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Managed Care and a Suicide Attempt

By  (Name Withheld)

I recently assisted a friend to seek inpatient care following a suicide attempt. The process really opened my eyes to the need for better mental health care benefits and the need for hospitals to react appropriately. I would like to share this story in the hopes that it will help to improve this situation for others.

Sometime during the weekend my friend called her manager to advise that she would be taking Monday off. When my friend did not come into work or call anyone to say she wouldn’t be in on Tuesday several people became worried and attempted to contact her by pager and phone (at home and cell) but received no response. At about 3:00pm another friend and I drove over to my friend’s house to check on her. Her car was not parked in the lot, she did not answer the door, the shades were all drawn and there was no apparent movement or light in the condo. We slipped a note to our friend through her mail slot asking her to call. On our way out of the parking lot we noticed a car that looked like my friend’s (same accessories, make and color) in the parking lot of the condo unit next to my friend’s – we drove in and thought that it was someone else’s because the license plate was not what we knew it to be, later we learned that my friend had to get new plates when she terminated her lease on the car and purchased it and that it was her car. My friend later admitted to parking around the corner purposely, to make people think she wasn’t home. I went by my friend’s house again around 9:30pm on Monday with the same results as the afternoon attempt to contact her.

On Wednesday (around 11am), my friend came into the office, well dressed but apparently shaken and drugged with cut marks on the top of her hands and bandages on her wrists. Around 11:30am, I spoke to my friend and learned that she had slept through Tuesday and was shocked to learn that it was already Wednesday when she awoke. She told me that she had taken all of the medication she had at home between Sunday and Monday. I talked to my friend about going back to the hospital (she had been admitted to Inova Fairfax Hospital for three days in January after her first suicide attempt) she said she couldn’t go back to the hospital because of the financial burden it caused last time and that it had been a “terrible” experience. We then discussed calling her doctor and my friend told me that her therapist is on vacation this week, but she agreed to call her psychiatrist and dialed the number. Unfortunately, the psychiatrist practice is closed each day between 10am and 1pm for administrative purposes. My friend said that she would call the office again at 1pm. I was in and out of my friend’s office until 1pm when she called the psychiatrist. Unfortunately, I did not stay in the room with my friend when she was speaking to the doctor and later learned that she asked for refills of her medications but did not tell the doctor what was going on. The psychiatrist called in my friend’s prescription refills to the pharmacy.

At just after 2pm, my friend and I left the office to drop her car off at home. We then planned to go to the mall for lunch and pedicures (with me driving) – in hindsight, I should never have allowed my friend to drive: She rear-ended two other vehicles on the way home. One was a very minor bump and the driver of the other car did not stop and ask for info (driver’s license, insurance, etc.) the second was a more serious with minor scratches to a government minivan but more serious damage to the grill of my friend’s car. The driver of the government minivan insisted on calling the police for a report because it was part of her “check-list” – the police inspected the scene and both vehicles realizing that is was a fairly minor fender-bender and recommended that my friend and the other driver work it out with their insurance companies. The other driver insisted so they did file a report (my friend did not have her driver’s license or wallet because she had left it at home Wednesday morning) but the police took her number down without concern. By 3:30pm we were finished with the report and I suggested that it would be a good idea to park one of the cars and I could come back later with my husband to retrieve it. My friend would not agree so I continued to follow her home.

When we entered my friend’s condo, several days’ mail was still at the bottom of the steps and there was glass all over the steps to the kitchen (the top of a crystal candy dish) – My friend said she didn’t remember how the glass was broken. I picked up the broken glass and swept the kitchen floor to get any remaining fragments. The missing contents of my friend’s purse (including her wallet) were all over the kitchen counter in addition to about four empty prescription bottles with the caps off. My friend changed her clothes and we left for the mall where we ate lunch, got pedicures and did a little shopping while discussing what my friend needed to do next. Around 8pm my friend agreed to call her doctor and ask to be admitted to the hospital. We left the mall and went to my friend’s house to make the arrangements.

This time I had an opportunity to better comprehend the scene at my friend’s condo. In the living room, there were magazines, mail (some opened, some not) candy, an empty cookie bag and several more empty prescription bottles (with the caps off) all over the coffee table and floor with blankets and a pillow on the sofa. While my friend made some phone calls and gathered the things she wanted to take to the hospital, I piled up the mail and magazines and folded the blankets to make room to inventory the empty medication bottles. I asked my friend to tell me how much medication was in each bottle when before she started. My friend admitted to the overdose on Sunday and said she slept through Tuesday, so it appears that she took the following drugs over a two-day period (Sunday and Monday):

Drug Name 1 pill mg normal dose Amount taken over two days
Clonazepam 0.5 2 x daily ¾ of a bottle
Effexor XR 150 2 x daily ½ a bottle
Ambien (sleeping pills) 5 2 @ bedtime ½ bottle + 6 – 50 mg pills

** Some of the empty bottles only had a few pills, which is why there were so many (approximately 10)

After my friend had spoken to one of her therapist’s associates and the psychiatrist we went to Inova Alexandria Hospital at about 9:30pm on Wednesday. The psychiatrist had called the hospital and gave my friend the name of a nurse to speak to, that nurse warned us that the emergency room was very busy this night and the wait might be long. My friend signed in and we waited until 1am before she was called back to the emergency area. In the emergency area my friend and I waited until 3:30am (Thursday 7/13) to see a doctor who said she would be admitted as soon as the insurance company approved the admission. About 4:30 am I stood outside the door to my friend’s room to ask what, if anything was going on. A shift change had occurred and the first doctor was off duty now and the new one was arrogant, rude and not very helpful. The doctor informed me that “real emergencies” are handled first and that we would just have to wait “INSIDE” the room (I was standing all of about one foot outside the door to the room that my friend was in and we had been at the hospital for about seven hours by now) this doctor infuriated me so and I did loose my temper a bit which upset my friend a little, but the nurse on duty was helpful and caring taking

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 us to the staff lounge to get coffee. She said they were trying to get Cigna to approve the admission. I told the doctor and nurse that if the situation was not resolved by 5:15 am to let me know because my friend was willing to give them a credit card to admit herself until the insurance issue could be resolved (the worst part about this is that emergency admissions do not require pre-certifications – the hospital and patient have 48 hours following an emergency admission to obtain approval from the insurance carrier)! At 5:15 am, my friend was taken to the registration area in the emergency room lobby to provide payment information but was informed they couldn’t process it until the cashier opened at 7am and they WOULD NOT admit her until then. We continued to call the Cigna, our company’s Personnel department and check with the ER nurse but no progress was made. Finally at about 9am Cigna approved admission at two other “in-network” hospitals: Dominion (a psychiatric hospital in Falls Church) or Arlington Hospital. Inova Alexandria Hospital would not admit her. We waited until 10:50am for the paperwork to transfer My friend to Dominion Hospital where we believed (based on the ER nurses’ comments) that my friend’s psychiatrist had privileges.

When we arrived at Dominion, my friend completed some paperwork and we went back with an admissions person where we learned that the psychiatrist has not had hospital privileges in several years. My friend did not like this facility and spoke to her doctor on the phone who advised her that while she didn’t have privileges at Arlington hospital either, she recommended that my friend go there. We left despite the admissions person’s efforts to convince my friend to stay and arrived at Arlington Hospital’s emergency room at approximately 1:30pm.

Arlington treated my friend’s condition as an emergency and with compassion, she was admitted to the psychiatric program by 4pm. My friend was placed under heavy observation in a room adjacent to the nursing station with only a bed and a window. My friend’s nurse advised her and me that this is customary when a patient has recently attempted suicide (a very serious situation) so that the nurses can ensure her safety and that she would most likely integrate with the general population of the program on Friday. She was not happy but very tired, as was I so I left around 5:15pm

While I am very impressed with the staff and program at Arlington Hospital, I am extremely concerned about the lack of care my friend received and the poor communication we experienced in the 16 hours prior to arriving at Arlington Hospital. I am also disheartened to learn how poor mental health benefits are today, I expect better from healthcare providers in the United States – we as a society should demand better!

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