Involuntary Hospitalization 1013s

1013/HOSPITALIZATION FAQs

 

My loved one has been hospitalized involuntarily and I want him out. What can you do to help?

 

Our firm now offers only consultations for involuntary hospitalizations. Our ability to get directly involved with representation was so severely limited by the fast-moving nature of these cases and the volume of calls that we simply didn't have the resources to provide that direct representation of patients. You can read more about our consultation service here.

 

Generally speaking, Georgia law gives the combined forces of ERs and crisis stabilization units (CSUs) about a week, all things static, to treat a person who they believe meets criteria for involuntary civil commitment under the parameters of O.C.G.A. §37-3-1. That means if you are contacting us after your loved one has already been hospitalized for four or five days, there's little we can do to speed things along that wouldn't happen without our involvement after a day or so. Know that a consultation with us at this stage is better suited for preparing for the discharge, understanding the law, and avoiding future hospitalizations.

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Why offer these services if you can't, or won't, always get involved?

 

I have debated this very question myself for years. The reality is, though, that there are very few private attorneys in this state who offer these kinds of services, so I feel the need to offer whatever resources I'm able to accommodate. But, I do so with a great deal of caution, as we receive multiple calls a day asking for help in hospital commitment cases. Moreover, it is a time of extreme stress for a family and for the patient, and balancing the need for, yet scarcity of, this kind of service with our refusal to simply cash in on a family's anxieties leaves a very narrow sliver of services.

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That said, I continue to offer our consultation service to help enlighten families and help them navigate the system, as there are few others who understand it.

 

What rights does my loved one have when hospitalized?

 

While the laws in Georgia are archaic and very favorable to the hospitals, a patient is afforded a variety of rights that he may exercise either himself or through his representative(s). Those include, but are not limited to:

(1) the right to request transfer to voluntary status (be wary of this request, however);

(2) the right to request discharge after being transferred to voluntary status;

(3) the right to be transferred, free of charge, to a state hospital for treatment;

(4) the right to be transferred to another private CSU hospital, if the other CSU will accept him and if he (or the family) pays for transport to said other private CSU (note, Skyland Trail is not a CSU and does not qualify for purposes of this statute);

(5) the right to have an attorney and to see and correspond with that attorney.

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The hospitals are required to assist in providing and completing most forms through which a patient exercises any given right, but the reality is that they rarely do.

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I can't get any information about my hospitalized loved one, or even confirmation he's there. Am I not entitled to that information?

 

This is a debatable question that, by my estimation, the hospitals play masterfully. While Georgia law, under O.C.G.A. §37-3-147 et. al, requires two representatives to be established by the hospital (primarily family members and/or those requested by the patient if possible) to receive information regarding the patient's hospitalization and certain notices, among other things, federal HIPAA privacy laws would seem to contradict this statute, and under the Supremacy Clause, federal law would win out.

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That said, while the hospitals don't make it easy, they will usually, eventually, make contact with a family or respond to their requests for information. Sometimes, it's most effective to show up in person to establish that representative status, as the hospitals are required by law (same statute) to gather this information. Also, social workers of some of the best sources of information and the most likely to communicate with you about your loved one, so angle for a social worker or "patient advocate" if you can't get feedback from a doctor.

 

How long can the hospital hold my loved ones? I keep hearing "72 hours"...

 

If there's one misleading phrase that needs to be eliminated from the provider lexicon, it's "we can hold him for up to 72 hours." While there might be some provision for this concept in the law, there's very little truth to it in practice.

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Here is the kernel of truth to the "72 hour" rule: when a 1013 (form authorizing involuntary commitment) is lodged, the emergency receiving hospital has 48 hours to certify that the person needs further treatment. If they don't, then the 1013 expires and the person must be discharged. This hardly ever happens. During that 48 hour period, a physician typically effectuates this certification for further treatment through a form 1014. After the 1014 is signed, the receiving hospital has 24 hours to transfer the person to an "evaluating facility," such as a Peachford, or Anchor, or Summit Ridge, etc. There's your 72 hours: 48 + 24 = 72.

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But, it doesn't stop there. After the transfer to the evaluating facility, the 1014 authorizes up to an additional 5 days of commitment. This does not include weekends and holidays. So, in practice, the combination of ER and evaluating CSU hospital have up to a week, weekends and holidays excluded, to hold your loved one with very little meaningful accountability.

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This does not mean it has to be a week; in fact, the law requires discharge if at any point the person no longer meets criteria for commitment. But, the hospitals have historically endured very little oversight from courts during this week-long period, and so they utilize it quite fully. That said, the typical period of hospitalization, in my experience, is anywhere from four to six days, including the weekends, all things static.

 

Can they hold my loved one longer than that week?

 

Yes, but at that point they must get the Probate Court involved via a 1021 petition. This rarely happens. Hospitals in most cases take their week of no oversight and then move along, discharging the patient at or before that time.

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However, if a 1021 is lodged, a hearing must be held, by law, regarding the patient's extended commitment "no earlier than 7 days and not later than 12 days." Why that odd window of time? I have my theory but it's not important here. I have seen doctors in some cases lodge these to give a little more time to treat but in most of those cases, the hearing is withdrawn before it happens and the patient is discharged.

 

My child is a minor. Can I not simply request discharge against medical advice (AMA) and get him out?

 

You can, but the hospital's ability to continue to hold a person is not affected by the fact that he or she is a minor, and you don't get meaningful extra rights just because you are the parent of the minor child patient. The criteria for involuntary commitment still rule the day, and the hospitals are given the discretion to make that call.

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That does not mean you shouldn't request an AMA discharge. I do believe that hospitals tend to be a little more receptive to requests for discharges in cases of minors, especially younger children. The reasons for this are up for debate, but pushing for discharge in these cases seems more effective than in cases involving adults, in my experience.

 

The hospitals seem to hold all of the power. Do they?

 

Practically speaking, yes, or at least most of it. There are bones thrown to patients via rights supposedly guaranteed to them under Title 37, and legal switches that can be flipped to hold them to the restrictions those rights afford the patient. But, I've always said the laws read as though the legislators granted the corporate big wigs over these hospitals a wish list; one that would maximize the profit they make from the patients they supposedly treat. Just the ridiculous windows of time the hospitals are allowed to "consider" the exercise of certain rights afforded to patients (48 hours, 72 hours, etc.) are clear examples of a baked-in hedge for losing out on additional billing that granting a discharge, or transfer, or other right might cost them.

 

You seem to be speaking mostly about private hospitals. Do the same concepts not apply to State hospitals like Georgia Regional?

 

I am speaking mostly about private hospitals, though the laws apply to State hospitals as well. But, State hospitals have no monetary incentive to hold a patient for a minute longer than he might reach clinical stability (and in some cases, discharge might come a bit too early). To the contrary, their beds are always full and they need whatever space they can get. The result, in my experience, is that discharge from places like Georgia Regional State Hospital in Atlanta is far quicker; closer to 24-72 hours in many, but not all, cases.

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While the environment of a State hospital is not ideal, I wouldn't call it that much worse than what I've seen in any private CSU. And while there are doctors in some of the private facilities who I respect, I also have an enormous amount of respect for many of the doctors, staff, and administrators at the State hospitals as well. 

 

What, then, are the benefits of the laws authorizing involuntary hospitalization?

 

They keep something worse from happening. It's a breath in time that affords your loved one a chance moving forward, a chance she would not have had she taken her own life or seriously hurt another. I will credit the law (and the hospitals who utilize it) for that and little else.

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But, don't mistake this for ground-breaking treatment. It's about stabilization, and it has been described to me in almost every case as, itself, being traumatic. That means that you, as support, need to remind your loved one who has been hospitalized that the real work happens in an outpatient environment, and with providers picked by your loved one and those he can trust. Remind her that real treatment goes beyond medications; finding a therapist to help understand the mind is just as, if not more, critical. Do not think that hospitalization by itself will fix everything. It won't, and it will happen again without a strong foundation of outpatient treatment and education.