Lawdamercy.

I've taken a few days off from the Cathy saga in order to try to regain my sanity a bit, and I have to admit, after dealing with her face-to-face (and daily on the phone) I'm finding it difficult to take the torch back up.

Not to mention, I just got a lovely email from my cell phone provider that I was tracking toward being over my allotted minutes this month. (I can't help but wonder, is there really any direct correlation between the number of minutes an individual subscriber uses and the expense the provider incurs? Honestly? Can anyone answer this question with any degree of certainty? I fail to believe that every minute I spend on my cell phone costs them money and when I go over my allotted time, it costs them even more money.)

Anyway, point is (point about Cathy, that is, not the point about cell phone minutes), Cathy is a huge pain in the ass. Which I knew all along. I guess, though, to be honest, I didn't fully appreciate the new level of pain in the assishness that she'd managed achieved over the last 10 years. Which is partly due to the (obviously false) information I'd received from her doctors in Florida and partly due to my own notions of right, wrong, and obligation.

In other news (because, frankly, I'm pretty damned sick of Cathy right now--even though I feel a ton of guilt for even saying that), Lizzie turned 16 today. To celebrate, she, William, and I took a bus trip to Wintergreen and skied all day. (Well, William didn't ski; instead, he tried snowboarding. Honestly, I'm shocked that they don't make special snowboarding pants with added cushion and weather resistance--as much time as snowboarders have to spend on their tushies as they make their way over the learning curve. Learning mogul?)

It was a long day. We left the house around 4 a.m., managed to catch the bus anyway (shoulda left the house at 3:45 a.m.), arrived at Wintergreen around 9 a.m., left the slopes at 4:30, arrived home around 9:30.

I wish more days could be spent simply having a good time.

Can't believe The Sush is 16.

Tired.

Long day.

Real life stuff tomorrow. Blech.

So, OK, here's the deal...

I'm flying to Orlando tomorrow.

I have a "maybe" from Guardian Care, hoping to hear a "yes" tomorrow. Worse case scenario there's a place in Fuquay that said they could take her on Tuesday. If it turns out we have to wait until Tuesday, then I guess I'll have to put her in Benjamin's room for a few nights. Not exactly the ideal situation, considering she has to use a wheelchair and may need help showering and in the bathroom, but I'm hopeful that she's no worse off than Grandma was and if Grandma survived here, then surely Cathy can.

Of course, where she should go is to my mother's house, seeing as how Mother Dearest has a spare room and everything. But true to form, Mom's basically checked herself out of this whole thing and is more than willing to either let Cathy stay in Florida until we're sure there's somewhere for her to be, or let me take on complete responsibility. I'm extraordinarily pissed off with my mother right this moment.

A breakthrough!!!!

I just got off the phone with Carol, who said that the guardian advocate had given her permission last night for the hospital to speak with me!!!!

Now I'm simply waiting for the social worker to call me back to (hopefully) give me info. re: Cathy's medicaid case worker in Orlando, as well as get a "level of care" form to me.

Gah! Forgot to ask about the damn books! I think I'll send Carol a text message. (I bet she thinks twice before giving out her blackberry number again!)

Oh, and mainly just to be a bitch, I called Val (Bell? Mel? Vel? I can't understand what she says) at the court processor's office. As soon as I ID'd myself she started with "Did you not understand what I said earlier." Yes, bitch, I sure did, now I need for YOU to understand that you can, in fact, talk to me. Of course, she said she needed to verify that (basically calling me a liar) and that she'd call me back. Wanna place bets on how quickly that happens? I call never.

Have just sent the following email to Charlotte at Florida Mental Health something-or-other (dept. that oversees the volunteer guardian advocate program). Not sure if this will help or hurt my case--hoping the former, of course:

This is one of the portions of the Florida statutes re: the Baker Act that I feel has been violated:
(http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0394/0394.html)

(5)In selecting a guardian advocate, the court shall give preference to a health care surrogate, if one has already been designated by the patient. If the patient has not previously selected a health care surrogate, except for good cause documented in the court record, the selection shall be made from the following list in the order of listing:

(a)The patient’s spouse.

(b)An adult child of the patient.

(c)A parent of the patient.

(d)The adult next of kin of the patient.

(e)An adult friend of the patient.

(f)An adult trained and willing to serve as guardian advocate for the patient.

In light of this, I would like to request another hearing for Cathy, or at least request that the court revoke the guardian advocate's authority, per this portion of the statutes (emphasis added):

(7)The guardian advocate shall be discharged when the patient is discharged from an order for involuntary outpatient placement or involuntary inpatient placement or when the patient is transferred from involuntary to voluntary status. The court or a hearing officer shall consider the competence of the patient pursuant to subsection (1) and may consider an involuntarily placed patient’s competence to consent to treatment at any hearing. Upon sufficient evidence, the court may restore, or the hearing officer may recommend that the court restore, the patient’s competence. A copy of the order restoring competence or the certificate of discharge containing the restoration of competence shall be provided to the patient and the guardian advocate.

Is this something you could help me with? Or at least point me to the right person/dept who could?

Many thanks,
Carmen

Court Processor Conversation

I just called the Court Processor's office at Florida Hospital and was told that "no one can speak to me because of HIPAA laws." I recorded the conversation. I'm officially pissed now.

Additional Notes

The previous blog entry re: the reason for Cathy's admission via the Baker Act was written by Carlos H. Ruiz, MD, on December 4th.

Here's another entry, written on December 6 by Maheridra 8. Shah, MD:

REASON FOR ADMISSION AND HISTORY OF PRESENT ILLNESS: The patient was referred to the emergency department after the patient was noted to be
increasingly agitated and paranoid at the extended care facility. The
patient has been claiming that people with motor wheelchairs are driving
towards her. The patient has also been demanding too much pain
medication, has been unmanageable and argumentative and, hence, was sent
for further stabilization.

Since admission, the patient has been refusing voluntary stabilization. She has been demanding pain medications. Does get paranoid and states that she was removed from the nursing home because she knew too much. The patient does claim that the patient is being mismanaged at the extended care facility and they are not keeping proper medication logs.

This physician further states:

A 53·year-old female with poor personal hygiene and grooming. Good eye contact. Her mood is irritable with appropriate affect. Her speech is spontaneous and goal-directed, pressured at times.

MENTAL STATUS EXAMINATION:

Denies any auditory or visual hallucinations or suicidal or homicidal ideation at this time. The patient is alert and oriented in all 3 spheres. Her cognitive function is grossly intact. She does get paranoid and suspicious easily. Insight and judgment is fair. Impulse control remains poor.

DIAGNOSTIC

AXIS I:

A. Adjustment disorder with mixed emotional features.
B. Rule out major depression with psychotic features.
C. Opiate dependence.

AXIS II: Deferred.
AXIS III: [physical/medical diagnoses deleted by blog author for confidentiality reasons]
AXIS IV: Multiple medical problems. No support system.
AXIS V: 40, upon evaluation. Past year 45.

FORMULATION OF PLAN:
1. I agree Dr Allen. The patient, at this time, continues to meet
criteria for involuntary placement and needs further inpatient
psychiatric evaluation and stabilization for a period not to exceed 3
weeks.
2. Continue to assess less restrictive means of stabilization and discuss
appropriate placement issues.
3. Agree with close medical supervision and pain management

Two days later, a major change in her medications (not listed for confidentiality reasons), and the biggest issue is that she got angry that another patient was physically harassing her at the nursing home! Paranoid? Well, hell, who wouldn't be by now? I certainly would be under the same circumstances. Suspicious? Agitated? For sure! And, hey, yours truly has been diagnosed with "adjustment disorder" as a result of the depression brought on by a bought of invasive cervical cancer. I readily and happily admit that I take medications to help me with my symptoms. Cancer is quite the mortality reality check and I'm here to tell you, it ain't no fun. But should I be involuntarily committed for divulging that information or as a result of my psychiatrist's diagnosis? Maybe I should be involuntarily committed because having cancer made me really damn angry? I did become quite agitated at times about the whole thing.

What a bunch of asshats these Florida physicians are. And anyone else involved in this entire scheme. (Yikes! That sounded a little paranoid, didn't it? Good thing NC doesn't have a Baker Act!)

Other Random Things

• I ordered a Stephen King book and a book of sudoku puzzles on the 15th from Amazon with the shipping address Carol (Nurse Manager) gave me for Cathy. According to Amazon and UPS, the package was delivered to the hospital on the 17th. Thus far, though, Cathy hasn't received it. I sent a email a few minutes ago to both Cara and Carol asking for them to investigate the whereabouts of the package.
• Dr. Allen and Carol have both told me that Cathy is not on any mood stabilizing medications; however, Cathy's records indicate that she's taking Cymbalta, which is an antidepressant, as well as gabapentin, which is an off-label treatment for bipolar disorder. Perhaps Dr. Allen and Carol have a different definition of "mood stabilizer" than I do? Perhaps they didn't actually give Cathy the medication? Perhaps they put her on the medication prior to her hearing on Monday the 13th (where she was deemed incompetent and had a health care guardian appointment to her [illegally, IMO]), and the guardian afterward told them to stop giving it to her? (Dr. Allen stated in his conversation with me on Sunday that the guardian wouldn't let him give Cathy any mood stabilizing medications.) I'm sure I'll never know the answer--at least not until this whole "guardian" issue is straightened out.
• On Dec. 5 a lab reported stated that Cathy was negative for MRSA, yet she continues to be held in contact isolation. The Baker Act states: A facility may not use seclusion or restraint for punishment, to compensate for inadequate staffing, or for the convenience of staff. Facilities shall ensure that all staff are made aware of these restrictions on the use of seclusion and restraint and shall make and maintain records which demonstrate that this information has been conveyed to individual staff members.