sailphish

Fellow ER doc. Hell, the amount of staff I have who preach those same bullshit statistics is mind boggling. I have had to scold so many nurses this week for doing viral swabs with no PPE. Like WTF people. How about you don’t go ahead and infect the entire department with your lack of concern.

I am very interested. Have you spoken to anyone from the hospital, specifically the psychiatrists who are in charge of determining when patients get released?

I am a physician who works in this general region of the state. I am not affiliated with facility and don’t have any personal interest in this case. That said, I deal with mental health patients frequently, and it is a very difficult situation. On one hand you want to uphold the patients rights. On the other hand you don’t want to release them in an unsafe condition, which is an incredibly hard thing to determine. I see suicidal patients almost daily, who were just released from a psych facility - clearly they weren’t ready to leave. With Baker Acts, someone is almost always telling you are wrong, wrong for keeping the patient, wrong for discharging them. Basically all you can do is try your best to do what is right for the patient and accept someone is always going to be upset. Dealing with BA52s is one of the least favorite parts of my job.

With medical billing, as a physician I am generally incentivized to provide efficient care. Keeping patients longer than needed would rarely increases my profit margin. Additionally, most of us are independent contractors- we work at the hospital, but not directly for the hospital. So while a hospital might want to be able to bill for longer stays, the physician is the one determining who goes home and when. Mental health patients will almost always tell you they don’t need to be admitted - lack of insight is often a hallmark of their diagnosis. Family members are frequently kept in limited contact because they often enable patients, bring them drugs/alcohol (I see this EVERY day)... etc.

I have worked for a number of for-profit centers and they mostly suck. They understaff and find other ways to cut costs. Safety isn’t always a priority. They might not always follow through on regulations. That said, the physicians are still always in charge of patient care.

How have you determined that their cost cutting mechanisms and poor regulatory efforts are directly related to maliciously keeping patients longer than necessary? I am not defending the facility (which seems to have definite issues) but a lot of these types of stories are sensationalized and one sided. I could list countless patients/families who would say admission wasn’t necessary, yet the patient in general was a very clear danger to themself or society, yet it would be easy for a reporter to interview them and spin a story that pulls at heartstrings of readers, and turns them against the big bad corporation. In this case I am not disputing your claims against the corporation, but do question the link to the psychiatrists who determine length of stay, as in my experience, that’s not necessarily how it works. Hell, there is such a lack of mental health beds in the area, most facilities seem to be trying quickly discharge existing patients to make room for new the new ones.

I am sorry if this all seems kind of blunt, but I have been in the industry for over a decade and it still confuses me. You seem to have written a very one sided and superficial investigation into an industry, yet might not fully understand the extreme difficulty that comes with determining a mental health patient is safe for discharge. Again, I am not saying this facility isn’t culpable, but also aren’t entirely sure about all your claims.

I heard some old guy bragging how his son got diagnosed with “Low-T” and was put on testosterone shots, and is now squatting 600 pounds in the gym. Like I get there is a natural range of testosterone, and symptoms of low testosterone go far beyond strength and muscle mass, but my guess is that if you are squatting that much and on testosterone shots, it’s mostly just about the gains.

This is such a dumb answer. In regards to the Bahamas, do you just expect an entire population to somehow manage to emigrate to other countries, especially when many don’t have the finances, education, or skills to do so. They are just supposed to leave everything they ever knew behind, to move to a foreign land with different problems. And just so you know, your north Midwest city couldn’t survive without goods coming into this country through the port cities you want all of us to relocate away from. You would have to move most of the country if you wanted to avoid every hurricane, earthquake, tornado, wildfire... etc.

Let me tell you... for the past 20 years, I've been saying that if they ever brought the Defender back to the US, I would be the first to buy one regardless of price. Then after decades of waiting they finally announce a Defender, and its some soccer mom, mall cruiser, slightly boxier version of the Discovery. Too bad Ford doesn't still own Land Rover.... they could have just slapped a Defender badge on the new Bronco as its everything the Defender should have been.