A young adult woman comes to the ED, having been brought there by her mother for having abnormal behavior. Displaying many of the classic signs of mental illness, she is obviously having a mental health crisis. The mother even said that she woke up in the middle of the night with her daughter standing over her with a large knife in her hand. The doctor considered her to be a threat to her own or someone else’s safety, and subsequently signed the Baker Act paperwork.
As I always do, I am explaining to the young lady that she is being held on an involuntary 72 hour psychiatric hold. I am trying to explain the rules to her- she can’t wear her own clothes, can’t have any of her possessions with her, she will be searched, and she can’t go home.
As I am doing that, the mother keeps hovering and trying to talk to her. The girl keeps trying to negotiate and delay: begging her mother to take her home, asking to go to the bathroom, and looking over my shoulder at the exit, obviously planning an escape. The mother keeps insisting that the girl can’t change clothes with me in the room, needs to be permitted to use the bathroom without a male present, kept blathering on about the woman’s rights, and said that she wanted to “take it all back” and sign her daughter out. I explained that it doesn’t work like that. Legally, once the doctor signs that order, the only person who can cancel it is a psychologist, and that is after the patient is examined by that psychologist. The doctor who signed the order can’t even rescind it.
After over an hour of trying to deal with this, I finally told the mother that she needed to be quiet for a minute so I could do my job. She replied with: “Wow! You’re rude.” I called security to come over so we would have someone that is wearing a body camera there for backup. Then I told the mother: “This is how it’s going to be: Your daughter, my patient, needs to be supervised and has to be within sight of a staff member at all times for her own safety. She doesn’t get to decide who or how that is going to happen, as that is all done according to state law and hospital policy. She is going to take her clothes off and put on these paper clothes voluntarily, or I am going to cut her clothes off and dress her by force. If she resists, I will sedate her. If you continue to impede my ability to provide patient care, I will have you removed. This isn’t a debate, it isn’t a negotiation, and this isn’t a courtroom. That’s how it’s going to be. You can either let me do my job in caring for your daughter and I will allow you to stay, or you can keep getting in the way and I will ask you to leave.”
The patient continued to argue and resist, so I gave her 10mg of Haldol after which we got her dressed in the paper gown, and put her down for her nappy nap. I put a hospital employee in her room as a safety sitter. Mom filed a complaint, and when the charge nurse came over to talk to me about it, she said, “I was waiting for you to have enough of that. You were more patient than I would have been.”
13 Comments
Boneman · April 28, 2024 at 6:36 am
Yeah, you were quite … well… “Patient” with the entire situation and utterly correct in your handling of it. Mom and Patient had a decision to make about “compliance” at that point. It was mandatory but… if you want to make a decision NOT to comply, here’s your consequences.
Stated in a way that broached no argument and demonstrated with the (as promised) medication administered when Phase on of “Non Compliance” was initiated.
Some folks are just too thick to understand that CONSEQUENCES are REAL.
Well done.
dc · April 28, 2024 at 7:03 am
I admire your sense of duty. A job like yours takes some real attention to detail and inner/outer strength at every moment of your watch. Hoping today is a quiet one at your ED.
Elrod · April 28, 2024 at 7:28 am
These are the same women who, having called 911 for help after hubby/boyfriend goes a couple rounds smacking them around, suddenly want to recant when the bracelets come out.
Which is why People In Domestics are herded outside, away from knives, heavy ashtrays and table lamps for discussions, and why Smart People arrive with backup and carry a second set of cuffs.
Swapping out a Taser for a dart gun with Haldol seems like it might be a good trade some days……
jimmyPx · April 28, 2024 at 9:09 am
People in Florida have to understand that the Baker Act is the law and very strict once it is engaged.
My adopted daughter was staying with me a few years ago and has some “issues”.
One day my wife and I were at work and I got a panicked call from her that the cops were at our house. I said “why” ? Apparently to get attention she cut herself on social media and was talking about suicide so someone watching called my local PD. I told her to let the cops in and she was Baker Acted and would have to go with them and spend the next 72 hours at the psych facility being evaluated. Luckily the shrinks released her within 24 hours to the care of her existing therapist and she learned a valuable lesson.
I know you guys are busy but maybe it would help if that had a pamphlet they could give when the Baker Act is engaged ?
Divemedic · April 28, 2024 at 9:13 am
What would you suggest be included in that pamphlet? I am always interested in good ideas…
jimmyPx · April 28, 2024 at 9:37 am
Just a quick blurb that the Baker Act is the LAW and it is very strict on procedure. That once engaged, have some bullet points about it like the things that you told the mother that it can only be ended by a shrink and the patient has no choice but to go to the psych facility.
It seems that then if the mother gets mad you can say “i understand but it’s state law” and you guys aren’t the bad guys, the state of Florida is.
jimmyPx · April 28, 2024 at 9:39 am
This is a little much and could be cut down to just a few pages but something like this:
https://www.myflfamilies.com/sites/default/files/2023-03/2014%20Baker%20Act%20Manual_0.pdf
Divemedic · April 28, 2024 at 9:54 am
Yeah, at over 400 pages, that document is not useful. Something else would have to be written. That’s a difficult process because it has to make it past management and the legal team, as well as half a dozen committees. It would largely be a waste of time, because arguing with a psychotic is about as useful as arguing with a drunk. They won’t see reason, because if they could, they wouldn’t be Baker acted in the first place.
As to the families of those, it’s emotion that has them angry, not reason.
I’m not sure that your idea will work.
GuardDuck · April 28, 2024 at 10:15 am
Ha! Good luck.
My wife’s hospital systems ‘workplace violence team’ – management level – took 9 months to agree to the verbiage for a sign in each ED that admonished that they had a zero tolerance policy for violence against medical staff. And the last meeting to agree to it before being sent to the printers – some bozo with a biz degree objected that they weren’t being nice or inclusive and people may feel alienated…..
Rise Again · April 28, 2024 at 10:46 am
SSRI? A lot of the terminal madness is the headshrinker drugs and experimental gene therapy?
There are some serious dedicated people in healthcare and I wouldn’t be here without them. (h/t)
Others are only in it for the paycheck and there even some sadists on a power trip.
Aesop · April 28, 2024 at 10:47 am
In 99% of the times I’ve had a serious problem (other than someone amidst a full-blown psychotic meltdown), it’s not the actual patient, but rather always family or friends “advocating for the patient”, who become the biggest PITA and eventually need to have security explain to them as they’re being dragged out by the hair why they’re being thrown the f**k out of the building.
“Sir/ma’am, you’re interfering with my care of my patient, which isn’t a party foul, it’s an actual criminal act, and you have now crossed over from being a visitor to being a Pain In My Ass the size of Alaska. Your visitation privileges have been revoked for the rest of this shift. That discussion is over, and there’s no appeal. I understand this may be a lot for you to process, so if you go quietly, right this minute, I won’t ask them to ban you tomorrow too. If you refuse to leave with these gentleman, I’ll be calling the police, who will explain the laws in this state about trespassing to you as they take you to jail in handcuffs to be booked. Once I make that call, if you’re still here when they arrive, please believe me when I tell you that nothing on earth will stop you from leaving here in the back of a police car. Additional tantrums at that point range from misdemeanors to felonies. Think very hard about that. You have 5 seconds from now to come to grips with that reality, and start walking out. Otherwise, I suggest you call someone you love to start the process to secure your bail bond. If you have any further questions, you can call hospital administration on Monday morning. 5, 4, 3, 2, 1.”
Divemedic · April 28, 2024 at 11:08 am
One of the things that makes this tough is that Florida passed a law in the wake of COVID that prohibits hospitals from prohibiting visitors, except in the case of a particular patient whose life would be placed in danger. It requires a specific “no visitors” order from a physician. When this was pointed out to me by my charge nurse, I replied that “I am not prohibiting this patient from having visitors, I am simply prohibiting that particular visitor.”
She wasn’t sure that would fly, but I intended on testing the limits if pressed, but you know hospitals can be.
Aesop · April 29, 2024 at 12:38 pm
Agreed. I would take exactly the same course.
“I am not prohibiting all visitors. Just that one obnoxiously rude @$$hole. If you don’t like that, you can assign that patient to someone else, because I’m firing that patient, and I’m not dealing with that @$$hole’s shit any longer. Or Plan B is sending me home now. Would you rather be one visitor short, or one nurse short, in this ED, for the rest of the shift? You’re the boss; I’ll play it whichever way you like.”
BTDTGTTS.
I’m 5-0 on that contest, lifetime, both before and after COVID.
Favorite: One rude @$$hole I ejected came back, same ED, about 5 months later, as a patient. My patient. And having a full-on stroke.
“Why no, Mr. Asshole, I don’t recall meeting you here before. I see a lot of people, and I can’t remember all of them.”
I gave Jerkweed excellent care, but he was shitting bricks over the possibility that a little payback was in order, because we both remembered what an unmitigated shit he’d been when I had him thrown out. Karma can be exquisite.
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