At fort drum river east of two tell you pet Specialty Care. Jail inmates are entitled to access to care for significant health problems. That care require transport or transfer to a community hospital or other facility, where the evaluating physician must consider the level of health or mental health services follow-up that is necessary and whether or not those services are available at the jail. ER physicians should have some prior idea of the services the jail can reasonably provide; educational visit or detailed communication with local correctional facilities is recommended. Although jails and lockups have substantial duties to monitor inmates whom they suspect are at clinical or behavioral risk, the ER evaluator should not expect perfection. Unless the jail has 24-hour comprehensive health or mental health services and staff the physician find it helpful to think of return to jail as similar to returning the patient to home care. Is mere observation sufficient, or is direct care and continued evaluation required. Are minimally-trained correctional officers acceptable for the task? What scope of care and observation is available the infirmary or administrative segregation ER clinicians, including psychiatrists and counselors, often assume that jails have 24-hour health care staff. This be true very large systems, but not most jails and lockups. Although there be administrative pressure to release the patient, extended observation the emergency room or a secured inpatient setting is often a better alternative. Return to Current Table of Contents. Misunderstanding Confidentiality and Privilege Civil Commitment and Risk Assessment Regular readers and professionals who sometimes hear me speak on suicide assessment, gathering collateral history, and similar topics know that I am greatly concerned about misplaced adherance to misunderstood confidentiality rules and laws. I have often argued with other clinicians who believe that confidentiality prevents them from gathering important, potentially lifesaving, information from other clinicians, hospitals, and or family members. There are different clinical and administrative scenarios that involve assessing the risks associated with potential danger to oneself or others. psychiatrists, psychologists, and other clinical evaluators erroneously believe that some rule or law precludes their asking for, or reasonably sharing, risk-related information that can be vital to adequate diagnosis, treatment, protection from self-harm or reducing danger to others. Further, some evaluators even fail to understand the very basic importance of collateral information such situations, and make important admission, detention, commitment, discharge, and level-of-care recommendations or decisions without it. the wake of the recent Tech killings, the Office of the Inspector General for Mental Mental Retardation, and Substance Abuse Services investigated that state's civil commitment proceedings and published several deficiencies and recommendations. I want to focus on only one aspect of that investigation, the finding that psychiatrists civil commitment roles often misunderstand the law concerning obtaining information from outside sources. Some 16 months before the shootings, the perpetrator, Cho Seung-, was evaluated for civil commitment based on reports of psychiatric symptoms and apparent dangerousness to himself or others. The OIG investigation revealed that during Cho's initial screening, a certified prescreener from the local Community Services Board reviewed evidence of extremely odd, frightening and or threatening behavior and interviewed another Tech student and the detaining officer before recommending involuntary hospitalization. initial hospital detention was accomplished, and Cho was evaluated by authorized independent examiner the next morning. The psychologist stated that he interviewed Cho for 15 minutes and reviewed the prescreener's report and medical records. The examining psychologist apparently did not obtain any additional collateral information, saying that he rarely found it necessary to obtain collateral information from pertinent people such individual's life. Hospital staff reported to the OIG that additional collateral information is not sought before commitment hearings. Based on the brief interview and review, with apparently no corroborating information, the psychologist-examiner determined that Cho did not require involuntary hospitalization. After a hearing which did not include the independent examiner, the prescreener, the detaining officer, or any of the roommates witnesses, Cho was released with to outpatient commitment with no specific treatment plan and no known follow-up to determine whether or not he attended treatment. During its investigation, the OIG conducted informal telephone survey of 20 attending psychiatrists at facilities approved to admit detained patients such as Cho. That survey found, the words of, a very inconsistent understanding among them regarding their ability to access collateral information regarding their patient when the patient refuses to authorize this access. excellent summary and discussion of the complete report appears the August issue of The report itself be obtained from the Office of the Inspector General for Mental Mental Retardation and Substance Abuse Services at http: documents VATechRpt-140.pdf. Return to Current Table of Contents. Mental Screening and Monitoring Correctional Facilities: Suicide, Psychiatric Care, Prison and Jail Safety A recent article the newsletter