reactive depression. Her husband died in April and her only daughter,
her caregiver, has rheumatoid arthritis and breast cancer. It's very sad, but
also very typical for people in her age group. Her son is correct when he says
we haven't helped her. Older patients need a different kind of care that is
more structured to their place in life and their late life losses. Do you
think we have been effective with her, Monique?" Donna looked carefully at
Dr. Desmonde.
"Perhaps
the meds have helped some, but basically we haven't helped her much. You're
right, Donna. What we are doing isn't helping. I'm philosophically opposed to
mixing these patients, but in view of managed care and reimbursement, we have
no choice. I guess some concentrated care is better than none at all. At
least we can watch her for suicide attempts -- at least, most of the
time." Monique looked sheepishly at Alex and Donna.
"What
do you mean, most of the time?" Alex asked, her voice anxious.
"Face
it, Alex. I usually have two RNs and two psych techs on the day shift. There
is even less staff on evenings and nights. We have no security and not a lot
of muscle to wrestle these people down if they have outbursts. My RNs have to
assess each patient, do paperwork, run groups, give meds, handle emergencies,
and participate in community meetings. The psych techs supervise the daily
care of the male patients and, together with the RNs, monitor the five-step
patient responsibility level." Maybe it will get better when the new
health reform act goes into effect. I heard that it may."
"Five
step what?" Alex asked.
Donna
explained, "Well, it's really not five steps anymore, not since the length
of stay decreased to three to four days, sometimes even less. It is a system
of patient responsibility level used as a gauge to grant individual patient
privileges. As patients improve, they're given more responsibility and
freedom. On level I, patients are restricted to the floor. On level V, they
may leave the floor unescorted and take unaccompanied trips off hospital
grounds."
Alex's
legal mind was racing. Her thoughts scared her. She interrupted Donna.
"Are you suggesting that we could have possibly sanctioned an activity
where one of the psychotic patients could have left the hospital last night and
attacked Angie, with CCMC's blessing?" Her eyes were wide with worry.
Dr.
Desmonde intervened. "No, we haven't had a patient on level V for several
years, mainly because insurance won't pay. They figure if the patient can be
off hospital grounds, he can be out of the hospital. Most of our patients
reach level III, meaning that they can leave the unit in a group, escorted by a
staff member. They go to the coffee shop for meals, the gift shop, and so on.
Right, Donna?"
Donna
looked pleased. "Good, Monique. Very good. You are the first attending
shrink that ever understood the system! I'm proud of you." Donna grinned
at Dr. Desmonde.
Alex
smiled as the nurse and physician high-fived each other.
"I
don't know if admissions will ever return to the pre-HMO days when a psychiatric
admission actually changed behavior. According to news reports, mental health
services are supposed to get better under the new health care system.
Supposedly, 32 million additional mentally ill people will receive psych
benefits and the benefits of the 30 million Americans who already have them
will improve. I just don't see how that is going to happen, but it surely
sounds good," Monique added. "Of course, I am totally clueless on
how we are going to care for them. We have no space for more admissions now
and I am pretty sure we have more than our fair share in Louisiana," she
added.
"Yes,"
Alex agreed. "It sounds good in theory, but it's all determined on how
states interpret the "rules" set forth by the President. Some
states could make as many as 500 drugs available for the mentally ill,
her caregiver, has rheumatoid arthritis and breast cancer. It's very sad, but
also very typical for people in her age group. Her son is correct when he says
we haven't helped her. Older patients need a different kind of care that is
more structured to their place in life and their late life losses. Do you
think we have been effective with her, Monique?" Donna looked carefully at
Dr. Desmonde.
"Perhaps
the meds have helped some, but basically we haven't helped her much. You're
right, Donna. What we are doing isn't helping. I'm philosophically opposed to
mixing these patients, but in view of managed care and reimbursement, we have
no choice. I guess some concentrated care is better than none at all. At
least we can watch her for suicide attempts -- at least, most of the
time." Monique looked sheepishly at Alex and Donna.
"What
do you mean, most of the time?" Alex asked, her voice anxious.
"Face
it, Alex. I usually have two RNs and two psych techs on the day shift. There
is even less staff on evenings and nights. We have no security and not a lot
of muscle to wrestle these people down if they have outbursts. My RNs have to
assess each patient, do paperwork, run groups, give meds, handle emergencies,
and participate in community meetings. The psych techs supervise the daily
care of the male patients and, together with the RNs, monitor the five-step
patient responsibility level." Maybe it will get better when the new
health reform act goes into effect. I heard that it may."
"Five
step what?" Alex asked.
Donna
explained, "Well, it's really not five steps anymore, not since the length
of stay decreased to three to four days, sometimes even less. It is a system
of patient responsibility level used as a gauge to grant individual patient
privileges. As patients improve, they're given more responsibility and
freedom. On level I, patients are restricted to the floor. On level V, they
may leave the floor unescorted and take unaccompanied trips off hospital
grounds."
Alex's
legal mind was racing. Her thoughts scared her. She interrupted Donna.
"Are you suggesting that we could have possibly sanctioned an activity
where one of the psychotic patients could have left the hospital last night and
attacked Angie, with CCMC's blessing?" Her eyes were wide with worry.
Dr.
Desmonde intervened. "No, we haven't had a patient on level V for several
years, mainly because insurance won't pay. They figure if the patient can be
off hospital grounds, he can be out of the hospital. Most of our patients
reach level III, meaning that they can leave the unit in a group, escorted by a
staff member. They go to the coffee shop for meals, the gift shop, and so on.
Right, Donna?"
Donna
looked pleased. "Good, Monique. Very good. You are the first attending
shrink that ever understood the system! I'm proud of you." Donna grinned
at Dr. Desmonde.
Alex
smiled as the nurse and physician high-fived each other.
"I
don't know if admissions will ever return to the pre-HMO days when a psychiatric
admission actually changed behavior. According to news reports, mental health
services are supposed to get better under the new health care system.
Supposedly, 32 million additional mentally ill people will receive psych
benefits and the benefits of the 30 million Americans who already have them
will improve. I just don't see how that is going to happen, but it surely
sounds good," Monique added. "Of course, I am totally clueless on
how we are going to care for them. We have no space for more admissions now
and I am pretty sure we have more than our fair share in Louisiana," she
added.
"Yes,"
Alex agreed. "It sounds good in theory, but it's all determined on how
states interpret the "rules" set forth by the President. Some
states could make as many as 500 drugs available for the mentally ill,
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