It will go easier on you if you cooperate with them,” said the nursing assistant sitting beside my bed. Clearly, she had seen this before.
I was curled up in a fetal position, in terror, in the emergency department of an urban hospital in northern New Jersey, awaiting news about when—or if—I would be let go.
I had been awakened that April morning in 2014 by repeated pounding on my door. I got out of bed and opened the door to find a crew of EMS workers standing there. They pushed their way in, and said that someone had called saying I might be suicidal.
I assured them I was not suicidal, and asked who had told them that, but they wouldn’t say. Days later, I found out that an ex, on whose voicemail I had left a sad message, had made the call. Little did he know what he was condemning me to.
Despite my assurances, they said they were taking me to the hospital so I could be “checked out.” When I told them I didn’t want to go, they said I could either go willingly or they would strap me down to a stretcher and take me out in front of all of my neighbors.
I said I’d get dressed and go with them.
When I needed to use the bathroom, they had a female EMS worker go in with me and observe. I was not allowed to take anything with me (including essential medication) as I was rushed out the door.
The hospital was terrifying: the screams, bleeding and unattended to pain of an urban emergency room. I was panicked from my kidnapping and already suffered from severe post-traumatic stress disorder. But I managed to remain polite and cooperative. At no point was I combative. I assured multiple personnel that I was not thinking of hurting myself, and that I just wanted to go home.
My ex had reported that I’d been drinking heavily, and EMS had seen a bottle of wine on my counter. I had been drinking for several days, but had not had a drink since the night before. It was already late morning in the ER, so my blood alcohol level wouldn’t have been high. I was not acting drunk, nor did I feel drunk.
“If you don’t sign these papers, we will strap you down to this bed until a psychiatrist comes. That will be hours.”
People came in and out. A nursing assistant, the one who advised me to cooperate, was assigned to sit by my bed. My phone was dying but I texted my boss that I was in the hospital. That was the last communication I was allowed with the outside world until the next day.
Eventually, a nurse came in with a clipboard and said I had to sign into the hospital for a four-day alcohol detox. I said I did not want to, that I needed to get some rest and then get back to work.
She said words I will never forget. “If you don’t sign these papers, we will strap you down to this bed until a psychiatrist from [another local medical center] comes to evaluate you and commit you. That will be hours.”
I was not allowed to call my parents, friends, a lawyer, anyone. I was alone and terrified. I signed the papers.
Is threatening me with being restrained in an ER for hours if I don’t sign commitment papers legal? As I later verified, it is not. But they did it anyway. And because I was extremely vulnerable and didn’t know my rights, they got away with it.
I told the next nurse who came in, a nicer one, that I had a panic disorder and was terrified. She gave me a shot of Ativan. I stayed curled up in the bed, freezing in the cold ER and listening to other patients’ screams, until they wheeled me up to the detox unit. There, they gave me a huge dose of Librium (a benzodiazepine that is used for alcohol detox) and I fell asleep.
When I woke up, I wanted to contact my parents and my job. But they had taken my phone, and I was not allowed to access it.
The only option was a public phone right next to the nurses’ station, where anything you said would be overheard. The one number I could remember was my mother’s cell, where eventually I reached her. I found out later that I sounded confused and over-medicated, which I was. I told her I was in the hospital and that they were going to keep me for a few days.
She was hours away, with no way to quickly come to see me. Knowing that I could be overheard, I didn’t do what I wanted to do, which was say, Mommy, come rescue me! I was following that nursing assistant’s advice to cooperate. I played along, pretended everything was okay.
Nothing was okay. And nothing was okay again for a long, long time.
How the Hospital Broke the Law
The hospital’s actions violated the federal Department of Health and Human Services Patient’s Bill of Rights on several levels. For example, it states:
“A hospital must inform each patient, or when appropriate, the patient’s representative (as allowed under State law), of the patient’s rights, in advance of furnishing or discontinuing patient care whenever possible.”
I was given no information about what sort of “care” I would be given. I was not informed, for example, that once I signed the papers, the hospital’s physicians could decide when to discharge me. I was told that I would be discharged automatically after four days, which I found out the next day was a lie. Had the physicians decided to keep me longer—in fact, they did release me at that point—the only escape would have been to be discharged “AMA” (Against Medical Orders). Health insurance typically does not pay for treatment if a patient is discharged AMA. Unless I wanted a ruinous bill, I would have remained a hostage.
The Patients’ Bill of Rights also states:
“The patient or his or her representative … has the right to make informed decisions regarding his or her care. The patient’s rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment.”
I had no voice whatsoever. I was given medications without being informed of what they were or consenting to their use, even though I was awake, alert and completely oriented to my environment. I was denied my legally prescribed medications, including psychiatric meds, and not allowed to contact my psychiatrist. I was clearly denied the right to refuse treatment.
The nurse’s threat was clearly coercive, and clearly illegal.
The Patients’ Bill of Rights states that a patient also “has the right to have a family member or representative of his or her choice and his or her own physician notified promptly of his or her admission to the hospital.”
Because my phone had run out of charge by the time I was forced to sign the papers, and then the staff took it away from me. I was not given the chance to notify a family member or friend. So my mother had no idea where I was, my boss had no way to contact me after one mysterious text that I was in the hospital, and I had no access to local friends who might have helped.
And the nurse’s threat to have me restrained to the bed until a doctor showed up hours later was clearly coercive, and clearly illegal. The Patients’ Bill of Rights states that a patient “has the right to be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.”
The DHHS sets strict conditions for the use of restraints, which are defined as drugs used to control behavior, as well as physical restraints. These conditions include that restraints should be:
* selected only when other less restrictive measures have been found to be ineffective to protect the patient or others from harm.
* [used] in accordance with the order of a physician or other licensed independent practitioner permitted by the State and hospital to order a restraint.
Neither of these conditions applied to me, and the threat to restrain me “for hours” was also against the law. The DHHS also states:
* The treating physician must be consulted as soon as possible, if the restraint or seclusion is not ordered by the patient’s treating physician.
* A physician or other licensed independent practitioner must see and evaluate the need for restraint or seclusion within 1 hour after the initiation of this intervention.
In addition to the Patients’ Bill of Rights, various states, including New Jersey and New York, have their own laws under which one can sue if restraints are improperly used. Your state may do too. Regardless, federal law puts such strict limits on use of restraints that unless a patient is truly violent, there is never a justification for them.
Why I Didn’t Sue
I knew nothing of my rights at the time, and was already coping with PTSD—brought on by an even more traumatic, earlier incident at a neighboring hospital.
I had seriously considered fighting back through legal means then. Breaking state and federal laws or regulations represents evidence of a violation of the hospital/practitioner’s duty of care in a malpractice action.
But I had decided, with considerable input from my family, friends, therapist and psychiatrist, that I would be “re-traumatized” by the process and should just try to go on with my life. I applied that conclusion to my illegal forced detox.
I am still afraid whenever I see EMS. Six years later.
My attempts to go on with my life were in part successful. I went on to earn a Master of Public Health degree from a prestigious university. I worked in alcohol harm reduction, primarily through HAMS—helping to lead an organization that supports thousands of people worldwide who want to change their drinking according to their own goals.
In retrospect, I wish I had fought. The statute of limitations on filing a lawsuit has long passed, but the fear has not gone away.
I am still afraid of seeking medical care, and have refused to go to the hospital at times when I probably needed to. I have delayed seeking physical care that has nothing to do with alcohol or mental health, due to my fear of the system.
And even though I walk around the streets of Philadelphia stone-cold sober, I am still afraid whenever I see EMS. Six years later.
Not Only Me
I wish my incident was isolated, but in talking with hundreds of people, mostly women, over the last four years in HAMS, I’ve found similar situations.
One woman told me, “I didn’t give in, but a hospital saw that I had a history of SUD pre-pregnancy and was a single mom on welfare, so they spent my entire labor trying to force me to sign into detox and let them take my baby. Then they tried to discharge me and keep her (a perfectly healthy nine-pound baby) for an extra week for ‘evaluation.’ I knew if I left, they would say I’d abandoned her and not give her back, so I refused to leave. It was horrible.”
It’s not just the US. A woman from Australia wrote:
“I spent 28 days in an involuntary detox unit. They caught me at 8:15 am. I was sitting on my couch in my pyjamas, just woken up, sober, and contemplating breakfast. I had 20mins to get ready. I had to beg them to wait outside so I could have some dignity whilst showering and dressing. If I had refused, they would have had me arrested. The idiots were so incompetent they gave me my first seizure, cause they messed up the benzo taper (you have to taper off of the strong benzodiazepines they administer in a hospital detox, or else risk seizure) and yes, I have the ED report to prove it. Both my mum and I put in separate official complaints, which probably did nothing, other than hopefully I am on the ‘never to return’ list.”
Rights mean nothing if you don’t know about them or don’t have the power to enforce them. Based on my experiences and research (I am not a lawyer), here are some ways you can protect yourself:
* Never be combative or in any way physically resist medical personnel. This gives them an excuse to use restraints.
* Demand to have contact with people who can advocate for you. If possible, have a friend or family member who lives close by ready to show up and advocate for you if you are involuntarily taken to any sort of medical facility.
* Refuse to sign any consent forms for commitment. It is actually very difficult to forcibly commit someone legally, and it requires proof that the person is a danger to themselves or others. Here is an excellent description of the laws surrounding involuntary commitment in Pennsylvania, for example. Look up your state laws: You may find it comforting to know how difficult it is to get you locked up, in spite of the threats you may hear.
* If you are threatened, demand to see the facility’s patient advocate. It is that person’s job to speak up for you. Often, simply showing that you know something about how the healthcare system works is enough to back down hospital staff who disregard laws and policies.
* Have a Psychiatric Advance Directive. The National Alliance on Mental Health Issues (NAMI) defines this as “a legal document that details a person’s preferences for future mental health treatment, services, and supports, or names an individual to make treatment decisions, if the person is in a crisis and unable to make decisions.” This is especially good to have if you might end up in a hospital unconscious (from an overdose, alcohol poisoning or any other reason). Unfortunately, not all states legally recognize these documents, but whether yours does or not, it is advisable to create one and have it put it in your medical records—and make sure trusted family or friends have copies.
* If you do not trust your next of kin to make medical conditions for you in an emergency, give someone else medical power of attorney. (This only comes into play if you are incapicitated.)
* And last but never least, have a malpractice attorney’s number memorized, if not tattooed somewhere on your person!
Even before my most traumatizing experiences, I already knew far too much about what happens to people who use substances once they enter the medical system.
Too often, the stigmatization we encounter there is so intense that it might as well be a personal vendetta. We lose our power once we enter these spaces. By learning and exercising our rights, we take back as much as we can.
Photograph via Unsplash