Sometimes we have to transfer psychiatric patients from our hospital to a different hospital. Usually it’s because they came in for a medical problem, somebody realized during their stay that they also had a psychiatric problem, but our psych unit is either full or doesn’t take their insurance.
Regulations say that every transfer from one hospital to another has to be done by ambulance. It doesn’t matter if the patient is in the hospital for depression, or obsessive-compulsive disorder, or something else where it’s hard to see why an ambulance would be necessary. If we send them by some kind of transportation method other than ambulance, maybe they’ll have a heart attack, or decide to commit suicide mid-taxi-ride despite never having been suicidal before, or whatever, and then someone will sue us. So those are the rules. Every transfer has to be done by ambulance (this adds a few thousand dollars onto their final bill, but whatever, that’s the insurance companies’ or the taxpayers’ problem, right?)
Ambulance companies refuse to transport psychiatric patients without a petition. A petition is an official legal paper signed by psychiatrists saying that somebody is a danger to themselves or others and needs to be hospitalized against their will. The ambulance companies say that if they don’t have that, then the patient can just ask them to get off the ambulance at any point, and they could get sued if this caused problems down the line. Or something. I don’t really know what the ambulance companies are thinking.
The problem is, a lot of the time we want to transfer patients who aren’t dangerous or in need of involuntary commitment. A lot of times there’s a depressed person at our hospital, and they’re not suicidal or homicidal or anything, and they’re asking for psychiatric help, and we want to give it to them, but our hospital is full and we need to send them somewhere else.
So the first thing I tried was just to tell the ambulance companies “Yes, we’re sending this patient to another hospital. No, they’re not dangerous.” The ambulance companies said they didn’t care. No petition, no ambulance.
The second thing I tried was explaining this to the patient. “I know you’re requesting to come into the hospital voluntarily, and I know you’re not suicidal and you’re just looking for help, but for bureaucratic reasons I just have to sign this paper that says you’re a grave danger and takes away all of your rights. It doesn’t actually mean anything and it will probably get thrown away after the ambulance ride, although really that’s the other hospital’s call and if they want they can just keep it and then you’ll continue not to have any rights.” This was not popular among patients. Also, it turns out that the legal document says “THIS IS AN OFFICIAL LEGAL DOCUMENT AND YOU HAVE TO SWEAR EVERYTHING ON IT IS TRUE AND IF IT ISN’T THEN YOU ARE GUILTY OF PERJURY AND CAN GO TO JAIL”, so I’m kind of wary about falsifying it.
Now what I do is give the ambulance companies a petition, but instead of actually filling it out I just write in the comments field that the patient is fine and no legal action is required. Whoever is on the receiving side apparently just confirms that they received a petition-looking piece of paper, nobody reads any of it, and the patient gets sent where they need to be without me risking a jail sentence. Although I guess if the patient ever decides to just stop the ambulance and get out halfway, and then gets hit by a car or something, I’m going to get in a lot of trouble.
Everything in medicine is like this.
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