Emergency Room Rights bill–ALIVE!

by Cathy Levin

Thank you for your faithful support for the Emergency Room Rights bill (H.2042). As the number of people with psychiatric histories being treated in emergency departments increases, complaints about discrimination are skyrocketing. Frequently complaints are inferior medical care for psychiatric patients, and harsh methods of control like restraints and forced injections of sedation, and even illegal treatment.

Please see the article pasted below about the ER Rights bill. This article ran in the Telegram & Gazette on Aug 8, 2008. At the end of the formal session on July 31, H.2042 was still in Bills in the 3rd Reading.

However, we understand from Chairman Golden’s office that news of H.2042’s demise has been greatly exaggerated. In fact, 3rd Reading may yet release the ER Rights bill. The bill can make it to the House floor, and it can pass this year. This is very good news.

To the credit of Rep. Ruth B. Balser, who filed H.2042, her bill brought together key decision-makers in government, the medical and psychiatric establishments, and advocates for people with mental health disabilities. For 9-months, since December 2007, the ER Rights bill has kept the leaders of profession organization’s feet to the fire. These historic committee meetings would not have taken place without H.2042.

People in our community’s lives will improve as a result of these committee meetings of ER decision-makers. A new policy statement to end certain emergency department’s practices of strip searching mental health consumers has been sent out to all hospitals in Massachusetts.

Moreover, just today this committee agreed to survey the rate at which restraints are used in emergency department. We, who use emergency departments, know the use of restraints varies widely between hospitals. A culture of respect and dignity uses restraints less often, but hospitals that mistakenly believe restraints are the only way to keep patients and staff safe overuse them. We know from our experience that being left tied down to a bed for hours doesn’t make us feel any safer.

And, in fact, staff members often get injured struggling patients into restraints. Staff members are safest when they are well trained in de-escalation techniques. Treating people with respect and dignity reduces violence. One of the other accomplishments of this terrific committee was opening the doors to involvement of our peers in better staff training.

We are very grateful to Rep. Ruth B. Balser. She wrote H.2042 is such a way as to bring together professional organizations associated with ERs. These high-level committee meetings have been a fascinating and productive process. Her wisdom and vision should be legend.

Now please pass help pass H.2042, so the hard won agreements of this committee can become state regulations. This was is the only that way can we ensure long-lasting reforms.

Please find your house member (state representative) at http://www.wheredoivotema.org. Call the state house at 617-722-2000.

Ask to speak to your state representative’s office. Once you get a receptionist in their office, ask to speak to an aide who handles legislation.

Tell the aide that you support House Bill 2042. Briefly ask them to contact Chairman Golden’s office. This is the only way to get the ER Rights bill released from Golden’s committee!

Go for it!

We need you!

Help yourself and help others like yourself, who need your help.

Your call can make a difference whether you have ever called the state house before about this issue or if you have never called.

Please see the most recent news article below from Aug 8, 2008, and below the article are links to our press file.

Cathy A. Levin

Chairwoman

M-POWER’s Emergency Room Rights Campaign

617-623-0807

~~~~~~~~~~~~~

August 08. 2008 3:10AM

ER rights bill for mentally ill gets lost in crush

Legislative process helps air needs

By Lee Hammel TELEGRAM & GAZETTE STAFF

lhammel@telegram.com

A bill to ensure the rights in emergency rooms of people with psychiatric histories went into the House Committee on Bills in the Third Reading and did not emerge before the end of formal legislative sessions July 31.

But the chairman of the committee that is sometimes thought of as a legislative graveyard said Tuesday that the bill “is still alive.” State Rep. Thomas A. Golden Jr., D-Lowell, said, “It’s still being discussed.”

The bill that was opposed by the Massachusetts Hospital Association, Massachusetts Psychiatric Society, Massachusetts College of Emergency Physicians, and others would have required the state Department of Public Health to write regulations ensuring the rights of people with mental illness in emergency rooms. Even the departments of Public Health and Mental Health opposed the bill, which was sponsored by Rep. Ruth B. Balser, D-Newton, and backed by M-POWER, a psychiatric patients rights organization.

Mr. Golden said that no one asked him to bury the bill. He said “there’s not a particular aspect” of the bill that prevented its being acted upon by July 31, but rather the crush of bills – including two other significant mental health bills – at the end of the legislative session that forced the committee to make hard choices on what could receive the attention of the House of Representatives.

Mr. Golden said he still wants to speak with DPH about the bill: “From what I know, it’s a good piece of legislation, but there could be some unintended consequences.”

With a friend of his having a family member suffering the consequences of psychiatric illness, “I’m in a process right now with a small group of people” from the National Alliance for the Mentally Ill in which he also is visiting providers of psychiatric services in Lowell “to really find out what is going on in the system,” Mr. Golden said. “I’m committed 100 percent that this is going to be better.”

He said that when people with mental illness go to hospital emergency rooms, “many times they felt there’s some embarrassing situations that happen. We need to find a way to make it more user-friendly toward people with mental health problems.”

The bill would impose regulations to address complaints by people with mental illnesses: Their physical symptoms are sometimes ignored after medical personnel learn they have psychiatric histories; they are forced to disrobe when people with physical illnesses are not; and, in general, they endure stigma, indignity and lack of respect in emergency rooms.

While Mr. Golden said many bills are passed by affirmation in the informal sessions of the last five months of the year, he acknowledged that an objection by even one representative can keep a bill from being approved.

“If it doesn’t get through before (the end of the term), I really believe it’s something that would be re-filed, and by that time we’ll have talked to most of the stakeholders and find out how we can make this happen,” he said.

Even though the bill has not passed, said Ms. Balser, House chairman of the Joint Committee on Mental Health and Substance Abuse, “our goals have in large measure been met. These are going to be treated as though they’re going to be regulations.”

In fact, the DPH has notified hospitals they need to comply with a policy that evolved from a consensus reached through meetings between patient rights advocates and medical providers in a process envisioned in Ms. Balser’s bill. Under that guidance, hospitals should rescind any policies they have regarding forced clothing removal that apply only to patients with psychiatric histories.

Paul Dreyer, head of DPH’s bureau of healthcare safety and quality, said efforts are ongoing to develop a similar consensus that DPH could enforce on the issues of restraint and seclusion and on when the emergency room is the proper setting to get psychiatric care. He said complaints of people with psychiatric histories allegedly not being treated properly for physical ailments have gotten lower priority.

Cathy A. Levin, chairwoman of M-POWER’s emergency room rights campaign, also saw the bill as “extraordinarily successful” because it got emergency room doctors and others to negotiate with patients and reach a consensus against forced disrobement.

_____

Order the Telegram & Gazette, delivered daily to your home or office! <http://www.telegram.com/homedelivery> www.telegram.com/homedelivery

PSS. Pasted below is a Lowell Sun article (Aug 19, 2007) about kids getting stuck in emergency departments. Adult members of M-POWER also complain they can sometimes get stuck for 24 hrs, 36 hrs, 2 days or more. Psychiatric patients can get stuck if they have additional complicating factors to their mental health diagnosis, such as cardiac problems, epilepsy, developmental delays, severe psychosis, or history of restraints.

_____

Needing Help, Left to Wait

By Bridget Scrimenti, bscrimenti@lowellsun.com

Article Last Updated: 08/19/2007 07:02:20 AM EDT

Nineteen-year-old  ___________, who has bi-polar disorder, has spent more than 24 hours in the emergency room at Saints Medical Center in Lowell, waiting for treatment. The hospital, like most in Massachusetts, lacks a psychiatric unit, and feels the effects of backlogs elsewhere in the state. SUN / DAVID H. BROW

LOWELL — __________ __________ waited on a gurney for 26 hours.

She came to the emergency room to treat her depression.

But the longer she stayed, the darker her mood grew.

“I felt horrible and hopeless — like I was in a deep ditch and I couldn’t get out,” said __________, who has bi-polar disorder.

While she sat in the hospital hallway, the Lowell 19-year-old watched accident victims being wheeled in on stretchers, a grieving family, and other types of trauma.

Saints Medical Center, like most hospitals in the state, doesn’t have a psychiatric unit.

Instead, ___________, who was 17 at the time, was stuck in the ER for more than a day before she could be placed in a psychiatric treatment facility.

The ER too often becomes a “lock up” situation, said Dr. Peter Gorlin, an emergency room physician at Saints, and president of the Merrimack Valley Independent Physicians Association.

Children “wind up being in the emergency room from two to four days,” Gorlin said. “These are frequently heartbreaking and sad cid:image003.gif@01C9019E.EAFF7300cases — to have an 11-year old who is profoundly depressed.”

Why the long wait?

Children, mostly in state custody, are stuck in psychiatric units for weeks and sometimes months after they’re well enough to go home. Many of these “stuck kids” are waiting to be placed in foster care or another living environment. They cannot go home, because they do not have one.

“When there’s a lot of stuck kids, it’s like a chain reaction. The kids in the emergency room can’t get in,” said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, an organization that represents 46 private inpatient mental-health and substance-abuse facilities in the state.

At a Statehouse hearing in May, Matteodo told the Joint Committee on Mental Health and Substance Abuse that a 12-year-old boy, under the care of the state Department of Social Services, had been waiting in a psychiatric treatment facility for 148 days. The average stay for treatment is usually about 11 days, Matteodo said.

“He is becoming increasingly difficult behaviorally and sometimes has required restraints,” Matteodo wrote in his testimony. This, in turn, brings questions by the state Department of Mental Health as to why the hospital is using restraints on a 12-year-old.

In June, there were 138 children stuck in either psychiatric units or residential-treatment centers in the state, according to the Executive Office of Health and Human Services. The number changes daily, and was taken from a final count on June 30.

The state doesn’t use the term “stuck children.” A day spent waiting is called an “administratively necessary day.” It’s a Medicaid term, which allows the child to stay in the facility, while the state finds them a place to go.

“We don’t like the term ‘stuck children’ because we consider them children the state is working very hard to determine the best discharge plan for, which includes their placement and support services,” said Kathy Betts, assistant secretary for children, youth, and family for the Health and Human Services.

The placements for children vary: Traditional foster care, intensive foster care where the foster parent is trained to deal with behavior issues, a group home, or a residential program with an on-site school.

“These children have had trauma in their lives and have higher instances of behavioral health issues,” Betts said.

At the private Lowell Treatment Center on Varnum Avenue, one child patient has been waiting to leave the facility for about a month. The center provides acute inpatient psychiatric care for children and teens, in addition to partial hospitalization for adults and teens.

Child patients “don’t see it as DSS trying to find an appropriate placement. They see it as ‘no one wants me,’ ” said Jean Barrile, a clinical case manager at the Lowell Treatment Center.

Dr. Mark Miceli, an adolescent and child psychiatrist at the center, said he often has to determine whether a child is suffering from a psychotic disorder or if they’re simply frustrated with the “lack of control” they feel from being hospitalized.

Miceli and other staff members often become like parents to the children, especially those in state custody. Miceli can sometimes be found teaching kids how to throw a football or baseball on the center’s screened-in patio.

“We take a kinder and gentler approach to how we deliver care,” said R.J. Lawson, director of the Lowell Treatment Center. “We don’t want these kids to stop dreaming or aspiring.”

Betts said members of the state Department of Social Services, Department of Mental Health and Department of Youth and Family Services meet every other week to discuss preventative care for child psychiatric patients, and ways to expedite placement for children in treatment facilities.

State Rep. Ruth Balser, D-Newton, is drafting legislation for a children’s mental health bill, which includes setting “a reasonable timeline” for child patients to leave the hospital.

“Its unacceptable for a child who does not need to be hospitalized to be in a hospital for months at a time,” Balser said.

State Rep. Tom Golden wants the area to be a leader in mental-health care.

Golden, a Lowell Democrat, is working with the Department of Mental Health to address long emergency-room waits.

“The emergency departments aren’t doing anything wrong,” he said. “They’re just not equipped to deal with mental-health clients.”

In June, a child psychiatric patient waited in the emergency room at Lowell General Hospital for 21 hours, said Dr. Nate MacDonald, chief of emergency medicine.

“We can keep them safe and we can watch them, but they’re in a holding pattern,” MacDonald said. “They’re not getting comprehensive psychiatric care.”

___________ __________ and her mother, ______________, want to start a support system of volunteers to help families while their children wait in emergency rooms.

“It’s a long road,” ____________ _________ said. “I know what other parents are going through.”