NH has new procedure for involuntary emergency admissions
Emergency department boarding has been a long-term problem in hospitals. It first started with a shortage of beds when psychiatric hospitals were shut down. And now, particularly after two years of a pandemic, there’s a shortage of staff.
Units can’t be opened because there’s no one to cover. In an already chaotic environment with nowhere else to go, patients in a mental health crisis can sit in hallways for hours, days, or even weeks waiting for a psychiatric bed to open up. If another patient comes in presenting with more severe symptoms, that can bump the earlier patient down the waiting list.
That situation can occur when a patient is seeking psychiatric treatment. But what if it’s involuntary?
Through a new process, implemented in March, circuit courts are holding hearings for those who wish to challenge admissions while they are still in the hospital.
“The patients with mental health issues are entitled to their civil liberties. Just because they have a mental health problem does not mean they shouldn’t get their due process,” said Susan L. Stearns, executive director of NAMI New Hampshire. “From the courts and from families, I have heard that the process has gone smoother than they expected.”
Holding hearings within the hospital setting came as a result of one recent court case in which the plaintiff, Jane Doe, was held for 17 days waiting for admission. The case ruled that a person cannot be held against his or her will without probable cause for more than 72 hours.
That time constraint is based on when the patient is admitted into the designated receiving facility (DRF), not when the court receives his or her petition. Stearns noted that this change in procedure is because Jane Doe had the courage to stand up for her rights. New Hampshire Circuit Court Administrative Judge David D. King explained how it got to this point.
New Hampshire Circuit Court Administrative Judge David D. King
“The courts didn’t know until we got the petition through DRF and then we’d hold the hearing within three days,” he said. “But that person may have already been held 21 days. So, then the question became, `when do the three days begin? Does it begin with the DRF or does it begin at the hospital?’ It’s now been determined when the patient has been assessed they are a danger in the hospital and the doctor signs the certificate.”
Since its inception, there have been 324 hearings with only three dismissals because of missing the 72-hour deadline.
In the current process, the patient is examined by the practitioner and the practitioner signs the certificate. A petition of involuntary emergency admission is filed and sent electronically as an email attachment. The courts are now getting the petition the same day and scheduling it within three days.
An email is then sent to all parties involved that include the factual elements of the case. The hearing is done telephonically. The judge and lawyer are in the courtroom. The patient is in the hospital or at the very least, in a private setting. It’s effectively a three-way conference call between the court, the petitioner, and the patient. Everyone is sworn in, they testify, and they are cross-examined. With 26 hospitals around the state, this scenario is no small feat.
King admitted this process was floated as a possibility a few years ago but the hospitals were reluctant to implement it. But since the hearings have gone smoothly, the hospitals have been very responsive.
“The big difference now is that a person’s civil rights are being adjudicated in a timely fashion,” he said. “This is an interim process. It isn’t permanent. We’ve definitely improved the process, but we’ve got a way to go.”
He explained that the process should be more centralized and streamlined, for example, using video conferencing instead of the phone. While that change may happen in the future, he is aware they need to work quickly. “This has been labor intensive,” he said. “But the goal is to get this done within the next six months.”