Is removing all meds a common hospital experience, or does this hospital have issues

[DebJ]

23. Thanks Steve. I did take some action today, actually.

This is long and detailed, because this is also going to be the basis of the letter I will be sending in a day or two, to the woman to whom I spoke, so that nothing is forgotten, and it is clear I truly experienced this mess and want to see it improved upon.


I called the operator and asked who to speak to about procedural issues on admissions. (I had asked a nurse for the name of who to contact on this, and she refused to tell me.) The operator said she tried to put me through, but it was busy. I said that actually I was writing a letter, and just needed a name other than the only name on the website (CEO and President). Suddenly, I got put through to Patient Relations.

I had a nice long chat with a woman there. I stressed throughout that I simply wanted things to be better the next time that my son needs their services. I said that I am certain there are many in the hospital system who truly are dedicated to the high and difficult ideals of excellent patient service. I said I was a business manager for many decades, and I know that every system is full of humans and full of faulty procedures or missing procedures they should have.

I first discussed the fact that my son in effect is stripped of all his medications for 48 hours anytime he goes in, and not because a doctor has ordered such, for in fact, no doctor has done anything upon admittance. I pointed out that people who enter the hospital for this service are there precisely because they are not in control of all of their mental processes, and so relying upon them to self-report their medications, with an accurate listing of all current drugs, no old drugs, and at proper doses, doesn't seem like a safe and logical procedure. Likewise, if they have a card in their wallet, is it updated? I pointed out that their hospital is very familiar with my son's regular psychiatrist, as he himself was in charge of the Behavioral Health ward just a year or two ago. I pointed out that my son was admitted around 2 pm Thursday, and that they could have picked up the phone and called his doctor anytime Thursday afternoon or all day Friday, but their choice was to never call. I pointed out that my son's girlfriend had located my son's actual prescription bottles (instead of his med strips) Saturday afternoon, but they told her she could not bring them in until Sunday morning, delaying things yet again.

I explained to her that in every visit that he has been there, I have been told on Day 2 "Oops, seems like the doctor's request for medications just didn't make it to the pharmacy, and that the pharmacy takes up to 24 hours to let the ward know that they do not stock something, and so only after 48 hours of no meds, does anyone begin the process of saying "Ok, get his meds in the original bottles and we will dispense those." I said when we KNOW your pharmacy never stocks a certain med, why can't the intake nurse expedite the process? She said the intake nurse should call the pharmacy and get a reply immediately. I explained to her that this particular medication is for both ADHD and blood pressure control, and that they had forced my 425 lb son (he's 7' tall too) be without his blood pressure medication from Thursday through Sunday afternon.

She began to explain to me how the pharmacy can't stock every medicine, but I gently interjected how thoroughly I understand that, how that is completely sensible, how no hospital can stock everything, nor even everything in the psychiatric category. Lord knows there's enough in that category alone...well, I know, after almost 20 years you become intimately familiar with a huge number of them.

But I then re-emphasized that even with meds they do stock (like klonazepam), they still aren't able to give him his normal dose for days.

I again emphasized that I was a manger for several businesses for many years. That I understand mess ups with procedures and that there will always be some employees somewhere who just don't measure up. That I was certain that the hospital overall wants to have an excellent standard of care, and that they would want to know of these things so as to address them, improve patient care and results, and prevent reoccurrences in the future. Then I told her about the nurse, who I had asked to please tell me who at the hospital I should contact, or the department name, so that I might bring some of my concerns about procedures to their attention, and that she refused to give me a name or department. I said that as a manager, I know I would always want to IMMEDIATELY know of any concerns so that these could be immediately addressed, and I am sure that most likely this is hospital policy, to just give your department's name to anyone who asked for it. I said if I was part of your administration, I would want to insure that everyone in that unit was immediately reminded that this is hospital policy and it needs to be adhered to no matter what.

This went quite well, so then I ventured into the more unclear realm of HIPPA, as concerns an adult with bipolar disorder. I explained what happened with the Celexa, and how the doctor assigned to my son 1) did not change the medication after being made aware that his patient had a previous bad experience, 2) no one would even tell me he had decided to not change it; I had to conclude that after 2 days and 6 shift nurses came and went with no change and no explanation, and 3) that I still very much want to know WHY he decided to not remove this medication...there are many other options available to have addressed my son's needs. I said I really, really, want to know.

The woman had been very pleasant with me, at first the almost falsetto phony type of pleasant she must be for her job, but over the course of our speaking, she came to understand and be comfortable with me, and that all I want is for things to be better next time. She began to explain HIPPA, and I said that my son had signed the release form for me. That the nurses did provide me the information as to what medications he was given, and confirmed that he had indeed taken those medications. She said, "Oh". Then I said after many shifts with no changes, I had specifically asked to be advised, to have explained to me, why the doctor had chosen to leave my son on a medication that had previously been quite harmful to him. What decision-making process over-rode a possible choice to changing the meds? I was told that Brian, the 'social worker', would be the liason with the doctor. I asked him many times to answer this question, and he refused to answer it and simply said other things instead each time I asked.

I also told the woman that as the son of a child with this disorder, I am quite aware that it is likely the best thing that the doctors of adult patients do not consult directly with the parent; that there are hereditary factors that might well mean the parents are themselves also unstable, and speaking with a doctor would be unproductive, a waste of time due to lack of real knowledge of all the shades of practice in psychiatry, and could perhaps even be dangerous. I said it is not a face-to-face that I am requesting. I just want an answer to my question. I told her that my own physician has at times recommended things to me, and I've said "WHAT????". Then she explains her reasoning to me, the pros and cons of various choices, and why she made her recommendation, and then I follow it, or sometimes not, and explain to her why I chose not to do so in that case (such as not using a psych med to help me quit smoking, as a psychiatrist told me that with my family history, I should never, ever touch any of those meds at all unless I was under direct and intense supervision of a professional psychiatrist, and that using psychoactive substances could actually trigger a serious case of bipolar that I would otherwise avoid my entire life. I've never needed any meds for this myself, at all. She wanted to scare the poop out of me, and she did! And I am grateful...not that I even take aspirin unless forced.)

So then the woman in Patient Relations said that over the course of her career there, she has received lots of calls from parents about their adult children in the Behavioral Unit. And she said that she usually doesn't wade into this territory with them, but she would with me. She said it could possibly be the case (hedging about we don't know, etc etc but it COULD be), that my son instructed the doctor himself to NOT tell me what was going on, after he signed the HIPPA. My first response was that this wasn't like my son, but yes when patients are manic there is no point at being surprised at anything. But I strongly doubt it. And I said I have easily obtained the information that he was offered the drug, and that he took it, from the nursing staff; there was no hold on that, so that seems odd. Then I came up with an alternate solution.

I said that in a few weeks, after my son's release and seeing his own p-doc and getting stable again, could my son call and find out the doctor's reasoning for this? He would have a right to know, would he not? She said yes, of course. I said okay, I will still put this in my letter, but we might pursue that also. I said maybe we will never find out anything, but I feel that it is urgent and critical that you, the hospital know that a doctor on your staff who deals with people who are in no position to speak for themselves, went against standard medical practice and gave my son a drug that could do him permanent harm, when he was advised of the patient's prior negative history with that drug, when he was told it was precisely SSRI's that would make my son blow up into severe mania, when there were many other choices and such risk was not necessary, and that he offered no explanation for his choice, even though repeated requests were made for that information, so that we could simply understand.

I also explained to her that my son feels like he may have a legal right to refuse a drug, but that this will mean he is noted as uncooperative and then they will retain him longer and keep him even longer from seeing the p-doc that really knows him well. I said part of that is his current mental state and paranoia, but only part, because he has experienced precisely this in past visits. And that the doctor's refusal this visit to explain his choice of medications for my son does not help this situation. That when a doctor is so busy or whatever that he won't speak more than 2 sentences to a patient in this state, this does not help the patient to feel comfortable in speaking up for himself...no matter what a kindly and wonderful nurse says (I also gave her that nurse's name with high thanks.) I said the entire experience leaves me, as well as my son, feeling that you have my child imprisoned there, that we have no say in his treatment, that his prior medical history will not be considered, and that there are no communications as to what is really going on (ie the reason for the doctor's choice post-advisement of the past history), and so what our experience is, is that my son is a helpless prisoner, and that the doctor feels like an Omniscient and Invisible God who can do as he wants, and we have no say.

As a final note, a friend of mine who just got his PA in May called us today. I explained the situation to him. Our friend is one of those extremely brilliant, exceptionally brilliant people, where it takes you like 30 seconds to see that. He went through a special fast-pace training program and graduated in just two demanding years. (He did already have a bachelor's or masters in science). When he heard me begin my story, he interjected "Who the hell prescribes an SSRI for a patient with bipolar?" Now, our friend did not specialize in any way in psychiatrics, his own family, to my knowledge, does not have any members with bipolar. But, somewhere in his crash courses, his trainers obviously took the time to insure that they mention that you don't prescribe an SSRI to a bipolar person generally speaking at least. I was quite surprised to hear him say this. He does have a steel-trap of a mind, but to blow through that training in 2 years...that was a lot to remember, and he did.

Thanks for all your support steve. It really does help.

Deb


On Edit: I also told her that one possibility that my son's meds weren't changed, is that the doctor had so many patients to deal with, that he never took the time to actually make any kind of decision to change my son's meds. But that the hospital should definitely know about the outcome.