That's right, if you live in a nursing home in the state of Florida and another patient at the nursing home harasses you, whatever you do, don't tell anyone! Because if you do, you run the risk of being involuntarily locked up in a psychiatric ward of the local hospital. And by all means, no matter how much pain you may be in from your myriad documented ailments (including at least two terminal illnesses), do not seek out medications to alleviate your symptoms! Because then you're a potential junkie, and that's even more reason to hospitalize you against your will. (But if you are silly enough to actually ask for medication, for god's sake, don't sit on the edge of your bed when you do it--at least fall on the floor and writhe a bit in agony until the attending physician is convinced that you really are experiencing pain.)
The patient was transferred from Florida Hospital with complaints of
altered mental status exam. The patient has become paranoid towards other
residents, claiming that they are running into her with their power
wheelchair. Apparently, these allegations were not supported by staff at
the nursing home. The patient has also been picking and choosing which
medications she will accept. Patient appears medication seeking,
according to staff, frequently requesting opiate medications every 2
hours. The patient has refused additional recommendation from medical
attending for additional augmentation medications.
According to the patient, she continues to state that there is a resident who is in a wheelchair who continues to run the power wheelcnair inio her back. The patient minimizes her medication-seeking behavior at the facility, but during the interview was constantly refocusing on pain, although appeared in no acute distress. In fact. she was sitting up at the edge of the bed at the time.
Oh, and there's more...
MENTAL STATUS EXAMINATION: Normal rate of speech. Thoughts are mildly"Mood is depressed"? Gee, do you suppose? I know if someone were trying to commit me to a mental hospital, despite the fact that I showed zero signs of having any acute psychiatric issues, I certainly wouldn't be ecstatic about it. I would feel, if I had to guess, a little down about the situation. Depressed, you might say.
tangential. Follow for paranoid themes. The patient denies any auditory,
visual hallucinations, She denies any suicidal or homicidal ideation.
Denies any prior suicide attempts. Insight and judgment are fair. Use of
language and fund of knowledge low average. No abnormal movement
appreciated. Immediate, recent, and remote memory appears intact. No
abnormal movements. Affect is constricted. Mood is depressed.
The report then goes on to say (and I've asked someone to translate this axis stuff into English for me--will edit when/if I get a response):
IMPRESSION:
AXIS I:
1. Major depressive disorder, rule out psychotic features.
2. Opiate dependence. rule out withdrawal
AXIS Il: Deferred.
AXIS III: see medical section above.
AXIS IV: Moderate
AXIS V: 30
The risks and benefits of medication were discussed as well as side
effects and alternatives. Start Cymbalta 30 mg p.o, daily. Augment with
Ability 2.5 mg p.o daily. Follow for response. TM patient may benefit
from pain management consult. Additional management as per Dr. Akella.
Obtain parallel history from previous facility. Once stable for
discharge, the patient would benefit from ongoing psychiatric followup care. Estimated length of stay is 7 to 10 days. Rlsks, benefits, and
alternatives of medications were discussed as well as side effect.
And there you have it. All the Florida state government needs to put a person away against her will is a physician who, while admitting the patient has nothing exceptionally compelling about her behavior to suggest that she's a threat to herself or others, nonetheless signs off on a document stating that the person could benefit from a little forced observation.
I am completely appalled that this sort of thing can happen this day and age.
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