 7 year old, 2 days later an 85 year old man shots a director of nursing here in Stanwood.  I have brought this to the attention of Group Health, The WA. Med Quality Ass. Board, Workers Comp, and the University of Washing Hospital Risk Management, and Senator Nick Harper.  To be told that they can not work to change this problem, you see, they have let me know that the bottom line of the HMO's is more important than taking care of, and protecting patients, and providers. Yes please fund mental health projects ASAP, your are going to need them when half of these health care providers realize after their injured by one of these patients that their injuries are not going to be covered and treated. I have been a male CNA in WA for the past 15 years, who is stuck sitting one to one with mentally ill patients.  In rooms that have glass windows, telephone cords, sharp cornered edges, ect.  Now I find my self going insane because of a system that just is not there for its mentally ill, nor the providers who care for them. Â
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Trying to get someone into the hospital is not as easy as it sounds. They used to have psych wards but they've all been closed. Good luck!!
 @Carol B Yes, they have psych wards. Harborview has several depending on severity, U hospital has several as well. Highline in W. Seattle has a few long term wards. Overlake has at least one. There are crisis units at Harborview and UW as well and DESC has a crisis facility. The problem is that there are still not enough beds.
"Dangerous patients âwarehousedâ at local hospitals" and many of them also choose a political career and become legislators and even senators.
Been a growing issue ever since Reagan kicked the loony bin doors open and all mental health funds have been cut over the decades. Now all they get to do is see pharmacist masquerading as a doctor and get some drugs to hide some of the symptoms but doesn't address the actual problem. Much like all health care is these days.
Mental health should be included in Medicare and then properly funded from the Medicare taxes
@Blindman You should check your facts. It was the Supreme Court case in 1975 O'Connor v. Donaldson, that would be five years prior to Ronald Reagan. Reagan cut federal funding, which is true, and the states should have taken over but they didn't want to take any money from the pork they were spending it on. In all reality Reagan did not kick the loony bin doors open, he shifted financial responsibility where it belongs, the states, and they dropped the ball
 @Blindman Deinstitutionalization actually started with JFK.
@Blindman what does medicare have to do with this? medicare is for those over 65 or on SS disability - and i don't think all mentally ill patients fit those categories
 @justme  @Blindman Most public mental health is funded by medicaid. Medicare is horrible for mental healthcare and none of the public mental health facilities accept medicare for persons on disability.
 @Blindman Not just Reagan, the ACLU did a great job of fighting for the, ehem, right, not to take medications, not to be hospitalized, and creating a rat maze of laws in the protection of rights.
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Here is a chilling thought. In Washington state, at 13 years old, you are, under RCW, able to make ALL decisions on your mental health care, drug, and alcohol treatment. You can refuse medication. You can refuse treatment. If you are committed you can sign yourself out AMA - at 13-freakin'-teen. The only way to get a hard commitment beyond a 72 hours psych hold is by court order. Want your 14 year old to take their meds. You need to file a YAR petition (the child gets a lawyer free, you don't) and convince a judge to make an order. If the child still refuses you got a contempt hearing (which again your child gets a lawyer, you don't) and part of doing a YAR filing is meeting with FRS as part of DSHS and CPS. So yup, you get the government completely in your life. The parents are guilty until proven guilty. Surely you did SOMETHING wrong because precious little wuggums wouldn't be this way if you didn't it.
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The upshot of this is between the massive budget cuts of the Reagan era, the stigma in our society around mental illness, and laws that protect the mentally ill more than the people around them when it comes to rights and placement, has created a perfect storm. Tie into that the, "I don't want to pay for anything other than me and if you don't feel that way you're a commie pinko socialist liberal," who don't seem to understand that if you're too mentally ill to hold a job, you're probably not going to have health insurance either - simply don't want to pony up for the care.
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There is no answer, beyond what we do today - shuffle them from hospital to hospital and when they break the law - throw them in prison. Where the get sicker.
 @Howard Beale  @Blindman You might want to check your facts. You CANNOT AMA at 13 years old. You Cannot AMA if your mental ability is not normal.Â
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In short if you are showing signs of a mental illness you WILL be taken to the ER and you WILL be placed on an 72 hour hold.Â
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Don't spew nonsense when you clearly don't know what your talking about. I would suggest you read Title 71 of the RCW
 @seattleemt  @Howard Beale  @BlindmanÂ
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Don't spew nonsense. OK, provide me a list of all non-state run juvenile lock-down drug and alcohol treatment facilities in Washington state. Key word there is "lock down."
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The answer - zero.
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There is a reason why there is a massive number of treatment centers huddled on the Oregon border along I-5 and the Idaho border on I-90. At 13 years old WITHOUT A COURT ORDER (which is near impossible to get - been there - done that - have the bills - the scars - physical and emotional) you have FULL SAY in your mental health care. You can refuse treatment, you can refuse medication. You can only be taken to an out state facility with permission for the minor (kidnapping charge otherwise). The minor must also agree to go to the out of state lock down facility. Otherwise under RCW then can sign themselves out at anytime - unless there is a specific court order.
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And good luck getting that.
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Oh yes RCW Chapter 71 spells it out quite well.
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RCW 71.34.740 in particular reads quite well on how the deck is stacked against the parents, even on an involuntary medical commitment.
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RCW 70.96A.110 Voluntary treatment of alcoholics or other drug addicts makes it crystal clear. If there is no standing court order, and your 14 or above (sorry 14, not 13) then adios, you can walk right out the door and there is nothing the agency can do - UNLESS they go to the courts for an involuntary.
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Which once again requires parental notification, DSHS FRS getting involved and a court hearing. There are only 21 (last report I read) juvenile inpatient involuntary commitment beds in the entire state of Washington.
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Mental health, drug, and alcohol treatment for our children in this state is a sad joke, at best.
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Educate yourself - and don't talk to me like I'm talking out my ass after the tens of thousands of dollars, lawyers, court hearings, social workers, more lawyers, commissioners, doctors, counselors, social workers, drives to Oregon, exploring broader options I've gone through.
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I'm grateful that son number one is living with roommates, employed, and paying his bills after all that went on. But you don't get the "system"
 @seattleemt  @Howard Beale  @Blindman You CAN AMA when you;re 13 and over. You cannot be held just for being mentally ill. You MUST present a threat to self or others.
 @Howard Beale  @Blindman I'm glad the ACLU fought for that. It should not be easy for the government to force you to take drugs you may not need. The only way they can force you is if the court deems you a threat to yourself or others. I'm fine with that. I don't want pharmacists as the go to person for treating mental illness. I want professional mental health experts to treat mentally ill people. All irrelevant of course. No money left to treat relatively healthy people much less mentally ill people.
I'll tell you who is to blame. All of the people who vote down the itty bittiest slightest tax increase that would add pennies to their property taxes, etc. When we vote no there is so much revenue lost that we cut beds from psych hospitals and services from the disabled. The first services to be cut when there needs to be something cut is healthcare and services for the poor. I'm speaking for the genuine poor and disabled, not the lazy people who don't want to work or the illegals mooching off our sweet deal of a do nothing and still get something system.
@cm257n7   I hate to tell you this but the problem is our elected officials who CHOSE how to spend our money. Some of them think it is more important to pay for the college education of ILLEGAL ALIENS or have the state pay for thier DRY CLEANING bills or pay the entire cost of thier FAMILY cell plan that they wont properly set up to avoid over usage fees. We vote down tax increases because we already know how they spend the money we do give them.
@scared_citizen Yes, I suppose you are right. It's just that when they decide to close the budget gap they cut these types of services first then wonder why we have crazies running around. Maybe we need to start shacking the crazies up in the
governor's mansion. Perhaps that will motivate them to get spending back on track.
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@cm257n7 @scared_citizen The politicians cut these types of services intentionally to hold us all hostage for more and more and more taxes. "If you vote no, we will fire police and fire and not take care of the mentally Ill" It isn't about a lack of revenue, it is a spending problem.
 @cm257n7 You are crazy, no matter how much money we give Olympia it's never enough and they will find a way to waste it all and then ask for more. I am sick of paying through the nose for nothing to be told by the state: "sorry, we misspent 5 million dollars on sound transit, we need another 10," or "well, it's not really legal but we'll need to toll I-90 to pay for 520."
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You must be insane to trust them with any money.
Thanks to all the feel good people out there who thought deinstiutionalization was a good idea.
 @missyk There is an estimated 57,000,000 people in the US with a diagnosed mental illness of one kind or another. If we lock them all up, at a modest cost of say, $40,000 a year it would cost the taxpayers $22,800,000,000. Not a burden most want to bear.
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http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml
http://articles.sun-sentinel.com/1990-02-27/news/9001260683_1_mental-hospitals-patient-florida-state-hospital
@Nic Stevens @missyk I found the money! Money spent on illegals in our country. These are estimates of course... 22 billion in state welfare, 1.9 billion in food stamps, 1.6 billion in federal prison and court costs, 2.5 billion in medicade. We would even have a 5.2 billion dollar surplus!
 @missyk Read the post up above from NW-Economist - they don't want to pay for it missyk. They don't want to pay.
 @Howard Beale  @missyk If by "they" you mean Olympia and with our current taxes, you'd be right.
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There's enough money now to do it, but instead they waste it on stupid crap.Â
When you see your legislators proposing bills to fund college education for illegal aliens instead of using that money to fund help for the mentally ill, use that information to vote properly at the next elections.
Wonder why our medical bills are so high?
Sat it isn't so... Crazies amongst us. Wow...
Wake up WA, you made huge cuts to Western State and they had to close down a lot of beds there. This is happening everywhere around the country too with the budget problems.
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Now, you complain that psychos are going crazy and killing people. Here's a hint: banning guns won't help, getting these psychos help and/or locked up WILL.Â
 @NW-Economist Interesting post, considering that up above you basically declare you don't want to pay what it will cost to get them help and/or locked up.
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A person to mentally ill to function in society and is at high risk of violence is very likely not going to have a job and even more than likely not going to have health insurance. So where exactly do the facilities and beds come from, if you don't want to pay, to "lock them up."
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By the way - I AGREE WITH YOU - but then I don't spin around and write in this exact same discussion, "but I'm not giving anyone a dime to do it with."
 @Howard Beale  @NW-Economist I think his post above has nothing to do with no wanting to pay a dime for mental health. It has more to do with mismanagement of funds already paid to our government.
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So you think that by asking for some more clarity in the appropriation of funds is declaring that one doesn't want to pay? Interesting twist.
 @komotriedtosilenceme  @Howard Beale Exactly, there is no contradiction on my viewpoints, we need to fund this care with EXISTING taxes. What this means is Olympia needs to stop wasting money!
 @Howard Beale  @NW-Economist *not wanting to pay