In my last post, I talked about the informed consent form for my practice, and mentioned that part of the consent form says that emergency care might be more difficult via telepsychiatry.
I wrote that section because I doubted that there was any case law on emergency petitions and telepsychiatry.
In Maryland, certain mental health professionals (physicians, psychologists, licensed professional counselors, clinical nurse specialists in psychiatric and mental health nursing, and psychiatric nurse practitioners) can seek an emergency petition to have a person evaluated for a psychiatric admission, potentially against that person’s will, by filling out a form asking a police officer to pick up the person and bring that person to the nearest emergency room for a psychiatric evaluation.
There are some laws (Maryland Code, Health-General Article 10-620 et seq.) governing this procedure, but, to my knowledge, much of what judges go on in cases where someone feels the law wasn’t followed properly is based on case law.
The Maryland Code says that the mental health profession who seeks an emergency petition has to have examined the patient. I’ve been told by various forensic psychiatrists that I have to have examined the patient in the last week (or perhaps two weeks, depending on whom I spoken with) for me to be able to seek an emergency petition. I’ve also been told that a phone call doesn’t count as an examination, so if I haven’t seen the patient in a month, say, then I can’t really fill out an emergency petition because I haven’t examined the patient recently, even if I speak to him or her on the phone.
If my understanding is true, then telepsychiatry is an interesting case. Have I “examined” the patient sufficiently for an emergency petition, or not?
I don’t really want to be the person who finds out the answer to this question, but I’ve decided that I’ll do what I’ve always been taught is the “Golden rule of forensic medicine:” Always be a doctor first, don’t try to be a lawyer. I think I’ll just do what I would normally do if I were face-to-face with the patient. Hope someone else gets to find out if this is the right decision….
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