Greg, thank you again for your call today. I spoke with Senator Hanger
afterwards and he does want to follow-up. He is enroute to a meeting in DC of
the National Conference of State Legislators, where I am sure the VT issue will
be raised due to its national media coverage. The Senator chairs a
committee on NCSL and was formerly on their Executive Committee so he may
even be able to get some additional details on the other state's legislation
that you mentioned.
I will file your email with the notes I took from our phone conversation
for his review. He is very busy campaigning right now for a June 12th primary
for re-election, but as I indicated earlier, your call was of interest to him
both professionally and personally. Thank you for all you do!
April 18, 2007
Dear Senator Hanger,
Thank you for your service & I was hoping you could
help influence the legislature to bring about positive change to Virginia’s
mental health delivery system. I very much appreciate the support your office
has provided in addressing the emergency psychiatric services in Virginia.
Let me start by saying we have more then enough index cases to
emphatically express the desperate condition of the Virginia State emergency
mental health system. I have been frustrated in attempting to improve the
Virginia system since moving to the state 7 years ago. The system simply fails
both the patient & society and has resulted in severe consequences.
Additionally, it is embarrassing to me to have the national media highlight the
state’s deficient mental health system when there were many attempts to avert
such catastrophes in prior legislative sessions. To give you recent publicized
examples of problem just in the past year, Fairfax County Police Detective Vicky
Armel and Officer Michael Garbarino died at the hands of a deranged person last
summer. Vicky was a relative of one of our physicians. You personally have
experienced the failings of the system with the loss of your family member for
which I extend my condolences. The Virginia Tech murders will likely be found to
stem from a similar failure in the state psychiatric system once the
investigation is complete. I
personally have numerous medical cases of inadequacies in the law resulting in
compromised care to the patient and imminent danger to the public. I believe the
Great State of Virginia can no longer sit idle in regards to the problem. The
follow article written by a Lawyer gives some perspective on the issue,
http://gazette.gmu.edu/articles/8530/ .
The emergency psychiatric patient should be treated as
any other emergency. In the state of Virginia, a patient can only be considered
an emergency if deemed so by law enforcement or a community service board
member. I can offer many examples of how this flawed chain of intervention is
misguided. It is noteworthy to recognize health care professionals are
not included in this system despite being the only truly qualified health care
providers to treat & determine a psychiatric emergency. The hands of an
emergency physician are tied by the law & the physician cannot emergently detain or treat a psychiatric patient
until the processes of a TDO &/or ECO are implemented by the bureaucracy imposed. The
bureaucratic appointees are not physicians & do not posses validated
training in determining a psychiatric emergency. They also do not provide acute
psychiatric care or incur any liability for their decisions. In the emergency
situation they add little if any value to the emergent stabilization or
determination of a psychiatric emergency. They actually delay care because the
emergency health professionals have to wait sometimes hours before gaining
approval to treat. The system relies on community service board &
magistrates who are not in the emergency department 24 hours a day to determine
an emergent psychiatric condition. Additionally, they often make determinations
of a psychiatric emergency independent & contrary to the professional health
care provider without ever being in the hospital to assess the
patient's behavior. It is amazing to allow emergency treatment for a trauma
patient who may not have capacity to make decisions, but in the case of a
psychiatric patient, who clearly does not have capacity, the
physician has to wait for state approval before stabilization can occur. To
initiate emergency care would otherwise be considered assault under the Virginia
statute. Incidentally, this statute is in direct violation to the Federal EMTALA law which mandates stabilization of emergent
conditions. It is also ridiculous to have non physicians tasked with
responsibility of medical need when they do not have the credentials to make
such a decision. The law needs to change to reflect the emergent nature of the
acutely mentally ill patient. Following stabilization then it is appropriate to
review the situation, determine the level of care and consider future
disposition of the patient. Only then is it appropriate to invoke the services
of a community service board or magistrate.
The Florida Baker Act or New York’s 9.4 with the addition of Kendra’s law are good mental health law models for
the State of Virginia to emulate (http://www.psychlaws.org/LegalResources/StateLaws/NewYorkstatute.htm). Additionally, Assisted Out
Patient Treatment (AOT) systems are
available with validation which demonstrated a significant reduction in violence
associated with mental illness. Please refer to http://www.psychlaws.org/BriefingPapers/index.htm
for resource information.
Please feel free to contact me is if I can be of
assistance.
Best Regards,
Greg Christiansen, D.O.
Gregory Christiansen, D.O., F.A.C.O.E.P. Assistant
Professor
Director of Medical Education
Department of Emergency
Medicine
MCV/VCU Health Systems
West 210,
P.O. Box 980401
401 N. 12th St.
Richmond, Virginia 23298-0401
(H) 804-706-6463
(W) 804-828-4860
(H)
erdrgregc@netscape.net(W)
gchrist@mail2.vcu.eduNOTE:
The information contained in this message may be privileged
and
confidential and protected from disclosure. If the reader of this
message
is not the intended recipient, you are hereby notified that
any
dissemination, distribution or copying of this communication is
strictly
prohibited. If you have received this communication in error,
please
notify us immediately by replying to the message and deleting it from
your
computer.