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Senate panel rejects medical protective custody plan

CONCORD, N.H. (AP) — A Senate committee on Wednesday rejected a rushed attempt to create a new system for the involuntary detainment of patients in emergency rooms.

The Department of Health and Human Services proposed the medical protective custody system in response to last month’s state Supreme Court ruling that psychiatric patients being held involuntarily in emergency rooms must be given a chance to contest their detention within three days of their arrival.

State law requires probable cause hearings for such patients within three days of an “involuntary emergency admission,” but the state had argued the clock does not start until someone is transferred to an inpatient facility. However, those facilities often have no available beds, leaving patients “boarding” in emergency departments for weeks at a time.

The state has temporarily reduced the number of adults waiting for beds in the last few weeks by offering financial incentives to long-term care facilities and local hospitals. But its longer term solution hit a roadblock when the Senate Health and Human Services Committee voted 4-0 against adding it as an amendment to an unrelated bill.

“There’s no consensus that anybody’s bought into, and I see no way this amendment can go forward without an awful lot of collaboration among the interested parties,” said Sen. Jeb Bradley, R-Wolfeboro.

Officials wanted to create a new system that that would allow hospitals to detain and assess patients who need help but not necessarily inpatient psychiatric care, such as elderly patients with dementia and those with substance abuse problems, said Commissioner Lori Shibinette.

“We are not saying that these patients don’t need care, but they certainly do not need an involuntary emergency admission,” said Shibinette, who denied suggestions from critics that the proposal would end up extending the time spent in emergency departments.

“It is meant as a tool for the provider to hold an unsafe person for up to three days whose condition is not related to a serious mental illness and get them on the right path,” she said. “That may be substance abuse rehab, that may be long-term care, or that may be a voluntary admission.”

The proposal was opposed by the Disabilities Rights Center and the New Hampshire chapters of the American Civil Liberties Union and the National Alliance on Mental Illness. They argued that it would weaken due process and result in patients spending more time detained.

Michael Skibbie, policy director for the Disabilities Rights Center, said the plan would be a step backward and compared it to the days when people with mental illness spent their lives in institutions.

“We left behind a system of involuntary confinement of people on the decision of a medical provider half a century ago, when we realized that judges need to determine if the legal standard for confinement is met. We can’t abandon that,” he said. “In criminal cases, the U.S. Supreme Court has said that judicial review of the basis for custody must occur within 48 hours, unless there’s some extraordinary emergency circumstance. We shouldn’t be providing more procedural protection to people who are accused of a serious crime than for people who as a result of illness find themselves in the emergency department.”

Virginia Nossiff, of Conway, told the committee her 24-year-old son waited two and a half weeks in a windowless room at her local hospital earlier this year. She said she fears such waits would grow if the proposal goes forward.

“He received no treatment whatsoever except food and water,” she said. “We need to treat all psychiatric patients in a timely, effective and respectful manner.”

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