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re: Being PEC'd
Posted on 8/21/18 at 10:59 pm to JabarkusRussell
Posted on 8/21/18 at 10:59 pm to JabarkusRussell
quote:
I had a patient who refused to sign documentation consenting to being hospitalized. The doctor told her that he likes all of his patients to be there voluntarily and failure to sign could keep them up to 15 days. Is that true or was it just a strong arm scare tactic?
it could be both. if they voluntarily check in then they are probably mentally stable enough to not be an immediate danger to self or others so no PEC needed.
If they refuse and cannot be convinced they need to be evaluated, then they may not be stable enough to make the right decisions.
Kinda like if you blow for a DUI... if sober you go along your way after a quick eval... If you refuse to blow your'e raising suspicion of intoxication and they are gonna test your blood at the station to find out.
1
Posted on 8/21/18 at 11:01 pm to VanCleef
no no I agree with you.
I was saying docs will have a good reason to PEC someone.
they will get sued like a MF if they are handing out PECs like opioids.
ETA my username comes from the emergency setting. Altered Mental Status.
I was saying docs will have a good reason to PEC someone.
they will get sued like a MF if they are handing out PECs like opioids.
ETA my username comes from the emergency setting. Altered Mental Status.
This post was edited on 8/21/18 at 11:06 pm
Posted on 8/21/18 at 11:05 pm to AMS
Does a PEC start when admitted to the ER or once they are transferred to the psych hospital?
Posted on 8/21/18 at 11:13 pm to JabarkusRussell
quote:
Does a PEC start when admitted to the ER or once they are transferred to the psych hospital?
People can be brought to the ER by police under ORder of protective custody (OPC) 0r brought by family or by themself for suspected danger to self/others. A physician after evaluation the person decides to issue an emergency certificate(PEC) if there is immediate possible danger to self or others or gross disability which kicks off this ordeal. Once a PEC is signed the time begins and the person is to be admitted to the psych facility. Then the person is held for up to 15 days until clearance from a psychiatrist, coroner, or judge to be discharged.
A judge can decide to involuntarily hold for up to 6 months i believe.
Posted on 8/21/18 at 11:16 pm to JabarkusRussell
quote:
Does a PEC start when admitted to the ER or once they are transferred to the psych hospital?
PEC starts at the time of signing by a physician. Doesn't necessarily start on presentation to an ER. Sometimes there is a delay if the patient is drunk or under the influence.
Posted on 8/21/18 at 11:18 pm to JabarkusRussell
a PEC starts at the time the doctor writes the PEC was issued.
I dont think you get admitted to the ER, you just kinda go check into the ER.
being admitted usually means you leave the ER completely and go to a hospital bed.
I dont think you get admitted to the ER, you just kinda go check into the ER.
being admitted usually means you leave the ER completely and go to a hospital bed.
Posted on 8/21/18 at 11:21 pm to akimoto
quote:
PEC starts at the time of signing by a physician. Doesn't necessarily start on presentation to an ER. Sometimes there is a delay if the patient is drunk or under the influence.
Right. I can't tell you how many of the PECs started out as a normal(ish) interaction and then mentioned something like hearing the devil like 2 minutes before discharge. or the family member calls/shows up giving an entirely different description of whats going on.
A patient could even be discharged and walking out the door talking on their phone "he banged my wife ima keeeeeeel heeeem!!!!" and gets a PEC.
This post was edited on 8/21/18 at 11:25 pm
Posted on 8/21/18 at 11:43 pm to AMS
quote:
A patient could even be discharged and walking out the door talking on their phone "he banged my wife ima keeeeeeel heeeem!!!!" and gets a PEC.
I've usually dealt with the patient that is looking for 3 hots and a cot that pull the suicidal card as they are being discharged.
Unfortunately truly suicidal patients don't bring themselves to the hospital to be PEC'ed. I'm curious as to why the OP wants to know how long a PEC is valid. Other posters are correct about a CEC being signed to keep a patient longer than 72 hours.
If the OP is concerned about a loved one, my advice is to try to find help from anywhere you can get it. Don't rely on the mental health system/industry/hospital to be affective. If you don't have great insurance or cash, expect there to be time limits.
Joe Rogan had a female doctor on his podcasts that treats her patients based around diets instead of medicine. It might be worth a shot to find her. Sounds crazy, but medicine isn't always the answer.
I'm not an expert, but I did lose a loved one a month after she walked out of an inpatient psych facility. She wasn't discharged home, her CEC ran out of time and they couldn't do anything else to keep her. She had a lot of the staff convinced she wasn't suicidal.
Posted on 8/22/18 at 12:19 am to akimoto
quote:
I've usually dealt with the patient that is looking for 3 hots and a cot that pull the suicidal card as they are being discharged.
Right. its sad either way, but better than them catching a criminal charge for 3 hots and a cot.
Posted on 8/22/18 at 12:29 am to AMS
quote:
They have 72 hours to be held under PEC, if there is necessary evaluation past the PEC it turns into the coroners (CEC) hold I believe
I’ve actually PEC’d people and this is bass akwards.
Out in the world a coroner can issue a PEC but once the person is in a medical facility an MD has to sign off on the validity. Once that happens it is a 72 hour involuntarily hold.
It has to go in front of a judge within 72 hours or the person has to be cut loose.
This post was edited on 8/22/18 at 12:32 am
Posted on 8/22/18 at 12:56 am to JabarkusRussell
If a patient is deemed a danger to themselves or to others, or gravely disabled (think psychotic and incapable of functioning) then any physician can place them under PEC (Physician’s Emergency Commitment). This allows 72 hours for patient to be held involuntary with no legal right to refuse treatment or transfer to another facility, essentially to see a psychiatrist, as most hospitals/clinics don’t have psychiatrists available. If it will take longer than 72 hrs, the coroner of a parish (or his designee) may fill out a CEC, which for 2 weeks allows treatment without consent. Once under the care of a psychiatrist, any involuntary treatment (due to persistence of one of the 3 reasons listed above) beyond 2 weeks must be approved by a judge.
Under PEC, CEC, or judiciary commitment, the patient cannot refuse treatment, transfer, etc..
Under PEC, CEC, or judiciary commitment, the patient cannot refuse treatment, transfer, etc..
Posted on 8/22/18 at 1:17 am to Scoop
quote:
They have 72 hours to be held under PEC, if there is necessary evaluation past the PEC it turns into the coroners (CEC) hold I believe
I’ve actually PEC’d people and this is bass akwards.
Out in the world a coroner can issue a PEC but once the person is in a medical facility an MD has to sign off on the validity. Once that happens it is a 72 hour involuntarily hold.
It has to go in front of a judge within 72 hours or the person has to be cut loose.
Dude I think you misunderstood, or i said something goofy. I said 72 hours to be held under the PEC, as in the PEC can last 72 hours. maybe i should have said " necessary treatment" past the PEC instead of evaluation Either way you aren't making much sense for someone who has PECd people.
Are you saying the coroner is going around in the world PEC'ing people who then get brought to a medical facility who then get re-PECd by a doctor to be held for up to 72 hours. This is bass ackwards.
The coroner's evaluation determines the validity of the PEC, not physician determining the validity of the coroner. PECs that do not get a CEC approved are considered null.
Posted on 8/22/18 at 4:33 am to AMS
.
This post was edited on 8/22/18 at 4:35 am
Posted on 8/22/18 at 5:02 am to MyNameIsNobody
Damn a lot of people have issues PECs here. What I hate is all the requirements to medically clear someone for placement. Back in the day at Charity we’d do a “very basic” exam and you were cleared. Now you have to get the BAL below 100. Because you have to be sober to be psych
Posted on 8/22/18 at 5:21 am to Lithium
I had a friend who caught her boyfriend cheating. Took every pill she could find, drank bleach and carved "hate" in to her chest with a pair of scissors. She was at the hospital overnight and then discharged. I was sure they were at least going to hold her for 72 hours, but they didn't. 
Posted on 8/22/18 at 5:29 am to liz18lsu
In Louisiana? Psych Hold laws are different from state to state
Posted on 8/22/18 at 5:35 am to Lithium
Yes, Lith, LA. While it doesn't sound like it, she was very smart and manipulative. I always assumed she talked her way out of it.
Posted on 8/22/18 at 6:25 am to Lithium
quote:
What I hate is all the requirements to medically clear someone for placement. Back in the day at Charity we’d do a “very basic” exam and you were cleared. Now you have to get the BAL below 100. Because you have to be sober to be psych
That is for a couple reasons. One is to ensure that the person is appropriate for a psych unit or hospital. Most are not equipped to ha doe people who are intoxicated. The other reason is to do with insurance. Have to make sure that the oresenting problem is psych and not SA or insurance will deny the inpt psych stay.
Others have it right. Typically a PEC is issued by an MD. From there, there is a 72 hour window for the coroners office to see patient and extend with a CEC. This allows involuntary placement for psych treatment. Any treating physician can rescind the PEC/CEC if the pt improved prior to the time expiring on the PEC/CEC.
If a pt is not in the ER then a family member or other concerned person may go to the coroners office and request an OPC (order if frotective custody). This is a sworn affidavit which outlines the reasons a person needs psych treatment. If the coroners office agrees that the facts presented indicate a need for involuntary treatment they can issue an OPC and the sheriff will execute the OPC and bring the person to an ER for a PEC evaluation. From there the process is the same.
It is serious business because you are depriving someone of their basic liberty. Doctors generally don’t like doing so, but some (especially ER docs) are more comfortable with the process than others because of the environment in which they practice.
Posted on 8/22/18 at 6:26 am to JabarkusRussell
The initial emergency certificate is good for 72 hours. You must be reevaluated within that period. If you are still deemed a danger to self, others, or gravely disabled the PEC is extended up to 15 days. Your signature or non- signature is moot. In fact, there is no place for you to sign It is involuntary.
Posted on 8/22/18 at 7:38 am to JabarkusRussell
quote:
Technically they expire after 72 hours but it's rare for psych-hospitals to release them after that window.
PEC lasts 72h. CEC lasts 14 days. JC lasts indefinitely or at the discretion of the judge. Once one expires, the patient is free to leave against medical advice at any time if the next step isn't in place.
quote:
Often they keep the patient as long as the insurance pays.
A ton of them are uninsured. Where are you getting this info?
quote:
How is that allowed when patients sign a paper that expires after three days?
Patients don't sign PECs. Physicians with medical licenses do. It's a commitment (IE- We had her committed...). It is against the patients will.
quote:
Also, say a patient refuses meds, doesn't participate in groups, or refuses to have blood work drawn. Are they really helping "stabilize" if the patient is there again their will and not utilizing resources?
In some instances, treatment can be forced, particularly when the patient is not in their right mind or able to make decisions for themselves, which is done under pretty strict scrutiny with the PEC/CEC system. It does not apply to all instances.
quote:
How do hospitals justify thousands of dollars a day in reimbursement when the patient isn't engaging in activities?
Based on the name alone. You have a Physician Emergency Certificate which means a physician, under penalty of law, believes that a patient is
1) A danger to themselves
2) a danger to others
3) gravely disabled
and is willing to sign his name saying so. The coroner must come evaluate before the 72 hours is up, and he can extend this period to 14 days if he believes that to also be true. At 14 days, a hearing can be held to have a Judicial Commitment where a judge takes this person's rights away indefinitely.
It's not fun. I don't like doing them. They're necessary, though, and a lot of time it gets people who are really sick the help they need to get better.
I am not a psychiatrist and make no money from issuing a PEC.
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