A bit rusty on my psychiatric hold HIPAA dance

My brother, who’s been devolving for a couple weeks, wasn’t home when I attempted to pick him up for an ENT appointment this morning. It’s a long story, but I think it likely he was picked up by the police and taken to the Emergency room.

My sister and I have access to his online health record, and we see where he had his vitals recorded at 6:00 PM yesterday. He also received some instructions for dealing with an injured shoulder, but beyond that there’s a bunch of blank documents showing pending and scheduled for update in two or three days. This period is suspiciously near the typical 72 hours of psychiatric hold.

He hasn’t called and we’ve tried to get information from the hospital, but nothing. He doesn’t have his phone and may not know any of our telephone numbers without it. My sister thinks she needs a PIN number to get any information out of the hospital, and doesn’t have one to her knowledge.

Any ideas on how to navigate this? We’ll continue to check his online records. My recollection is he’ll probably have a hearing after 72 hours, or does that happen before then, it’s been so long ago I forget. I suppose we could wait until something changes on his record, but it would be nice to know what’s going on and where he is— even though we have a pretty good idea.

Hi MB, One of our forum members reported they had good results by sending a barrage of faxes to hospitals in their area. If you can tell from those records where your brother is currently “residing” you can focus on faxing just that hospital.

I have no idea why much of the medical world still relies on fax machines. If you don’t have a fax machine around (because its 2022) there are phone apps that can send faxes.

Let them know your concerns about your brother not knowing any of your telephone numbers in this age of smart phones.

What seems to happen is that a sympathetic someone who is on the receiving end of the faxes will reach back to you. Be sure to include various means of contacting you and the names of anyone he may have listed as emergency contacts. Good luck!

Just found him, he’s in jail. Resisting arrest without force, obstruction of justice, assault of law officer or medical personnel etc from his booking information. Don’t have the full story yet, he called my sister.

My guess is he started off with a psych hold, assaulted someone in the hospital and they decided to transfer him to jail. Curious to see if my guesses are correct.

If you don’t mind, I will guess that he resisted arrest, possibly became injured and they had to have him treated before taking him to jail.

You’re probably right. We got caught up in the delay between visiting the hospital and learning he was in jail and the the omnibus possible targets of the assault charge. As it turns out he was delivered to the ER of a hospital that doesn’t have a psych ward.

I often remind my sister that when you deal with mental illnesses there’s a tendency toward the reverse of Occam’s razor. You tend to favor answers to mysteries that are perverse and complex as being more likely than something straightforward. I think I’ve said in the past, when you hear hoof beats you hear unicorns, not zebras or horses.

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Unsurprisingly all roads of least convenience lead to HIPAA it seems. Fax and phone communication I believe were deemed HIPAA compliant when the law was approved in 1996. At the time widespread email, web and other communication were in their infancy. Phone and Fax communication is functionally point-to-point and there are robust laws surrounding wiretapping.

Email traffic isn’t always point to point, encryption in transit until recently wasn’t widespread, and robust mechanisms for preventing and detecting impersonation and other fraud aren’t well established for the medium. Voice calls don’t leave a paper-trail, and it’s notably problematic and cumbersome to record or transcribe private health information to tape or electronic records. People understand how to manage paper as far as filing, copying, scanning and (most importantly) shredding goes so Fax technology persists largely as a least common denominator.

The ACA act advanced much of the digital storage aspects of medical technology, but didn’t touch much of the communication ends of things. So most medical records are communicated directly to/from medical portals to web clients or medical portal to medical portal with secure encrypted sessions or fax to fax—especially when humans are involved.

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Sending good wishes​:heart: For your brother and your family :raised_hands:

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I hope all this isn’t too traumatic for him and that he gets the help he needs.

Well my siblings and I had a group call to present a united front and we have a holdout with no practical experience who wants to withhold bail until some sort of inpatient treatment/rehab is arranged. My estimation is he’ll remain in jail longer than his potential sentence for assaulting an officer if this line holds. My sister and I were only hoping he’d remain in jail for a week to keep him away from my mother who’s heading in for surgery and a rehab facility afterward.

As for trauma, hate to say it but generally my brother only rights himself mentally in response to a degree of trauma. He presented formidable intellectual anasognosia running up to this with bizarre contradicting logic as only a manic person could appreciate. He might have managed his manic symptoms as long as he didn’t drink and the weather was cooler. Drinking now seems the express train to jail, as this was his second arrest in a week, and within days of his first drink in six months. It seems he’s become so sensitized to alcohol, a few drinks makes him obstreperous and potentially violent.

My sister and I have reached the conclusion he’s fundamentally broken, but my other brother still holds out hope. His arraignment is today. I’m going to try to hide in the back of the court and hope he doesn’t notice me or that it’s a remote hearing.

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Personally, I think we were able to make better decisions for my son once we realized he was fundamentally broken. We put better supports in place and he did much better in other aspects of his life. Getting all siblings to agree on anything can require some alignment of the celestials.

Bipolar is trickier in some ways. Many of our family members with bipolar will experience more intense symptoms as they grow older. My grandson’s mother’s episodes grow slightly worse each year. While she has several episodes a year, she usually has an especially severe episode around Christmas. The December episode of 2021 was a new level of severity as she actually stabbed her arm several times in front of her husband and children.

She wasn’t trying to kill herself, the wounds were just quite bloody and superficial. She told me later she just wanted all of them to understand how bad she felt at that moment. She felt they didn’t understand.

Good luck in court!

Resisting arrest kind of explains the injured shoulder. As long as the case is handled by the mental health court there’s a good chance that he can be transferred to a mental health hospital, it should be that way, and I think that you can advocate for him there; sometimes they really can’t make sound decisions; my son would say 'I rather be in jail ’ to avoid the meds but I know he doesn’t belong there.
It’s comforting to know where he’s at, not the best place but better than the streets.
My best wishes to you and your brother.

**I’m glad that you and your siblings are watching over him. It’s common that in many instances siblings don’t get involved/want to know.
Please let us know about the outcome.

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Ask to speak to the hospital social worker, explain you are family and his muse if transportation and will need to be involved in any discharge plan

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My brother tends to have bad patches Summer and Christmas, but sometimes skips years. The summer ones are generally longer in duration, and the Christmas ones trend shorter, yet more acute.

So far we’ve just the one phone call, but we got a call from his public defender this afternoon after she met with him for an hour in jail to tell us about his bond hearing tomorrow. We already knew about it—we’re getting pretty adept at navigating the jail and court websites. Navigating the commissary and the phone sites were actually much harder, but I think we have him reasonably well funded.

We have a bit better picture of the sequence of events, but we’re still missing a few pieces to the puzzle. His assault charge has been enhanced to felony, either because it was targeted due to sex/race, or because it was a first responder or all of the above. My initial instincts were partially correct. The complainant has a nursing background, but he was first taken to jail, then to the emergency room and then back to jail. Still unclear why they picked him up and when the assault occurred.

My latest theory is the nurse (who has a psychiatric background) was embedded in a crisis team who going to take him in for a psychiatric hold, but he resisted arrest and assaulted her. So they took him to jail, and he started complaining about his shoulder, so they made a side-trip to the ER.

My mother’s surgery is very early Friday morning and my sister is arriving Friday evening, so as long as we can keep him out of our hair until then, I think we’ll be okay—for now.

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In these situations, we seem to live in a world of guesses based on the prior behaviors of our family members and law enforcement. My son still changes his arrest story each time I hear it. In the last version he claimed he did not have a gun on his person. I have been surprised how often my FIL’s line “there’s some truth in that” comes into my mind over the years. Originally my son said the gun had been in his backpack. The only thing I know for sure is that there was a gun and the police had it in their custody and he wanted it back post arrest. And, of course, the laws being what they are, he did get the gun back after he was released. Perspectives can be so different - that doesn’t help either. Hopefully your brother’s complainant was not badly injured.

I’m glad the tale is beginning to unwind and you have worked through the support maze. Wishing your mom a successful surgery and a good recovery. At these times I always think, couldn’t things be just a bit less complicated - like - just long enough to get mom through her surgery without distractions?

Ah yes, and we all knew during the run-up to this that it was a bit of a race between him keeping it together and my mother’s surgery. But when he started drinking openly in front of me on his porch last week, I knew it was a matter of time and we’d probably lost the battle.

I agree with the FIL, there always seems to be a grain of truth in his stories. With our newfound court and jail website skills and other sleuthing, we’ve uncovered many mysteries. He’s had brushes with the law he’s handled on his own which were probable stressors that explain past behavior and his relative sobriety for the last 6 months. Seems like he needs these crises to scare him away from the brink, but has a deep-seated need to cover them up either consciously or unconsciously. I did my fair share of this in my prodrome and early recovery, but once I committed to therapy it became less necessary.

His bond hearing is at 2 PM and I’ll go from the courthouse to my mother’s place to stay overnight and take her for her surgery in the morning. There’s an off-chance he might be able to arrange bail without our help and from friends who have agreed to honor our wishes, but I’m hoping he won’t be able to mobilize quickly enough to disrupt matters.

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@hope Yikes! Perhaps a magnetic board with emoji magnets that could convey how she is feeling on any given day at any given moment? Discussion afterwards? Reach out to therapist if extreme emoji displayed? The holidays can be especially taxing emotionally. Maybe a session with therapist as a standard lead up prior to holiday period, or at least family check in.

Here’s me in Canada thinking that people with known mental health issues is one of the few reasons to bar someone from having a gun.
While it is true that those experiencing mental health issues tend to more often be the victims rather than the perpetrators of violence, in a crisis moment that doesn’t necessarily hold [less rational, less inhibited]. My mother got upset and tried to punch me in the face earlier this week, I had to hold her wrists to restrain her. She acts like nothing happened now.

@Maggotbrane Hope all is going well today for your mother’s surgery and recovery. Hope the judge recommends treatment rather than jail time for your brother. Good luck!

Update: my mother’s surgery went well; my brother’s bond hearing— not so much.

He was denied bond. Sounded like the prosecutor was reading directly from bodycam transcripts and it wasn’t pretty. His courtroom decorum wasn’t exactly stellar either. A less even-keeled judge might have found him in contempt. His pressure of speech often gets him into trouble. I kept my head down in court and sat in the back and he might not have seen me.

Amusingly, the public defender cited my mother’s surgery, his 10 years history at his address and proximity to family as reasons he should be granted bail. Never mind my mother says he’s the last thing she needs right now, his house is hoarded out and seemingly 50% aluminum cans with a “healthy” percentage of beer cans, and the rest of the family wanting him in inpatient treatment rather than anywhere near our homes. He’s appealing, of course, and it’s now very clear to me that we have no say in the matter at all unless he’s desperate.

The hope is he loses his appeal, and we step in to try and gets his case moved to a version of mental health court. If not, the hope is he’ll be unable to make bail on his own and we have leverage to negotiate something similar. He’ll need to submit to this willingly for this to work, and that may prove to be a high bar. Otherwise, I guess he might act up so much in jail that they transfer him to a psychiatric hospital, or he’ll remain in jail until trial.

Well… at least he’s making new friends.

Edit: didn’t mean to be snarky here, in case this gets misinterpreted. He’s making friends in jail, to be sure. And he could use some, because there’s nothing lonelier than a manic person without an audience. They’re just not likely to be the best influence on him.

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Thanks for letting us know that your mother’s surgery went well.

and its a captive audience - the other folks sharing jail space would deeply regret having to listen to my brother in a manic state.