Involuntary Mental Health Detention: Appeals Court Sees Grounds For Patient’s Lawsuit.
Legal Eagle Eye Newsletter for the Nursing Profession
April 2019
A physician will testify for the patient’s lawsuit that the symptoms she exhibited in the emergency room were related to post-concussion syndrome from a traumatic brain injury. The patient’s history given to the triage nurse when she arrived in the emergency room was that she fell and hit her head two days before. She said she noticed since then that she was having odd emotional reactions, unusual fatigue and confusion. Her family reported she had begun "talking funny" since she fell.
The triage nurse, a nurse practitioner and the social worker in the hospital concluded the patient was having psychotic delusions. She was involuntarily detained pending a mental health evaluation and was forcibly medicated with antipsychotic drugs. At the time she was first triaged in the emergency department it is not at all clear that the patient fit the definition of gravely disabled as a result of a mental illness or substance abuse or posed a threat of imminent harm.
COURT OF APPEALS OF WASHINGTON March 19, 2019A former patient sued the hospital, the emergency department nurse practitioner, the emergency physician and his practice group. The patient alleged she was improperly detained for mental health reasons in the emergency department and then committed for four days in the psychiatric unit. The Court of Appeals of Washington reversed the lower court’s decision to dismiss the patient’s case. The lower court had dismissed the case based on the immunity provisions of the state’s involuntary mental health commitment statute.
To hold a person for a mental health evaluation, first responders or medical personnel in first contact with the person must have reason to believe the person at the moment is gravely disabled or presents a likelihood of serious harm to self or others. Grave disability must result from a mental disorder or substance abuse. The person must be in danger of serious physical harm from an inability to provide for his or her own basic human needs for health or safety or have lost cognitive or emotional control of his or her actions.
The Court of Appeals expressly rejected the argument that the triage nurse in the emergency room could legally hold this patient for a few hours to see if psychiatric signs and symptoms developed that would fit the definition of gravely disabled, which would then allow a referral to the local designated mental health professional. Although the Court saw no malicious motivation behind the triage nurse’s actions, the Court did rule that discounting the verified history of a recent head injury and going forward instead with psychiatric treatment for psychosis could be seen as gross negligence.
Gross negligence in going forward with an involuntary mental health hold and treatment is one legal basis for a court to disregard the otherwise very broad legal immunity the law normally gives responders and providers in mental health crises.
Dalen v. Med. Ctr., __ P. 3d __, 2019 WL 1247102 (Wash. App., March 19, 2019).More references from nursinglaw.com
http://www.nursinglaw.com/psychiatric-medication-patient-consent.pdf
http://www.nursinglaw.com/psychmed1.htm
http://www.nursinglaw.com/psychmed2.htm
http://www.nursinglaw.com/psychmed5.htm
http://www.nursinglaw.com/psychiatric-medication-involuntary-nurse-lawsuit.htm