Ambulance Driver Files A Day in the Life | Kelly Grayson
…let's talk about how I transport people who have threatened – or allegedly threatened – to do harm to themselves to the Emergency Department for psychiatric evaluation.
In my Lines In The Sand post that torqued TJIC enough that he equated me with a Nazi death camp guard, I stated that words have consequences, and that the consequences of threatening to kill yourself may include the cops or EMT's holding you for a psychiatric evaluation against your will. Still, let's talk about how it happens.
When commenter Aaron suggested that I need to find a new line of work that doesn't require me to violate people's civil liberties, I replied that being a paramedic isn't just a line of work for me, it's who I am.
TJIC's rejoinder:
How is this argument not exactly the same one that a member of the religious police in Saudi Arabia would make?
"Worshipping Allah through my work is the most important thing in my life. Don't want me to beat you with a stick? Fine. Just don't speak your theological doubts out loud."
Why, exactly, is your self actualization more important than my liberty?
I see that you still haven't developed any sense of proportion to go along with your lack of manners, TJIC.
Because beating someone with a stick for apostasy is exactly like taking a psych patient to the Emergency Department for evaluation.
Because saying "1 down, 534 to go," is exactly like actually firing a shot at the President, right?
Still, let's talk about how it happens.
I have to have a credible threat, first of all. The patient has to admit to threatening self harm, or a credible witness has to attest to it. That means someone willing to sign an affidavit or otherwise give a sworn statement to police, or identify themselves by name on a 911 tape, etc.
Louisiana law carries substantial criminal penalties for swearing falsely in this regard; up to one year of imprisonment, which may include hard labor, and up to $1,000 in fines. I have seen people charged with this, when their part in the drama play included making false statements to the police.
But if the patient himself says, "Yeah, I said I was going to cut my wrists, but I didn't mean it," we have no way of knowing which part of that statement is false. You don't get to take it back.
Words have consequences. And no, those words have to constitute a credible threat, not something like the example you cited, "If I have to eat one more bite of this leftover soup I'd be better off dead."
There's your absolute lack of proportion again.
Likewise, if I have a specific threat but reported by an anonymous source – "Hey, 911? I just heard somebody shouting at 123 Anywhere Street that they were gonna off themselves by taking all their pills at once." – and I find a patient with slurred speech and lethargy denying they made such a claim, but with an empty vodka bottle and an empty bottle of prescription painkillers nearby that should still have 28 pills in the bottle…
… then yeah, I am going to cart that patient's lethargic ass off to the hospital, no matter what they say. And I'm going to sleep like a baby afterwards. If that makes me a moral coward and a tool of government oppression in your eyes, so be it. Your approval isn't necessary to my sense of self-actualization, either.
The law is messy, and it doesn't always work like it should. There are aspects of it that I am personally uncomfortable with, like transporting cutters to the hospital, for example.
I fully realize that, for some people, cutting themselves is a coping mechanism for stress. It helps them maintain clarity and focus. They are no more suicidal than the rest of us.
To my mind, it's a damned poor coping mechanism and there are plenty of healthier ways than self-mutilation, if for no other reason than to avoid getting taken to the hospital for a psych evaluation because someone who doesn't understand your coping mechanism thinks you're insane.
Still, I don't get to make that decision. A doctor does.
And in this situation, I am acting as a physician extender. In Louisiana, involuntary psychiatric holds can last up to 15 days. The physician usually orders it via a mechanism known as a Physician's Emergency Certificate. When *I* take you to the ED for that evaluation, it's done under that physician's auspices. You must be evaluated by a physician, psychologist, or mental health nurse practitioner within 12 hours to determine if a PEC is warranted. If one isn't warranted, or they don't evaluate you within 12 hours, you get to go free, with nothing more than an ED visit to show for it.
If the cops take you, it's generally under the auspices of the elected parish coroner. The effect is the same: to get you to the hospital for the PEC evaluation.
There are checks and balances, too. If the PEC orders you involuntarily committed – again, for up to 15 days – you are required to be evaluated by the elected parish coroner or designated deputy within 72 hours of admission. If their evaluation does not agree with the physician's, you go free. If the original involuntary commitment came from the coroner, you have 72 hours to be evaluated by a psychiatrist. If his evaluation does not agree with the coroner's, you go free.
So, effectively speaking, the most a sane person is going to be held against their will is 72 hours.
If an additional stay is required beyond those 15 days, you must be evaluated within 72 hours of the end of that 15 day period by the coroner and the psychiatrist, who both must be in agreement to extend the hold for another 15 days.
Beyond 30 days, the bar is set far higher, which brings us to my next subject:
Line 11f of ATF Form 4473 asks:
Have you ever been adjudicated mentally defective (which includes a determination by a court. board. commission, or other lawful authority that you are a danger to yourself or to others or are incompetent to manage your own affairs, OR have you ever been committed to a mental institution?
Note the phrases I placed in bold print.
This is NOT the same thing as a temporary psychiatric hold, or even a temporary involuntary commitment.
Note the term "adjudicated mentally defective."
Adjudicated, as in court proceedings. Judges, lawyers, juries and all that. In most cases, it requires more than a hearing before an administrative law judge. That means you get a civil hearing complete with jury, a chance to respond to the petitioner, your own choice of lawyer or a guardian ad litem appointed by the court, and time to prepare a case.
A 72-hour Physician's Emergency Certificate doesn't even come close to meeting that legal standard. In my state, court proceedings are usually required to hold a person beyond 30 days.
The instructions for Form 4473 define "Committed to a Mental Institution" as:
A formal commitment of a person to mental institution by a court. board, commission. or other lawful authority. The term includes a commitment to a mental institution involuntarily. The term includes commitment for mental defectiveness or mental illness. It also includes commitments for other reasons, such as for drug use. The term does not include a person in mental institution for observation or a voluntary admission to a mental institution.
Louisiana RS 28:53 states:
A.(1) A mentally ill person or a person suffering from substance abuse may be admitted and detained at a treatment facility for observation, diagnosis, and treatment for a period not to exceed fifteen days under an emergency certificate.
(2) A person suffering from substance abuse may be detained at a treatment facility for one additional period, not to exceed fifteen days, provided that a second emergency certificate is executed. A second certificate may be executed only if and when a physician at the treatment facility and any other physician have examined the detained person within seventy-two hours prior to the termination of the initial fifteen day period and certified in writing on the second certificate that the person remains dangerous to himself or others or gravely disabled, and that his condition is likely to improve during the extended period. The director shall inform the patient of the execution of the second certificate, the length of the extended period, and the specific reasons therefor, and shall also give notice of the same to the patient's nearest relative or other designated responsible party initially notified pursuant to Subsection F.
After that, further detainment at the treatment facility requires that you be adjudicated mentally defective. The Form 4473 instructions go on to state:
A person who has been adjudicated as a mental defective or committed to a mental institution is not prohibited if: (I) the person was adjudicated or committed by a department or agency of the Federal Government. such as the United States Department of Veteran's Affairs ("VA") (as opposed to a State court, State board, or other lawful State authority); and (2) either: (a) the person's adjudication or commitment for mental incompetency was set-aside or expunged by the adjudicating/committing agency; (h) the person has been fully released or discharged from all mandatory treatment, supervision, or monitoring by the agency; or (e) the person was found by the agency to no longer suffer from the mental health condition that served as the basis of the initial adjudication. Persons who fit this exception should answer "no" to Item 11.f.
So much for the belief that Leviathan can deny you your 2nd Amendment rights if I haul you off for a psych evaluation. I know that those of you who live behind enemy lines in May-Issue Land are subject to the whims and capriciousness of local police chiefs, but out here in Free America, it's pretty cut-and-dried.
If it was only a 72-hour hold, you have nothing to worry about.
If it was only a transport to the ED, and a 72-hour hold was deemed unnecessary, you have nothing to worry about.
If you were committed for even 30 days, and fully discharged with no court-mandated requirement for outpatient care, you have nothing to worry about.
If the court determined that you were crazier than a shithouse rat, and that even though you committed no crime for which you could claim not guilty by reasons of mental defect, that the safety of yourself and society was deemed preserved by locking you up for six months or six years, after which you were deemed competent to manage your own affairs and were set free… you have nothing to worry about.
This is the United States of friggin' America. Even as bad as things are now, we don't just lock people up in the gulag because they're a little odd. If that were the case, TJIC would be writing his little anarchist missives in crayon, snail-mailing them to me and begging me to post them in my comments section.
So don't let the fear of Big Brother confiscating all your guns deter you from seeking mental health counseling, calling a Suicide Hotline, or deter you from calling 911 because you legitimately fear a loved one may harm himself, yet you don't want to see his civil rights trampled on.
The bar is set a lot higher than that.
