Psychiatric ‘holds’ for nonpsychiatric patients
Rather than allowing an incompetent patient to come to harm, attorneys may advise physicians to write an order to keep the patient in the hospital. Then, physicians can obtain consent for treatment from family members, making them aware of any physical or chemical restraint that might be needed to continue the patient’s treatment. Depending on the situation and the reasons for the lack of capacity, hospital staff members may later need to help a family member obtain a court’s authorization for emergency guardianship to allow non-urgent care to continue.
Treating physicians also should document the thinking and findings that support their actions. Table 3 provides an outline for this documentation.
Table 3
Detaining a patient for medical-surgical care: 7 components of documentation
| 1. Description of the patient’s refusal or efforts to leave the hospital |
| 2. Patient’s stated reasons for refusing or wanting to leave |
| 3. Reasonable alternatives to discharge that were offered |
| 4. Description of how refusing medical treatment would create a clear risk of physical harm or death |
| 5. Evidence that the patient lacks capacity to give informed consent or to refuse treatment |
| 6. Actions taken by the treating physician (eg, obtaining psychiatric consultation, enlisting other patient services, instituting physical restraint) |
| 7. Person who provided consent to continue treatment and that person’s relationship to patient |
Related Resources
- Appelbaum PS. Clinical practice. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007; 357(18):1834-1840.
- Disability Rights California. Involuntary psychiatric treatment: California’s 72-hour hold and 14-day certification. www.disabilityrightsca.org/pubs/502401.pdf.
- Treatment Advocacy Center. Know the laws in your state. www.treatmentadvocacycenter.org/get-help/know-the-laws-in-your-state.
Disclosure
Dr. Mossman reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Acknowledgment
Dr. Mossman thanks David Schwallie, Esq, for his helpful insights about the topics discussed in this article.
