Thinking of filing a formal complaint against inpatient psychiatrist - experience, thoughts?

Discussion in 'General Parenting' started by seriously, Jun 21, 2011.

  1. seriously

    seriously New Member

    I am ready to spit nails. difficult child 2 was released today on 1 hour's notice. I was apparently the ONLY person not surprised by this.

    I was not surprised because I had finally spoken to the inpatient psychiatrist the night before and made it clear I did not agree with her about anything. Surprise, surprise, suddenly the insurance is denying his stay as of right now - even after the doctor spoke to them. More like because the doctor spoke to them.

    difficult child 2 was taken on a hold Thursday, admitted Friday. I saw this doctor for about 5 minutes on Friday and we had a very, very brief conversation about his medications. She told me that she wanted to add (note ADD) an SSRI and wanted to know if he had ever been on one. Yes, I told her he had been on Zoloft and it activated him - manic-like symptoms. But it was when he didn't have a mood stabilizer on board and maybe if he had one now an SSRI would be OK.

    That is the last time I talked to her until last night. I left her a message on Saturday to call me after our son told us she had put him on Zoloft and was also dropping his Geodon. He said she told him all he needed was therapy - not medications. GRRRRRRRRR.

    I was trying really hard not to get all worked up in case our son was distorting reality again.

    Unfortunately, he was accurately reporting his conversation with this jerk. I do not use that word lightly either.

    She didn't return my call Satuday, Sunday or Monday despite the fact that staff told me she had gotten my message and had been in to see my son all three days.

    Monday afternoon I called and spoke to the medications nurse. She told me that my son was up to 50 mg Zoloft and that he was scheduled to be completely off the Geodon as of that night. With NO OTHER medications.

    I blew a gasket. I informed the nurse that I had NOT consented to that treatment plan and did NOT agree with it. I told her that Dr. T needed to call me immediately so that she could explain her thinking to me. The nurse said she's in a meeting and I can give her the message after 1:30. Fine I said.

    This idiot doctor finally called me at 6 pm.

    She proceeds to inform me that my son does not have a mood disorder, that he is on toxic medications for no reason, that the only problem is conflict with ME and that is causing him to be depressed. She further informed me that he couldn't possibly be bipolar because she was trained and educated in this area and she knew what I did not - that people who are bipolar absolutely do not cycle "that fast" (as in a matter of a few days or even within a single day).

    Therefore, he was not bipolar and there must be some other explanation for his cycling behavior.

    After I recovered my power of speech and sat on my first impulse to tell her exactly what I was thinking, I tried to discuss these things like an adult. Apparently from her perspective the only adult involved in the conversation was her because she talked down to me like I could barely read and write with my knuckles hanging so low.

    She had the balls to tell me that she was acting in my son's best interests and clearly implied by her tone that I was NOT acting in his best interests. I informed her that my personal experience of bipolar disorder included cycling in a matter of a few days, sometimes even hours, although perhaps that was because I had gone undiagnosed for years and my rapid cycling was a result of being on antidepressants like Zoloft for years. She informed me that it was not possible to cycle that fast and there must be some other explanation.

    That's when I finally gave up making nice and icily informed her that I did not agree with her and that I had not given my consent to her withdrawing his Geodon or to her giving him Zoloft in the absence of a mood stabilizer.

    She icily informed me that that was fine. He would stay at 40 mg Geodon for tonight.

    And we hung up.

    So no, I was not surprised when the psychiatric hospital called us 30 minutes before we left for the family meeting at 3 pm to say that he would be discharged at the end of the meeting.

    What I am now trying to decide is whether and how to complain about this person. In a matter of 3 days, she has single-handedly screwed up the progress we have made in the past year in getting our son's buy in to taking his medications. He came home tonight and informed us he doesn't need to be on any medications and he will no longer listen to or follow the advice of his outpatient psychiatrist.

    I stopped at the desk on our way out and asked about the complaint process for a doctor. I was informed that this jerk is now the HEAD doctor there and that any complaints would go to her, unless she was the person we were wanting to complain about. In that case it would go to the head of nursing. Right. The head of nursing is going to sanction the Medical Director.

    The front desk person finally called admin and the admin secretary came out and gave me 3 names/numbers to call. One is risk management, one is head of nursing and one is some admin position.

    I plan to call the risk management person and ask about their complain process when the doctor involved is at the top of the hospital hierarchy. Risk management is the only one outside this chain of command and they are the ones who care about the hospital being sued so that seems the best place to start.

    I did not want to do this because I don't want to screw things up for us at this psychiatric hospital. It has been one of the best adolescent units in the area. But it isn't anymore if this is the caliber of physician they are going to hire to run the place.

    Anyone got any advice, suggestions or experience good or bad to share?
  2. JJJ

    JJJ Active Member

    I wish you luck. I'm glad you got some numbers outside the chain of command. Another option is to file a complaint with the state licensing board. They are (or at least should be) completely outside of her sphere of influence.

    Is there a different psychiatric hospital you can send him too when he goes off the deep end due to the wrong medications???
  3. pepperidge

    pepperidge New Member

    Wow. I would have thought that she would have least have consulted with your outpatient psychiatrist. Did she do that? Do you have a good relationship with your outpatient doctor? Or is s/he a jerk?

    What about the medical licensing board for your state? How can she be so ignorant? And how can the hospital just discharge him like that?

    You are kind of stuck between a rock and a hard place in terms of psychiatric hospital if she is the director.

    I am so sorry. Has your son tried Lamictal or other mood stabilizers? You're right it will be difficult to get your son to come around. Is he at all the type that likes to know about his own condition, research medications etc? Could you use that approach with him?

    No great advice, just a hug.
  4. HaoZi

    HaoZi Guest

    My kiddo is rapid-cycle, too. Those who haven't seen it, I tell them it's like PMS-moodiness on crack.
  5. CrazyinVA

    CrazyinVA Well-Known Member Staff Member

    I would agree that it most decidedly does *not* have one of the best adolescent units in the area, if the head doctor believes that there is no such thing as rapid-cycling. Unfortunately, I don't think there's much you can do except to not have him admitted there again, which isn't a great option if adolescent units are as scarce as they are in many areas these days. I think it's worth following up with a complaint, but they're likely to only see it as a disagreement with a treatment plan, not negligence (although discharging so quickly after a disagreement is certainly suspect from an ethical standpoint, and that may raise eyebrows).

    I would place a call to his regular psychiatrist ASAP and let him/her know what happened, and see where to go from here. If anything else, he/she needs to know that this particular doctor and unit may undo other patients progress, as well...

    I'm so sorry, I can only imagine how you must feel about this. I'd be irate, and scared, too, for what happens next...
  6. seriously

    seriously New Member

    I left out that the first thing I did when I got off the phone with this person was call his regular psychiatrist.

    She picked up her cell amazingly when I called and asked what was up. The first words out of my mouth were "I'm trying to decide if I am going to ask for a change of inpatient psychiatrists." and her response was "Oh, no."

    I told her what this idiot had said to me including the line about her having his best interests at heart and she said "she really said that to you?" Yes, exact word for word. There was this silence and she asked me if the doctor had said anything about calling his regular doctor and I said nope, not one word. I was so stunned by her position on rapid cycling and her willingness to buy everything our kid said at face value, despite input from her staff that it was not to be trusted, that it never even crossed my mind to ask if she would or had called you.

    No she hadn't called our regular doctor or even left a message.

    She told me that taking him off the Zoloft was no problem once he was discharged - we'd just d/c it because he'd only been on it a few days.

    I called yesterday immediately after they told us he was being discharged. Miraculously she had an opening this morning so we'll see her ASAP. But the kid says he's not going to take anything she rxs now so we'll see how that goes.

    Will keep you posted.
  7. JJJ

    JJJ Active Member

    I'm glad she can see him this morning. I hope she can convince him to take his medications.
  8. KTMom91

    KTMom91 Well-Known Member

    What a mess...glad you were able to get him into his psychiatrist.
  9. mazdamama

    mazdamama New Member

    been there done that...oh boy can I relate. Last time my Daniel was Baker Acted (Marchment Act) I had taken him where the insurance company told me to to avoid the pitiful place they have closer. At 11 pm I received a call saying that he had been transferred to the closer place due to insurance issues. Went over there the next day with his newly filled bottle of depakote because they had NONE on site and it was a weekend. No count was made of the medication (WRONG) and I was informed that they wanted to add another medication and I okayed it (stupid). I was told by the staff attendant that this child needed alot of care due to his extreme anger issues (you think?) and only spoke with the Dr via the phone. The day after the attendant told me that Daniel would need to be kept longer I was called and told to come get him. When I arrived I noted a police car at the door for admissions...apparently they had an admission and needed Daniel's bed. I asked for Daniel's depakote and was told that he had used them all and the bottle had been tossed in the garbage. I blew a gasket because this bottle had just been filled. My count at home showed that even with them giving him what he needed those three days he was there that we were short 26 pills. I do feel that they used the medications I gave them for their supply to other patients.
    I checked out their site on the computer and sent a very informative letter to the administration of this state funded group. I received a phone call within two days of mailing the letter and from what I understand...heads were rolling like bowling balls over there.
    Only problem is that if I have to call 911 on Daniel again they will take him there and I hate that place. They will most likely either try to hassle me or give me and my child the respect that is deserved.....if not the respect then the governor's office will be hearing from me. We HAVE to be proactive with our children's health issues, even if it means ticking people off.
  10. susiestar

    susiestar Roll With It

    First of all, I would get a copy of The Bipolar Child and highlight passages that discuss rapid and ultra rapid cycling. I am NOT a parent of a child with bipolar but my exsil has it and at times has cycled in several times in an hour. It is terrifying to watch.

    I would complain to several places, including copies of the pertinent parts from the book and other books you can find. Heck, I would be tempted to go to a medication school library and look it up in the textbooks there and xerox them and highlight them - complete with a copy of the cover and the inside page with the copyright info. I would go as far back as possible to find descriptions of this. I know that when my oldest son was 7 we discussed this possibility for his problems and it was in The Bipolar Child and other books back then. As he will be 20 in a few months, well, she is dangerously behind in her education. Seems someone has been faking her continuing education credits or taking fluff classes from drug reps (who will sign off on almost anything as a continuing ed credit - the drug co's pay for docs to go to conferences in fancy locations where they party and some doctor on the drug co payroll signs that they all went to lectures etc.... NOT ALL docs do this, but those who want to are able to.).

    I would complain to the CEO of the hospital AND the Board of Directors. I would also complain to the state medical board and to the board that certifies child and adolescent psychiatrists, as well as the AMA (amer medication assoc). Yes, lots of letters and forms, but she has potentially set your son's treatment back years. And it IS known that the cycles of bipolar create changes in the brain that make it harder to control the longer it goes on. Each cycle creates new pathways and establishes them more firmly. It is a major reason that early diagnosis and treatment is so important - to minimize the brain changes so that the person has the best chance of long term stability.

    I would also see an attorney for advice on suing as the info she gave you is so clearly out of date that it is reckless and irresponsible for her to be treating patients. in my opinion this goes especially for patients who are suffering from mental illnesses where it is known that they have great difficulty with medication compliance and that the longer they go with-o treatment the worse their illness becomes and the harder it is to treat.

    I don't know if it is possible to get your son to agree to read up on his disorder, to see if maybe he could see some of himself in the symptoms of the disease. This might help convince him to stay on medications. OTherwise, you may have to get medieval. By that I mean that he gets nothing, does nothing, watches nothing, unless he takes the medications that the doctor that YOU trust prescribes. I got very lucky in that my difficult child NEVER fought his medications. We started early, long before any problems, with the idea that parents make medication decisions and kids follow them. Mostly because I have an aunt with a son 6 mos older than Wiz and when her son was 2 she spent 45 min convincing him to take a dose of tylenol - kid had a 104.7 fever and she was trying to rationalize this so he would agree. WTH??? was my reaction. Wiz tried refusing medications a few times as a toddler and he was held down, his nose pinched and they were squirted down his throat. Esp as a toddler they have no business making medication decisions. So we didn't have medication refusal except when a he realized a medication was causing bad side effects - and he hadn't told me. All he had to do was say something and we called the doctor, but we had to practice that a few times.

    Anyway, I think that everything he enjoys, anything with a screen, any food he enjoys, going anywhere with friends, books, movies, even his own choice in clothing should go unless he takes his medications. he takes them or his world stops until he does. He gets up and leaves, hits, damages property, you call for transport to a different psychiatric hospital. Or for a cop to make him take his medications. As soon as he takes his medications he gets whatever back for the day or until the next dose.

    But i realize that is far easier said than done and may not be possible.

    WOuld he consider taking them if you paid him? Maybe start keeping a chart, WITH HIS HELP, of his behavior, attitude, mood, any risky/scary/dangerous/illegal choices and see how they change with the medication - and if nothing ever gets better and his moods never change, then maybe the medications are not needed. But if he isn't on enough medications and is doing those things, then they are documented, and if you can get a therapeutic level of medications in for long enough, and show on the chart how things are, then maybe he would see the logic in medications. It might be worth a try but you would have to stick with it.

    I would be all OVER that doctor's bosses about her dangerous denial of current medical knowledge concerning bipolar disorder. If wikipedia has this in it, then it has to be fairly common knowledge: Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.[SUP][54][/SUP] Ultra-rapid (days) or ultra-ultra rapid or ultradian (within a day) cycling have also been described.

    I probably wouldn't use wikipedia when citing sources for the doctor's bosses and the licensing boards, etc.... but i WOULD get quite a few different sources, asp ones from medical journals discussing Early Onset Bi-Polar (EOBP). Also contact NAMI and CABF to find out if they have any resources that could help.

    I would also ask WHY she didn't contact his regular psychiatrist (supposed to be part of her job), why she did NOT contact you, and why she administered medications WITHOUT your consent and removed medications WITHOUT your consent. Those are HUGE problems, and I know of cases where docs paid large settlements over the medication issues (giving or removing with-o parent's informed consent - not just consent but INFORMED consent. This means that they explained the benefits and risks to you of each new medication). The other question I would ask, and hammer hard on, is WHY she would tell a child that he shouldn't be on medications when she has to KNOW she has almost no medical history and no input other than a child with serious enough problems to land him in a psychiatric hospital??????? I am sure that she has to know that it is incredibly hard to get a patient admitted, simply because there are so few beds and even fewer funding sources.

    Make heads roll - hers and anyone who lets her get away with this koi. I am so sorry that she has done so much damage to your child.

  11. Marguerite

    Marguerite Active Member

    If you can, enlist psychiatrist in the complaint process. it will carry a lot more weight. Your psychiatrist can describe his response to taking medications now, vs before. Also describe lack of contact, lack of communication, lack of consultation and unauthorised medication change.

    When she said she was acting in his best interests and said he was on a toxic level of medications, I would have at that point said, "So why have you not dobbed me in to CPS already? If you believe this, then you clearly believe I am a negligent parent. So follow through, or shut up."

    Flamin' idiot!