In general, psychiatric calls involve a patient who is transported either voluntarily or involuntarily. Involuntary transports involve paperwork that people like physicians, psychiatrists and law enforcement officers can initiate based on whether a patient is potentially going to harm him- or herself.
Often, EMS crews can bring such patients directly to psychiatric receiving facilities if there isn’t a medical issue. Otherwise, these psychiatric facilities require clearance from the EDs for such obvious problems as injuries and drug/alcohol use, as they technically aren’t medical facilities. Many times, they require clearance even for patients with such minor issues as a cut finger or consumption of a beer.
Typically, there are not a whole lot of such facilities in each system. For instance, we may be talking about – and I’m just guessing – 1 or 2 psychiatric facilities for every 10 basic EDs in a given region. In other words, not a whole lot of options.
We’re at the residence of a young woman in her mid-teens, and her family is there. A mental health professional (MHP) from a nearby community clinic is on scene as part of a weekly follow-up. So are the cops.
The girl is polite and cooperative, and has agreed to be voluntarily transported to the psychiatric receiving facility for juveniles because of suicidal ideation. Because of that, the cops have written no paperwork, and I agree with that, because it’s one less unnecessary negative item in her record. Being a busy place, I bid the cops a good night.
We lead the girl into the ambulance. There is absolutely no reason for us to bring her for medical clearance, and I place a call to our intended facility to give them a heads-up.
Well, they want paperwork. Even though this is voluntary.
“Why didn’t the police write paperwork?”
“Because she’s coming with us willingly. We don’t make it a habit to write unnecessary paperwork, and I don’t like to burden patients with another piece of paperwork in their records if they are asking for help and perfectly happy to come with us. This isn’t a positive piece of paperwork, you know…”
They then imply that they would refuse to accept her with the paperwork, without explicitly saying so.
Now the alternative is to bring her to a basic ED, and they can arrange to transfer her to a psychiatric facility, which is most likely going to be the same one that I just spoke to. I don’t want to bring her to the ED, because she absolutely doesn’t need to go there. We’re going to waste a bed, and she’s going to sit there for hours for no reason awaiting the transfer. The ED may or may not write the involuntary confinement paperwork.
Her MHP is still at the residence with the family, so I go to talk to her to see what she thinks. She agrees that the facility that hinted they were going to refuse the patient without paperwork is ultimately the most appropriate destination.
So I do what I do not like doing – I ask the cops to come back out. Just for a stupid piece of paperwork.
Since this isn’t Pleasantville, it takes the cops quite a while to get back out here. Fortunately the same officer shows up, and fortunately he is cool, as I sheepishly explain to him the circumstances.
He writes the paperwork, and we’re on our way.
So, all in all, trying to do the right thing in my mind cost us about 90 extra minutes.
“This is why no one ever does the right thing.”