Sunday, March 22, 2009

Filling in the Blanks: Competency v. Transparency


Please read this carefully, and sign YOUR name if you can relate to single thing I have written below. Please keep in mind that I committed myself to a complete an online project related to healthcare by March 21, 2009, and right now this is the best I can do... recognize that this article is still very much a work a progress... but I need the your help and support personally, professionally and for our brothers and sisters here and across the world who are unable to speak for themselves or access the Internet to join in my campaign for an Army of ONE. Thanks guys... especially to those tweeters and crazies out there who helped carry me through this difficult time... Thx... ElyssaD

MEDICAL ALERT: Patient Safety NOW!

After refusing to sign several documents while seeking treatment at the emergency room on March 7, 2009, I found my self locked up on a 6044 hold at a local hospital in Nashville, Tennessee.

The most critical documents included a complicated consent form (informed consent for treatment) and several others regarding the assignment of benefits, insurance forms, HIPPA compliance, payment responsibility forms, and a few others.

When I requested that I be given a few minutes to read and process the legally binding agreements I was being given, they became angry and impatient.

Part 10: Declarations for Mental Health Treatment

33-6-1001 [NEW]
A competent adult may make a declaration for mental health treatment to express the person’s preferences and instructions about participation in mental health treatment, including hospitalization for a maximum of fifteen (15) days, psychoactive and other medications, and electroconvulsive and other convulsive therapies. The declaration may include consent to or refusal to permit mental health treatment and other instructions and information for mental health service providers.

33-6-1002 [NEW]
(1) (A) a court determines in a proceeding to appoint a conservator under title 34,
chapters 11 and 13, that a person is currently unable to make an informed
decision about mental health treatment as shown by the fact that the person is
not able to understand the proposed procedure, its risks and benefits, and the
available alternative procedures due to a diagnosed mental illness, OR
(B) (i) (a) two physicians examine a person, OR
(b) a physician with expertise in psychiatry by training, education, or
experience and a psychologist designated as a health service
provider examine a person, AND
(ii) the examiners determine that the person is currently unable to make an
informed decision about mental health treatment as shown by the fact
that the person is not able to understand the proposed procedure, its risks
and benefits, and the available alternative procedures due to a diagnosed
mental illness,
(2) the person is “incapable of making mental health treatment decisions” for purposes of this part.

33-6-1003 [NEW; derived in part from Tenn. Code Ann § 34-6-207]
(a) A declaration for mental health treatment continues in effect for two (2) years, for a lesser period if so stated, or until revoked, whichever is sooner. If a declaration for mental health treatment has been invoked and is in effect at expiration under the preceding sentence, the declaration remains effective until the service recipient is capable of making mental health treatment decisions but no more than thirty (30) days after the expiration date. Subsequent declarations shall conform to all requirements of 33-6-1004.
(b) A service recipient may revoke a declaration in whole or in part at any time orally or in writing if the service recipient is capable of making mental health treatment decisions
. (page 189-190)

In retrospect, I suppose it really didn't matter what I was signing, since I clearly have a good argument for diminished capacity, especially now that I have had time to reflect on the sick irony of it all.

After all, how could I be asked to sign a document accepting financial responsibility if I was clearly out of my freakin' mind?

And although one could argue diminished capacity, or no fault by reason of mental defect or disease, hind-sight is 20/20, so I assumed
that I would be held to that contract much like I was held to the terms of my student loans, my car loan, the non-compete clause from my last employer, or even the Columbia music club I signed up for when I was twelve.... you know the one where they send you 12 CDs (or cassette tapes if you hit puberty during the 80's) for the price of a penny???

Yes, they all held me to the terms of my contract... either by hunting me down and harassing me endlessly over the phone; reporting adversely to the credit bureaus, sending me to collection; and even a few times to court in an attempt to collect a debt from a creditor. They all held me to the terms of my contract, so i thought I should be cautious before entering into any others...

In fact, I was in Civil Court yesterday for a being sued for a $21 balance on my water bill. Granted it has since been paid in full and the check has been cashed... but now they have added late fees, attorney fees, court costs and a bunch of other things to the complaint, so I
with the addition of a late fee of $4.50, so you can expect to see me in Court again next Friday, hopefully with an attorney present if I can find one to represent me against this ridiculous claim.

Keep in mind that it will cost me $12 to park; the fact that balance has been paid in full, and for those of you who have been following along and paying attention, don't forget about the four days I went without hot water.

Add to that the 12-24 hours I spent in constant contact with the police regarding a shooting in the just below mine, clearly I must be
hysterical, on drugs, or both to make repeated calls to 862-8600 non-emergency police hotline, and then escalating it by making several calls to 911. Is it any wonder that I am acting just a little bit strange?

Well, to get back to the reason I am writing without reservation today, I currently face eviction and that makes me a bit anxious... because no sooner than I could return home form the Psychiatric Unit and take a hot bath at "my" apartment, that someone showed up from the Sheriff's office to serve me with a warrant (that was written on pink carbon paper and modified multiple times making it difficult to read or understand what I was being charged with, when I needed to be in court, and what I needed to do to adequately defend myself.

So within within hours of being medically cleared and released from a 5-day stay at "Club Head." the Sheriff shows up with eviction papers, and my mother became extremely concerned that I she might lose money if she has to change the flight... well since then she has severed the "family plan contract" and removed me a primary account holder on my cell phone contract, turned off the e-mail and text messaging feature, changed MY password, and has sworn never to speak to me again.

My cell phone number is being held hostage through T-Mobile so I cannot take my number with me to another carrier (even if I had the money or the credit to open an account with another provider, and has
promised to cut off my cell service on the last day of the contract, at midnight tonight (March 22, 2009). All this because I wanted to change my flight to Las Vegas
to attend her fourth wedding to a man she met
less than six months ago... but, I digress... and there I go, talking "crazy" again...

"RESET" ... and now back to the original program...

Back at the hospital... I refused to sign the admission papers until and unless I was given the opportunity to read the forms, process the information, and make an educated decision about the treatment I was requesting for whatever that prompted several people call my parents and my sister, to ask them what the ~ is wrong with me.

In fact, with a few exceptions (for which I am eternally grateful) very few people thought to pick up the phone and call ME.

Instead, they decided it was better to call my mother, who decided to take a holiday in Burlington, Vermont at the time, and didn't bother to check in on anything other than the dress I would be wearing to her Las Vegas wedding. Apparently several people attempted to contact my father's in his Philadelphia office, but he was in Denver at the time, and just left for a two week trip to Austria to lecture on "The Assertion by U.S. Courts of Extraterritorial Jurisdiction" So it is safe to say that he will be unavailable for at least the next two weeks...

Some people gossiped, others deleted me from their "friends list," and one woman actually had the nerve to post a statement online stating that she removed my comments from webspace since I must have been high on drugs to express any anger towards her personally; probably unaware that even if she believes that I was foolish enough to delete her e-mail, the good news about the new FaceBook layout is that they retain a copy... oops!) So while I spent a whole day crying over the e-mail she had sent me, and just passing waiting for computer to be repaired so that I can accurately amend that state,emt, I look forward to doing so. That is what I call transparency, especially since I donated $5.44 without realizing that it was a political organization rather than a grassroots local charity. Lucky for me, or lucky them, when asked about my employer, I had recognized that the I had not officially registered as a lobbyist with the State for this session. So, Miss Kathy... if your offended now, I'm sorry, but I really need that $5.44 back just in case I do take another position as a contract lobbyist with the legislature. I haven't checked with the state yet, since I have too busy "volunteering" and have had the time, tech support, or any ewxtramoney to spend at Star buck's just so I could look up the necessary procedures to see if I am guilty of a possible ethics violation by donating to your "non-partisan" grassroots campaign. Why don't you send me the paperwork, at your convenience, since you have all the technology and volunteers that you need at the -n-p headquarters.

While the woman referenced above may have been the most offensive and outspoken member of my "community," she was not the only one who have made me reconsider how I feel about the community I choose to live in... How difficult could would it have been to pick up the phone and call me, rather than god knows who else, to find out what the ~ was wrong with me.

Perhaps may not have realized that I had witnessed several crimes within the two months; been evicted for non-payment of rent -- that is legally set up so that I do not and can not make adjustments to my basic living expenses.

I requested that about 5 years ago, only to watch other people screw up even more than I did. The problem is, while I have neither the authority or autonomy to make adjustments to that account, I most certainly am held accountable on a day-to-day real world basis.

So for people who did make those calls to my family, the courts, or to whomever it it was who ultimatelyt decided it was in the best interest of the community to remove me from it... I would rather not read about it when i receive a copy of the 6044 order. I would appreciate if you would call me personally or send me a confidential e-mail to let me know, so that I don't have to hear about it from some doctor, lawyer, my parents (who fit into both categories) or read about it in the paper.

I you feel I need to be removed from my home for my own safety or the safety of others, then I suggest you try libving here for a few weeks on my income, with my bills, and my expenses, and my neighbors... then tell me what you would do and where you would go?

Perhaps a greater concern and reason to be removed is because of the chronic and violent crime that several times each month in the apartment complex where I live. That might be appropriate. And if you would like to why I still live here, well, then just send me an e-mail, and I'll tell you why. My hands are killing me and if I don;t get up now (thanks Maria B for that suggestion!!!) Even if I get NOTHING accomplished today, I think I still deserve a few moments to enjoy a little bit of sunshine.

To those people who may have been genuinely concerned but kept your distance out of fear, ignorance, or just plain next time instead of calling me, dropping by to see if I was really "OK" most people chose to speak around me rather than with me. I carry my medical records with me, as well as multiple forms of legal identification, such as my state issued driver's license, birth certificate, organ donation card, and a whole bunch of "OCD kits" in case I happened to get stranded in my car and need a pen, a flashlight, bottled water, and a old cell phone that does not have a SIM card, but still dials 911. So please, stop asking people who barely know me at all, what the ~ is wrong with me. I may speak a little bit fast, and a little bit loud, but keep in mind that I have been asking for help (160 words per minute-- thanks Ian) but I have silenced, ignored, and written off by by the Powers That Beat ever since I was a small child. I have a lot to say, if I ever get the chance.

I would have preferred people contact me directly, because none of this occurred within a vacuum or some alternate reality (so far I know thus far).

With very few exceptions, the community I have made my home for the last 13 years failed to take the simple route... clearly it would have been easier to call me or stop by my neighborhood to see if I was truly exaggerating and completed psychotic. This is one example how the simple route would have been far more efficient, effective, and empowering than the less direct route to locate my family scattered throughout the world and the country, each with busy, uncompromising schedules that they do not share with me.

Many people suggested that I "go home," without realizing that THIS is my home. I would not have left home at such an early age if I felt living with either of my parents was at all possible. The answer is no. I have never seen the home my father has lived in for the last 15 years or so, and mother just redecorated her house and the "guest room" in anticipation of her new husband moving into her $850,000 two-bedroom condo just outside of Manhattan.

I am not welcome there. And for the short period of time I did spend "living" after the 9/11 disaster, I slept on the floor in the guest room because it was more comfortable than the pullout sofa.

She had made it quite clear, on more than one occasion that I am not welcome there, and has been known to invite me for "family" get togethers, only to ask me to leave days before I was scheduled to fly out. She has made it quite clear that I am not welcome in her home, and refused to meet me in public unless I agree to wear make-up and decent clothing.

If you want to know what I did to make them so angry, then, and only then, would I suggest you call them to find out. Maybe you could clue me in should you learn anything of value.

"RESET: ... and now back to the original program..."

So back to 6044:

Apparently this (reading the documents before signing and consulting with a person of "sound" mind) was an unreasonable request.

By refusing to sign without being given the opportunity to consult with a member of my immediate family who serves both as my medical proxy and healthcare decision maker, and power of attorney, I was escorted by two security guards to the third floor where all of my personal belongings and cell cell phone were quickly confiscated.

Simply because I refused to sign a blank consent?

It was my understanding that informed consent is the standard of care for medical treatment in the united States. Furthermore, to be denied the opportunity to consult with my medical decision maker, it seems that they should have done so especially if they were planning to administer medical treatment without my consent.

My medical proxy is clearly identified in my medical records, and even listed on the back of my drivers license with a "MR / ICE" [Medical Record / In Case of Emergency.]

So, I refused to sign.

Part 1: Rights of Residential Service Recipients
33-4-101 [Former § 33-3-104(1)]

A person with mental illness, serious emotional disturbance, or developmental disability is entitled to:

(1) Receive visitors during regular visiting hours, and
(2) Communicate, orally or by sending and receiving
uncensored mail, with the service recipient’s family,
attorney, personal physician, minister, and the courts.

All other incoming mail or parcels may be read or opened before being delivered to a service recipient, if the chief officer of the facility believes the action is necessary for the physical or mental health of the service recipient who is the intended recipient. Mail or other communication which is not delivered to the service recipient for whom it is intended shall be returned immediately to the sender. The chief officer may make reasonable rules regarding visitors, visiting hours, and the use of communication resources. (page 115)

Hospital personnel did not pull my primary care records or even attempt to to take a medical history report, or locate my next of kin / emergency contact.

I chose this hospital because it is conveniently located on the same medical campus as my primary care provider, radiologist, and has a contract with my insurance company as as a participating (and preferred) provider.

Given the fact that all of this information was readily accessible [my medical records and providers are conveniently located within the same medical facility and hospital network] I do not feel I was making an unreasonable request.

By refusing that request, I feel the hospital failed to take reasonable safety precautions that are the accepted standard of care within the medical community, and considered to be among the "best practices" identified by the state health boards, accreditation bureaus, professional licensing and certification boards.

After clearly stating my requests, and subsequent objection, I was promptly escorted upstairs by two uniformed security officers who refused to give me there name, employee ID number, show me any type of identification badge or ID number within plain sight or marked on their uniforms.

Once inside the unit, I tried to call my sister, (my medical proxy and emergency contact) to alert her that I was being at the emergency room. They listed the wrong name and MR number on my ID bracelet. I actually had two ID bracelets on with conflicting information, yet neither contained allergy information, or medical history alerts.

Security would not allow me to make a phone call and used excessive force to grab me by the arm and take the cell phone out of my hand.

I explained that I had a medical allergy, and was intolerant to Haley, and have a lesion on my thoracic spine T1-T6 with cord damage and nerve root compression concentrated at T2-T3.

The nursing staff also refused to pull my medical records or take reasonable precautions to ensure my medical or physical safety and did not make any attempt to contact my primary care provider or my sister.

In fact, they claimed that my repeated requests were not only unreasonable, but a threat to my safety and the safety of others. Really???

At that point I held on tight to my deactivated old Nokia cell phone, circa 2001, and attempted to call 911. They quickly and forcefully pulled the phone out of my hands and physically began to restrain me through the use of physical force and medical intervention.

First they grabbed my left arm. pulled the dead cell phone out of my right hand; and escorted me into a room wit no windows, no call buttons, no bathroom, no fire exists or intercom, and no way to contact emergency medical or emergency personnel.
33-3-120 [NEW]

(a) Service recipients have the right to be free from isolation and restraints, in any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraints include physical and mechanical restraints and drugs used to control behavior or to restrict freedom of movement if the drug or the dosage of the drug is not a standard treatment for the service recipient’s medical or psychiatric condition. Isolation is placement of a person alone in a room from which egress is prevented. Isolation and restraint may be used only while the condition justifying its use exists.

(b) A person with mental illness or serious emotional disturbance may be isolated or restrained only in emergency situations if necessary to assure the physical safety of the person or another person nearby or to prevent significant destruction of property. If a person imposes restraints or isolation, the person shall immediately contact a qualified mental health professional who is permitted under department rules to authorize the isolation or restraint. If the treating physician is not the person who orders isolation or restraint, the treating physician shall be consulted as soon as possible. A professional authorized to permit isolation or restraint shall see and evaluate the person for the need for isolation or restraint within one hour of the intervention.

(c) A person with developmental disability may be restrained only as part of an approved plan or in emergency situations if necessary to assure the physical safety of the person or another person nearby or to prevent significant destruction of property. Isolation may only be used with a person with developmental disability as part of the person’s approved plan. Only psychologists, psychological examiners, senior psychological examiners, physicians, behavior analysts, masters degree social workers, and others authorized to do so under department rules may develop a plan that includes or authorizes isolation or restraint of a person with developmental disability.

(d) Staff shall remain in the physical presence of a person in restraint. Staff shall continuously observe a person in isolation or restraint for the health and well being of the person.

(e) The professional shall record the use of restraint or isolation, the reasons for its use, and the duration of its use in the person’s record.

(f) All staff who may have direct contact with a person being restrained or isolated shall receive ongoing education and training in alternative methods for handling behavior and the safe use of isolation and restraint. (page 76-77)

I was forced into submission by two men, for what seemed like a couple of minutes, though I can't be sure since there were no visible clocks and it was right around 2 am on the day we change the clocks for daylights savings time.

After being pushed me into the ground face and stomach against the floor, my arms were twisted behind my back.

I was then placed into an room with no emergency call buttons, intercom, bathroom, fire alarms and forcibly pushed into a plastic mattress in the corner. I mus have either feel asleep or lost consciousness because I woke up several hours later in the same room, with no emergency call buttons, intercom, bathroom, fire alarms, and laying on a plastic mattress in the corner.

With my head still pushed into the plastic mat, and my seems behind my back, one of them removed my black leggings and injected me with an unknown substance.

One of the men returned a few minutes later to taunt me through the observation window. The same man who injected me refused to give me his name, an employee ID number, or the name of the medication I was injected with. He told me he was "self employed" and taunted me about through the observation window. He threatened me, and laughed when I told him that I hope he remembers my face the next time he looks his own daughter in the face.

He thought this was absolutely hysterical, and was laughing uncontrollably and made physical gestures towards me and kept moving towards me despite my repeated requests that to stand two feet away from my body. He kept making rapid threatening movements towards me and removed his identification badge, from his uniform, and told me that unless I sit down he would be forced to physically restrain using whatever means he deemed necessary.

I am trained TAPS (Therapeutic Assault Prevention Systems) and Verbal De-escalation, and received my certification through the State of Tennessee Department of Children's Services, October 15, 2004. I can assure you that there was nothing therapeutic in the way I was restrained.

I was held on 6044 Involunatary Commitment (commonly referred to as a 2PC: Two Physician Commitment.) After four days, I was handed given a document to sign that would transfer me from 6044 / Involuntary status to a voluntary patient, and then gioven a notice that my TennCare would stop payment within 48 hours.

DISCHARGE SUMMARY: (unofficially of course since the nurse I called the other said that patients are not released with discharge summaries...???) but here are my notes I wrote within 48 hours of being discharged:

"I have cuts multiple cuts, bruises, abrasions, ankle pain, and hand and injuries that were not treated or evaluated medically during my stay, Given multiple injections, and discharged without meds. They refused to acknowledge that I have an allergy / intolerance to Haldol.

I have a 4-day supply of Geodon, 18-day supply of Klonopin, all of which must be paid out pof pocket. Trazodone (the cheapest medication I was prescribed) cost $24.19 but was covered by mey TennCare.

I was released without any medication, just a written prescription for three medications; and returned to my apartment where the shooting occured; had to pay $54.00 to retrieve my car from the parking facility, and could not get a ride to the pharmacy until that evening.... several hours AFTER I was shceduled to take my medications. The driver that was sent to pick me up from the hospital through transportation TennCare transportation, told me she did nothave time to take me to the pharmacy, even if only to frop of the [prescriptions to be processed. I was assured that the Geodon would be pre-authorized by TennCare, but it was not. The pharmacy could not even start the appeal process or let me know what the status of the prior-authorization rquest until he had a hard copy of the prescription so it could be run through the system.

Once we learned it had not been approved, it was well after 5 pm on Friday afternoon, so getting prior authorization before MOnday was unlikely. Because Tennessee no longer offers either a 3-day or 14-day emergency supply of medication (resulting from the legal battle known as "Grier" I was basically SOL (sh-t out of luck)

The 18-day supply for Geodon would have cost $243.19. I received 30 tablets. Approximately a 5-day supply since they hospital staff did not get the medication pre-authorized as they were instructed by the physician, the unit supervisor, and pestered relentlesly by me-- Elyssa)

Up until the time I left, I was prescribed Lorazapam which remained active on my medical chart and was never dicontinued, yet I was discharged without a prescription (Ativan 1mg. PRN) tobe taken every 406 hours as needed for anxiety and panic attacks.

I should have taken one before I left the hospital..."

Just before leaving, I asked, just as I had each time I took my meds for the 5 days I spent on the unit, if they were able to locate the record for the second injection that I was given while unconscious on the plastic mat.

"I am waiting for my Celexa to be approved at the pharmacy,
since Effexor was not covered. I have at least puncture wounds from at least 7 injections, cuts and bruises and abrasions, that were not medically treated or evaluated during my stay. In short, I need Geodon prior-authorization, med transport to pharmacy and medical transport to appt on Wednesday, 10am. The Geodon cost $243.19 for the 18-day supply, and the $523.19 for 30 days. Effexor and Cymbalta (ewhich ever is decideldly more therapeutic) requires prior authorization. and I have already requested a copy of my medical records from the psych unit asap. They have 10 days (it is now about 5 remaining) before the
are in violation, and do not feel I should be required to pay $2.00/page for a copy. I had to pay $54 in cash for parking, and this is all I can type for right now. I'm currently loooking at a minimum monthly pharmacy bill of $1650.01.

My monthly income from diasbility is $615.00 which must cover ALL of my living expenses. Maybe I'll write more on this later, maybe not..." Elyssa Durant, March 17th, 2009.

TODAY: Sunday, March 22, 2009:

I have another primary care appointment scheduled for Wednesday, and a psychiatric appointment scheduled for tomorrow. I must be in Civil Court on Friday at 8:45 because I am being sued for water fees ($21-) and was served with papers by the Sheriff's office with hours of returning home. The landlord is in receipt of that money and has "accepoted it with reservations" but is still seeking posession of the premises.

The attorney who represents my Landlord, Eric Stiler, refuses to speak with me over the telephone, and demands that any and all correspondence be sent via fax or first class mail to his Post Office Box. He refuses to accept an electronic copy offrom Legal Aid, that contains a list of precious violations against the property management, Section 8 violations documented by MDHA, or a ntarized affidavit signed by my anattorney authorized by the Social Security Administration to handle all my finances including the receipr of my disability check and the disbursement of my rent, and utilities (telephone and internet not included) the authorized representive MDHA and e-mail documents including a 6-page Affidavit signed by my Representative Payee must be faxed, mailed, but claims that regardless of any documwentation he receives, he will still be seeking eviction since that is what "his client" wants.

I have no fax machine, I am running extremely low on gasoline and printer ink, and my internet is scheduled to be disconnected on March 29, 2009 due to an overdue balance of $123.64.

Note: I originally wrote this email from my cell phone since my laptop computer had been brokem and the library only allows you to use login for 30 minutes at a time. I would say this setup is rather which is rather inefficient at best.

Please join me in an Alliance for Compliance to protect both individual rights, encourage medical compliance, and enhance patient safety, by letting you voice be heard.

-- insert click to call here --

Thank you all,

Elyssa Durant
Cell 615.424.8810
Sent via BlackBerry from T-Mobile

I do hope someone is keeping track of "crazy" posts I have been putting up, since it is very difficult for me to get organized within the technical and finacial contraints I am currently facing. Kindly take note of these complaints.

Because despite how dtramge, or crazy you may believe someone is acting, it would my personal advice to take a second lok before passing judgment or acting out of ofd tuen. You may inadvertently place them in a situation far worse tha the one you believe they are in. I will follow up when I have better access to a computer. ;-)

(modified / updated 3/22/2009 11:46am)

1 comment:



Elyssa D. Durant, Ed.M.