Can I force the hospital to treat my mom?
My mom (only 69 years old) suffers from numerous physical problems (disabled and requires a walker, congestive heart failure, renal failure, a-fib, obstructive sleep apnea, severe anemia, 3 heart attack in past 2 years, and on coumadin blood thinner). A month ago she started to have hallucinations occasionally. She then developed paranoid delusion fixating on me as her enemy. I am the only one who provides the care I can and maintain full-time employment away from the house. No one else in my home but me and now my mother. She has been hospitalized for the last 4 days for the almost constant hallucinations. They say that she does not meet the criteria for being evaluated in a psychiatric facility against her will. She is refusing the most basic of treatments, at the cost of her remaining kidney function (no iv, etc.). They say they can not force her and the California guidelines of if she is not suicidal or homicidal mean they can not force her to proper treatment and she can leave the hospital if she wants to. They say that she may have to physically fail to the point where she can not refuse treatment. I could not provide the care she needed prior to the hallucinations and delusions...can they allow a now diagnosed schizophrenic, suffering from hallucinations in grave physical condition to simply leave the hospital or are they obligated to find a facility to provide her the care she needs. I may have to refuse to allow her back to my home...for her own best interest. Any help or suggestions are appreciated.
Expert Answer
I am so sorry to hear about your mother, and her declining mental health. While we always expect physicians and hospitals to make everything better, there are times when their hands are tied. This seems to be one of those times.
Another time is when a patient has religious objections to treatment. When a patient is determined to have capacity, or to be mentally competent to make decisions about his/her own health care, then legally health care providers cannot override those decisions. The only way around this difficulty is to take your mother to court and have her declared legally incompetent and someone named her guardian. This is very expensive, lengthy, and unpleasant for all involved.
The one positive thing in all of this is that it is illegal for a hospital to discharge a patient into an unsafe environment. Clearly your home is not a safe place. Be very firm with the discharge planner and refuse to allow them to discharge your mother to your home. This forces the hospital to find an appropriate placement, probably in a locked unit. You are not responsible for the cost of her care. Medicare may pick up some of it but ultimately she will have to pay out of her assets or go onto Medicaid. Her method of payment may affect where she is placed at discharge.
Due to her multiple medical conditions, she probably needs to be in a nursing home, where she will have immediate access to medical care. If she is still suspicious, she may need a locked unit initially. Do not feel that you could have affected the outcome and avoided her going to a nursing home. You are not powerful enough to stop the progression of her diseases. It is up to you to continue to love her and to give her moments of joy, in whatever circumstances. If she believes that you will harm her, then send flowers or a card or candy without insisting that you see her.
To answer your original question as clearly as possible, you cannot force the hospital to treat your mother but you can force them to arrange appropriate care.