Clinic Vignette March 30th, 2006

driving in my car, i got a phone call from a distraught mom.

the question of doing "car medicine" with cell phones will be saved for another post, but the issues are seriuos - i wonder what the cost-benefit ratio is of "care given" vs auto accidents with cell phone use... would my car insurance count as liability insurance in that case? is there a special medicare billing modifyer that covers cell phone use but discounts for multi-tasking since likely you are talking on your own personal time? so many questions...

but back to the distraught mom. her son is a 40yo heroin user. still lives at home. he's been my patient trying to detox off heroin for a few months. over the past few days she reports that he is acting strange, hallucinating, disorganized, leaving the stove on and almost burning down the house with cigarettes. she had already tried unsuccessfully to convince him to get mental help, to enter a rehab facility, she had called the police to pick him up for his own safety (and hers), had called the mental health center twice seeking help. she was told repeatedly that since he is an adult, if he doesn't want to come in on his own, he doesn't have to, regardless of the fact that he is clearly incompetant to make that initial decision.

now i am all for personal autonomy, patient autonomy. but there is a line in our society between competancy and incompetancy. when someone is ill enough that they cannot care for themselves, that they are a danger to themselves or others, we respect the fact that they can be picked and evaluated by mental health experts. it's not jail. it's supposed to be done with good intentions, i.e. the express welfare of that person. and if the evaluation shows they are competant and perhaps the person calling is crazy or misguided, or trying to lock away someone they dislike, the system figures that out and lets the person go.

but why didn't our system, police or mental health, assist this woman with at least an evaluation? so there i am driving up 4th street on my way to pick up some pvc parts for a grey water system at 4pm and this mom is asking me to help her. my first step was to give her the special code words we use in healthcare - call the mental health center and say, "he is incompetant, he is hallucinating and is a danger to himself and others," don't focus on the drug use, heroin doesn't make you hallucinate. didn't work. she called me back and said they refused her concerns. next step was for me to fax the police dept with a "pick-up" order. that apparently is the right buracratic (side note - i am sick and tired of trying to remember how to spell bureacreaucy so from now on i'm going fenetic) form. i didn't have the form and it was 4 :30 and i'm now in the hardware store.

luckily, those guys are kinda cool and they let me fax off a prescription with the order. got a call back that the script wasn't adequate, couldn't i get the right form. NO! but thru some negotiations and begging, i convinced the police to at least send a cruiser by the house and look in on the situation. that way they could decide if he was a danger or not, at least. they went, thankfully, and actually took him in to the mental health center where he was evaluated.

the mom called me the next day to say thankyou. and then reported that they sent him home because he was an adult and didn't want to stay.

she heard my suggestion to call her county commissioners or the press, because what the heck else could she do? she hung up crying.

andru