Our California Legislature is considering a bill, AB 1300 (Assemblymember Ridley Thomas, D-Los Angeles), that would allow emergency room (ER) physicians to release psychiatric patients brought into their ER’s on a psychiatric detention, known as a “5150”, without any input from a psychiatrist.
Currently, when a patient in psychiatric crisis is brought to an ER on a “5150”, the hospital discharges the patient to a psychiatric facility where that patient receives a comprehensive psychiatric evaluation. Alternatively, a psychiatrist can remove the “5150” in the ER after assessing that the person no longer meets the “5150”criteria of danger to self, danger to others, or grave disability.
The purpose of this system is to ensure that the most seriously disturbed patients, those that are suicidal, threatening, or so impaired they cannot provide for their most basic needs, are psychiatrically evaluated to make certain they are not released while they remain acutely ill.
Imagine if your son or daughter with a serious mental disorder is brought on a “5150” to an ER. Under this proposal, they might be discharged to the streets by a busy ER doctor after a quick once over without ever getting a proper psychiatric evaluation. ER doctors are great at saving lives when patients come in with heart attacks or traumatic injuries. But those same doctors are poorly trained in psychiatry and have little time to complete a psychiatric exam while dealing with a myriad of medical emergencies.
The needs of these psychiatric patients differ radically from that of medical patients and cannot be met by emergency room doctors, conclusions arrived at in a new article in the Western Journal of Emergency Medicine. I have witnessed this inability repeatedly as a psychiatrist who worked evaluating “5150” holds for over 35 years.
California hospitals’ lobbying for AB 1300, gutting protections for the most vulnerable psychiatric patients, is inexcusable and would result in a revolving door in which patients in crisis are rapidly discharged only to cycle back into the ER or worse become a tragic statistic. Arguments that ER’s are overcrowded and rapid psychiatric services are unavailable do not justify the end result of AB 1300, dumping people in psychiatric crisis onto the street, when instead hospitals can creatively rebuild this broken system to ensure psychiatric access and minimize overcrowding by, for example, permitting ER physicians to call a psychiatrist from an approved list for a telephone consultation or utilize telepsychiatry to obtain permission to discontinue these holds in cases in which that ER physician believes the hold is no longer warranted.
Ed’s Note: Milton Lorig, M.D, J.D. is a recently retired psychiatrist and board member of the Union of American Physicians and Dentists.