Expert: Jennifer - 12/7/2009

Question
This is a long story but I will try to be brief. I have been under the care of a psychiatrist since June of this year for depression and bi-polar disorder. I have been taking my medication as prescribed but have had two relapses in the last three months.

The first one was in September when I began having visual/auditory hallucinations and several other symptoms consistent with schizophrenia. My famy took me to the nearest hospital with psych capabilities. In the ER it was discovered that my electrolytes were all out of whack. They corrected the problem and sent me upstairs to the psych unit. When I woke up the next day I was fine. They held me for 24 hours and I was discharged without a diagnosis or schizophrenia but of an electrolyte disturbance.

Last week I had another, more severe episode. I took an overdose of sleeping pills. Again, family took me to the hospital but this time it was the closest facility. They do not have a psych unit. In the ER it was discovered that my electrolytes were again severely abnormal. Again it was corrected and I was admitted to the ICU for observation. When I woke up the next morning I was back to baseline and very ashamed and upset about what I had done.

I was held in ICU from Monday until Thursday night. I was cooperative and behaved appropriately throughout my stay yet there was a "sitter" in the room with me 24/7. Furthermore, during those FOUR DAYS I was not allowed to shower, brush my teeth, use the bathroom (only a chair next to the bed with a bucket underneath it) or even put on clean underwear. Neither my psychiatrist nor personal physician were allowed to be involved in my care as they were "not on staff." I was seen by the hospital's psychatrist for about 30 minutes at 10:00 p.m. Monday night and never saw him again. I repeatedly asked the nurses what my care plan was going to be but was repeatedly told it was "up to the social worker" who I had never met. I finally met her Thursday afternoon, about 36 hours after I first asked to see her. She told me I was being transferred to a psych facility. I informed her I wanted to go to a different facility in the area but was told no as my insurance had already approved the one they chose (which also happens to be their sister hospital owned by the same company.) I also asked to make a phone call to let my family know what was going on. That request was also refused. When I became upset, stating even prisoners get a phone call, the social worker returned and told me "if I [kept] acting a fool" she would make sure I was "locked up" in the other facility indefinitely. I asked her if I had ANY rights regarding my care which was answered with an emphatic "No!" I arrived at the psych facility Thursday night and was discharged by the attending psychiatrist the next morning.

I feel I was treated very unfairly there and had decisions made about my care without my consent. I was lucid, alert, and oriented and perfectly capable of participating in the planning of my aftercare. So my questions are:

1.) What exactly are the commitment laws in Indiana? I know they can commit you for 72 hours but I had already been hospitalized for that period of time and was never re-evaluated by a psychiatrist. I was also refused a choice regarding where my treatment would continue.

2.) Is it true that someone who attempted suicide has no rights when it comes to treatments, medications, and after-care?

3.) Can they refuse you basic neccessities like showering and undergarments?

4.) Is the social worker's abusive behavior considered malpractice? What about the diagnosing psychiatrist who determined my mental status in 30 minutes in the middle of the night without speaking to my psychiatrist or medical doctor?

Sorry to go on and on but this was absolutely the most humiliating, degrading experience I have ever had. In fact, I am going back to school for social work to try and change they way psychiatric patients are treated.

Thanks so much for any advice you might have.

Answer
Alright, now that I had the wonderful tech people at allexpert.com send me a link so I can answer the question (I made a silly human-error, and apologize for the delay.)

First, the fact that you were diagnosed by the on-duty psychiatrist after 30min this person had spent with you is not unheard of, and provided that they are a competent professional, it follows the general guidelines and practices used by peers around the country.  The fact that it was in the middle of the night and your own psychiatrist may or may not have what's referred to as "hospital privileges" at the facility would support this theory as well.

Second, I did some research into the Indiana code (which is all sections of the laws for the state of Indiana) and although it was organized slightly different from how they are in California (where I live) I found a few places you can look that may help:

The Indiana protection and advocacy commission
http://www.in.gov/ipas/2424.htm

and if you do a search on Indiana code, which will be on the State Legislation website, the sections that you will want to read are the family and social services section (I believe it's section 2 under the main heading IC) and section 12 which deals with health services and the applicable laws for the state of Indiana.

Because there is so much information involved, I decided that simply copying and pasting all of the laws here would not be as helpful since it also carries the risk of leaving something that may be important out of what would be provided.  Also, by going to the website on your own, you can read through the material in its entirety at your convenience as well as print whatever you may wish to have a hard copy of.

Normally they allow patients to shower, but all hygiene products and clean clothing are the obligation of the individual (or their family) to provide for themselves.  In the future, you may want to have a psychiatric advance directive ready, so that the facility, treating staff, and your family will know how to proceed with your wishes regarding care.  The state of Indiana currently requires that in cases where an individual has a legally sufficient P.A.D. (which is defined and outlines the related law in IC 16-36-1.7 Chapter 1.7. Psychiatric Advance Directives)
the staff and anyone else who is involved in your treatment must honor it unless they can prove to a judge before they act that there is a legitimate reason for doing to the contrary.  The protection and advocacy group can probably provide you additional information about whether you have any legal remedies but you must contact them within 30 days of the incident in order to have them open an investigation.

Good luck, and please feel free to contact me with updates or any additional questions.