I am at my wits end. Long story short, we have a life-long mentally ill relative on the psychiatric ward of the hospital. Really out of it, doesn’t seem to be improving at all. AND he had been admitted a week before for a physical problem, stayed in the regular hospital a few days, and was then transferred to the psych ward. We’ve been to visit and no one will tell us anything - what his physical problems were, what treatment he might need in the future, if they’re going to put him back into a separate mental hospital, how long he will stay there - nothing. He had just moved into a group home, and those people can’t get any information, either. We have just gotten the runaround, told to go ask at this nurses station, at that nurses station, it’s all “sorry, can’t tell you anything without the patient’s consent”. The doctor, of course, is unavailable… Well, the patient did sign a ‘consent form’ (nothing legal, just a typed letter granting permission for a doctor to give us information, including our phone numbers). It was supposedly relayed to the psychiatrist. That was a week ago and no one has heard anything from anyone…So, right now I’m just waiting by the phone, and I’m a nervous wreck. What should I do, if anything? I understand what patient confidentiality entails, but the patient is not of sound mind (he is really, really out of it, hardly knows where he is). One of the problems is, he was supposed to be set up with a social worker when he moved to the group home, but that agency just put him on a waiting list, so he doesn’t have one yet! So there’s no go-between.
The staff have probably had the importance of HIPAA so thoroughly pounded into their brains that they would rather overcompensate on witholding information that risk breaching patient confidentiality. However, if this patient is not competent to make his own decisions the medical staff should be discussing his care with the next of kin. Does your relative make his own medical decisions? Are you the legal next of kin? When the people at the nursing station refused to tell you anything did you point out that the patient had given consent for you to know about his care?
So 2 things I can think of to do:
Make sure everyone on his treatment team knows that your relative gave permission for them to talk with you. For this to happen there needs to be a copy of that letter in his chart so that the next time someone cites patient confidentiality you can demand that they go look in his chart and then come back to talk with you.
Get in touch with the patient advocate or this hospital’s equivalent. Tell them that your mentally ill relative is in their hospital, no one is communicating with the family and the doctor has been “unavailable” for a week. It’s possible that staff need a hospital specific release of information form before they’ll tell you anything. If that is the case the patient advocate will know about it.
The last time he was in this hospital, he stayed a few weeks and was then transferred for several months to a psychiatric hospital, where there was a social worker who made a plan for his release into a group home. (This SW is no longer involved, though.) A separate agency was supposed to hook him up with a social worker, but he was just put on a list of “urgent cases” - 20, to be exact. So there he was in the group home, waiting to be assigned a SW, and just 2 or 3 weeks later took sick (I think it was a mini-stroke). I don’t know who his next of kin is supposed to be - he has a son who lives in California, but we only see him once a year. There’s our mother, who is 82 and shouldn’t be involved. There’s our brother who is trying to help, but he lives in Florida. That leaves me… I think I’ll try the patient advocate office the next time I go to visit. Maybe they’ll have some kind of form or can help out in some way.
Go to the offices of the appropriate court for your area – here it would be Clerk of Superior Court; in New York the chambers of the local Supreme Court judge. Ask how to petition for appointment of a guardian ad litem for a mentally ill adult (apparently your brother?). Detail the family situation as noted in post #4, and be prepared to give the name of the social worker who is no longer involved, and that he has not yet been assigned a SW by the relevant agency. He needs someone advocating for his best interests. (Note this person is not necessarily going to involve the family – they may or may not; their assignment is in HIS best interest, not anyone else’s.) I think what Pendgwen had to say is also relevant; the fact he has signed that information release is relevant.
If you’re not sure what court to go to, call any full-time court office, or the local DA’s office to ask them where to go, and they’ll either know or can easily find out, and tell you.
It’s been a week and you haven’t heard anything? I think instead of waiting by the phone, you need to get on the phone and call them. Insist that the psychiatrist get back to you ASAP, and make sure they know about the patient’s letter. As has been suggested, contact someone in administration (a patient advocate office or the director of the facility) if you do not get information in short order.
I’ve looked into the guardianship thing, and it involves two separate lawyers and costs $4,000! We would all have to go to the courthouse, and how I would get a 300 lb. mentally disturbed man who sits talking to himself down there is beyond me. And I certainly don’t have that kind of money. The person who told me this said an alternative is to get that signed consent, but it’s difficult because the way these things go, there’s always someone new on the case.
In my experience, and this is general stuff, the bedside nurses are going to turf the problem because 1. they’re busy and 2. the minutia of complex HIPAA cases really is somebody else’s job.
I would recommend talking with the patient advocate, the nurse manager for the unit, or the dayshift house nursing supervisor (charge nurse for the whole hosp), in that order. Mostly banker’s hours, that lot. It’s definitly in the pts best interest to have family involved, they want to resolve his care too, if only to move him on, and probably because they want what’s best for him, you just have to get with someone who’s tasked with helping that happen, not someone who’s tasked with preventing breaches of confidentiality.
Many hospitals also have a Case Management Dept. You may have success there. Good Luck.
You are indeed having a HIPAA problem. I used to consult on HIPAA for medical facilities. The facility in question where this relative is being held will have someone called a ‘Privacy Officer’, as the law requires it. Ask to speak with that person and if they won’t authorize the release of information for you, they will at least tell you exactly what is needed and by whom for their specific guidelines so that it can be released. That person exists for the specific reason of preventing these kinds of run-arounds from employees who live in fear of violating the HIPAA laws.
You don’t need full guardianship. You can get a power of attorney, that allows you to act on your brother’s behalf for specific issues. It should not cost $4,000. For $4k, you could get a full will, trust, powers of attorney, etc. drawn up. Should cost about $300-500 for just a simple power of attorney.
The staff may be discounting the release that the patient signed out of a concern that he would be found not to be competent to have signed it at the time that he did so.
{This is not legal advice. This is idle Internet chatter.}
But if the patient is not currently competent to sign a POA, it won’t do any good. That may be why it might be necessary to have a guardianship hearing in court, which runs up the expense.
A court or someone would need to challenge his competency to declare the POA invalid. Typically such challenges occur when someone else is interested in having the power over the person. Doesn’t sound like that’s the case here.
Thank you for the responses so far, I’m writing it all down to take with me next time I take my mother up to ‘visit’.
I’m hoping it will end up the way it went (for the same situation) earlier this year, that they’ll transfer him eventually to the psychiatric facility where he previously did very well. I’m worried that his insurance is going to run out. I’m worried he’s going to lose his current housing and they’ll have to start all over finding him another place. I think he should be institutionalized, and I don’t know anything about that at all, if it’s even possible, and who should be responsible. Me? Things were going so well for about 2 weeks and here we are back to square one.