TO: Members of the Environmental Matters Committee
RE:
Mental Hygiene - Involuntary Admission, Emergency Evaluation, and Clinical
Review
- Standards
House Bill 923 - Hearing March 5, 2002
The federal Americans with Disabilities Act governs institutionalization of the mentally ill. House Bill 923 would alter this State's stance as to institutionalization of the mentally ill. For that reason, great care should be exercised in passing or amending this bill.
House Bill 923 makes the assumption that evaluating clinicians 1) are competent, 2) are impartial and 3) are acting in good faith. It will be shown in this presentation that none of the above are necessarily true.
House Bill 923 also does not take note that the practice of psychiatry relies a great deal on hearsay, innuendo and gossip, generally unsubstantiated.
The point should be made in the context of House Bill 923 is that the clinicians generate the record and are in custody and control of the record. Pages can be added, deleted or substituted. Blanks on existing documents can be filled in at a later time.
House Bill 923 may sound good in theory, but it fails in practice. The integrity of the emergency evaluation, involuntary commitment and clinical review panel should be called into question.
The purpose of this presentation is to give a personal case history of my emergency evaluations of March of last year, my involuntary admissions to University of Maryland Hospital, my involuntary admission hearing, and the clinical review panel that evaluated my case.
My case is a case in point and will be illustrative of the typical handling of persons with mental illness even without House Bill 923.
Background
I was diagnosed with bipolar disorder ("manic depression") in 1979. Throughout the 1980s I was hospitalized a total of five times, mostly at Johns Hopkins. Then in 1990, I became a patient of an experienced, mature psychiatrist who established a medication regimen that would suffice for nine years, the last two of which were at the University of Maryland Outpatient Department of Psychiatry at 701 West Pratt Street in Baltimore City. I approached the University of Maryland Outpatient Clinic because I had very little money and could not afford a psychiatrist. I was approved for the "Compassionate Care" program, went to an intake interview and was assigned to resident Patricia Nnadi. When that resident rotated, I was assigned to resident Laura Gaffney.
I have a B.A. from the University of Pennsylvania in Science, was a National Merit Scholarship recipient, and was a Benjamin Franklin Scholar and a member of the General Honors group. I spent years working as a paralegal or a medical, engineering, legal or general secretary.
When Laura Gaffney rotated, I was assigned to Doris Balis and had exactly one visit with her. In October, 1999, due to a series of personal circumstances, I was emergency petitioned by my sister Janice and was offered and accepted voluntary admission at the University of Maryland Hospital.
By records from the 1999 admission obtained from my insurance company, I found out recently:
After discharge from the Adult Day Hospital, I was discharged to the Outpatient Clinic again at 701 West Pratt Street. Doris Balis was the attending physician. Because I was still having problems with alcohol, Balis assured me I could be referred to the Baltimore Recovery Systems. About this time, I started seeing social worker Sharon Lerner. Lerner told me she and Balis decided Harbor City Unlimited would be more suitable but that there was a five month waiting list.
Maryland Health Partners (MHP), a private branch of the Mental Hygiene Administration, approved funding for the Harbor City Unlimited (HCU) program. HCU is a functioning part of the University of Maryland Department of Psychiatry. After the five month delay, I found that HCU does not detox for alcohol. After two home visits by Mary Ellen Cahill, Ed., I was assigned to Dwain Howard, who carried the title of "Flex Counselor", and Dana Tarbox, who carried the title of "Program Planner". Dwain Howard had no education beyond GED and functioned mostly as a driver. Dana was a first year student at the University of Maryland School of Social Work.
By the time of the March 7 Petition for Emergency Evaluation my prescribed medications by Doris Balis were nortriptyline 50 mg, lithium 300 mg morning and 600 mg night, loxapine 5 mg PRN and Ambien 5 mg PRN.
Further information on the course of my outpatient treatment at University of Maryland Outpatient Clinic, its residents and Dr. Balis, can be found on my website:
The website area on Mental Health issues is clearly marked.
Documentary History
A
Letter of transmittal from State Farm Insurance Company of entire record of first admission.
Request for records dated October 3, 2001. The records were received on February 16, 2002. The records did not include admission summaries and did not include records from the Outpatient Clinic at 701 West Pratt Street, Harbor City Unlimited or Baltimore Crisis Response, Inc.
Transmittal letter for certified tape of involuntary commitment hearing, March 19, 2001.
B
Matters relating to outpatient treatment (Doris Balis, attending). Bipolar Realities email, fax mail to Balis and social worker Sharon Lerner re Rite Aid letter an need for renewal of prescription for nortriptyline. Prescription slip from Doris Balis - loxapine 5 mg PRN.
C
Petition for Emergency Evaluation dated March 7 by a Shantisse White, a person never known to me. Co-mentioned is Sharon Lerner, LCSW-C who had no legal authority to file any emergency evaluation petition as of that date. I found out at the involuntary commitment hearing that Dwain Howard had reported I went outside with "no clothes on" when I answered the door in a bathrobe. He also reported I had "barricaded" myself when I refused him entry. He apparently also had reported that I had stopped drinking as evidenced by the absence of beer bottles in my house, a factor never again repeated in the medical record. Items 9. and 10. are beyond the ability or knowledge of either Shantisse White or Sharon Lerner - they were done under the supervision of an (unnamed) doctor.
The remainder of the documents are evidence of the emergency room evaluation of that night and discharge at 2:30 am with nothing but a raincoat, cotton robe, bedroom slippers and two sets of house keys.
A nurse at the emergency room said I was "excused" and "you have to leave now". I found myself outside the emergency room dressed as above - there was no other choice - I walked home. No social worker popped out offering a ride home. The ER staff looked away when I walked past them. Embarking on what could have been a dangerous walk through inner city Baltimore, I arrived at my home shortly after 3 am, fed the dogs, had something to eat, and took a long bath. I fell asleep on the living room couch wearing a terry cloth bathrobe.
D
Petition for Emergency Evaluation submitted by Diane Ossip, a person not known to me and who never examined me. This Petition is not that carried by the Peace Officer who transported me to the hospital. That Petition merely said "psychotic, may harm herself". It was a postdated xerox copy. This Petition here was filed later and backdated. That is why the second and third pages are blank. This document was probably completed after the involuntary commitment had been completed and it appears to be completed in a different handwriting. The drugs mentioned were those variously I had been taking over the course of treatment in the Outpatient Clinic under assorted residents but they (tellingly) omit nortriptyline and the loxapine 5 mg prn mentioned above. If I took all the drugs listed in the quantities listed, I would probably be dead or brain damaged.
The Notice of Hearing Involuntary Admission to Mental Health Facility is defective to the extent I was never examined by a Dr. Baldomero or a Dr. Worodi. I was examined by a Dr. Bolgiano and the first year resident Ece Tek. There is no indication in the University of Maryland Hospital record that I was seen by Dr. Edward Bolgiano. The next two pages indicate that resident Tek filled out a form in her own handwriting and merely got a signature of Dr. Baldomero.
The next page is computer generated. "Taking clothes off in front of opened doors" comes from Dwain Howard, the driver of Harbor City Unlimited when I answered the door in a bathrobe. "Walking streets" is a way University Hospital covers up the fact they had let me out the night before with no place else to go except home.
The Notification to Individual of Admission Status and Rights is the boilerplate document the patient is asked to sign once arriving at the ward.
The next pages are from the Petition for Writ of Habeas Corpus filed after the clinical review panel. These pages refer to the legality of the Emergency Petitions and the experiences with the police.
On March 8, the day of the second emergency petition, the Hospital withheld food until just before second transfer to the ward. That meant that from the time the police officer drove me to the Hospital before about 3 pm until about 9 pm, and from the night before, I had nothing to eat for at least 16 hours. It is noted in the record that I was "vociferous" about food along with "labile, angry and irritable".
On March 9, after the involuntary commitment, while I was sitting in the hall in the ward, Doris Balis approached me and sat down. In the private and unwitnessed conversation, she asked, "What happened the other night?" I responded, "I walked home." She exclaimed, "That's dangerous!" and stood up and started to walk off talking about OPD resident de Guzman. I used the Greek word for "wine" (xrasĦ). "That means wine", she said. "OĦno means wine, too.", I replied. That was the last time I saw her until the clinical review hearing.
E
Involuntary Commitment Hearing. That portion of my Petition for Writ of Habeas Corpus filed after the clinical review panel along with the Certification of Administrative Law Judge England is attached. Also not present, along with Diane Ossip, was Sharon Lerner the social worker. Sharon was said by the resident and attending physicians to be my "therapist". No mention of Doris Balis was made either as my outpatient psychiatrist or supervisor of my inpatient treatment. The "Current Medications" list transmitted by the Outpatient Clinic (Balis) in the hands of resident Joseph Mullen omitted nortriptyline. The Administrative Law Judge England asked about "wandering the streets" and "consuming alcohol". He concluded by citing "not eating", "not sleeping" ("not refuted by expert testimony", i.e., the Public Defender), "house was infested" (according to attending physician Angela Udebiuwa citing Sharon Lerner), "wandering street", and "inviting strangers in the house" (i.e., Diane Ossip and her compatriots at the urging on Dwain Howard). The ALJ concluded I was therefore a threat to my own life and safety. He asked if the case would be considered by a clinical review panel.
F
About 25 days later, the Clinical Review Panel consisted of Doris Balis, Dwain Howard, the first year resident assigned to my case (Deniece Oldham) and a social worker who had never spoken with me (Janis Raynor). The "decision", according to Dr. Balis, is that I would go to a group home (supervised housing). The rationale, according to her was that I "do too many dangerous things", also, "I'm too trusting", and "When you're drinking, you have no judgment." Whatever presentations were made are probably not recorded in the record, the first year resident for the remaining 30+ days on the ward stated that I belonged in a State hospital. The social worker would not entertain any notion of going home with out "24/7 round the clock LPN supervision" at a cost of $6,000 per month. When I asked at the hearing, "What about my house?" Social Worker Janis Raynor said, "You can visit your house maybe for a couple of hours, once a week."
That portion of my Petition for Writ of Habeas Corpus including Affidavit in Forma Pauperis relative to Departmental matters and matters shared with Doris Balis prior to admission. Two additional pages describe how I detoxed myself from alcohol without the assistance of Harbor City Unlimited, Baltimore Recovery Systems or any other entity recommended to me by the University of Maryland.
G
Bipolar Realities. This is a document introduced previously. About the 45th day of my 56 day detention, I had multiple copies made and distributed them to the nursing staff and around the ward. The 1st year resident Deniece Oldham came to me wanting to talk about it (I never did talk directly to the attending physician Udebiuwa.) The only thing Oldham had to say about it was she "was not the dregs of my medical school class" - "In fact, I did well in med school." Since this person had been telling me for about 30 days that I belonged in a State hospital, I (tellingly) said nothing.
A day or two later, my neuroleptic, loxapine, was increased to 40 mg, certain to cause tardive dyskinesia. I experienced extreme leg tremors and jerky movements in my arms and hands. Until then I had been stable at least since the time of writing the Petition for Writ of Habeas Corpus. (At that time, for the first time, they added Neurontin to my regimen.) It is apparent that with regard to the First Amendment, I might have done better in a prison.
H
About ten days after the clinical review hearing, social worker Janis Raynor approached me for the first time. "You have no choice. You go to a group home and participate on a weekday program called Almost Family, or go to a State hospital and the result will be the same." I said, "I'll take my chances at the State hospital." After some days waiting for the Petition for Writ of Habeas Corpus to be heard, I was saying (consistently), "I'm going to the State hospital to get a better doctor and a better social worker."
Attached as Exhibit H are two products of the same social worker Janis Raynor. As before, none of the people listed on the "Involuntary Admission" form ever interviewed me though Udebiuwa was the attending physician at University of Maryland Hospital. The Spring Grove Hospital Center Admission Screening Form is also the product of Janis Raynor.
I
I was at Spring Grove Hospital from May 4 through June 2, 2001. I found that I had been preceded by a discharge summary written by 1st year resident Deniece Oldham and an admission summary written by 1st year resident Joseph Mullen, based in whole or in part on the two defective Emergency Evaluations. Spring Grove Dr. Yu, was competent, experienced and conscientious. The month I spent at Spring Grove can be said to be almost wholly overcoming the records from University of Maryland that preceded me.
About ten days after admission to Spring Grove, I received a Terminal notice from the Circuit Court for Baltimore City. I could tell from the form the case had been assigned to Judge Alfred Nance, but I didn't know what the number meant.
Only after I had been discharged from Spring Grove was I able to call the Court to find out the fate of my petition. The day after I talked to the person knowledgeable about Terminal numbers, I received an Order of the Court dismissing the case. According to the document, a hearing was held on May 30, 2001 and neither party appeared. I was still at Spring Grove on May 30 and had never received a notice of hearing. It was a Petition for Writ of Habeas Corpus. At least prisoners are transported for hearings.
J
CareFirst Blue Cross and Blue Shield Summary of "Benefits". The shortfall has been handled by Maryland Health Partners to my knowledge (the State has mailed me a form to disclose all my assets and I was told before admission that "they take your house").
The $100 and $125 charges down the middle were for 5-10 minute interviews with 1st year residents Joseph Mullen and Deniece Oldham. The $28,100 fee was for that University of Maryland Hospital charges above and beyond the capacity of my insurance (31st to 56th day) (in other words, a few days after the clinical review panel hearing).
Compare the $14,196 and $507 charges from Spring Grove with the University of Maryland $28,110 for a comparable period of time with lesser staff.