LPS conservatorship and 5150Read Now
What happens if a LPS conservatee calls a suicide hotline? If they are detained under a 5150 hold despite being under an LPS conservatorship? Is the conservator notified? Does the conservator play a role in the hold? What if the conservator objects to the conservatee being placed under a 5150?
These issues were issues that were addressed several years back. There are some answers for these questions but lots more left unanswered.:
LPS Conservatee in the ED
• Make reasonable attempts to determine if a conservatorship is in place
• Utilize 5150 until LPS Conservatorship is confirmed
• If possible, consult with conservator and/or case manager
• Standard emergency procedures apply to psychiatric disturbances, and the patient must be stabilized prior to transfer
• Surgery (and presumably similar procedures) are authorized when conservatee faces loss of life or serious bodily injury (apparently without consent of the conservator or conservatee)
• It is always best to obtain consent, if at all possible
Must Law Enforcement Transport LPS Conservatees?
• Conservators can request law enforcement to detain AWOL conservatees and return them to the facility where they have been placed
• Conservators can request law enforcement to detain conservatees and transport them to “the county designated treatment facility”
• This often causes law enforcement to feel that they are a taxi service
• Compare to 5150 where the individual must appear to the officer to be danger to self, danger to others or gravely disabled in order to transport. Requests for transport of LPS conservatees must be made in writing and must be accompanied by certified copies of the letters of conservatorship.
Although these answers the questions of what general procedures occur when the conservatee is in need a of a 72 hour hold there are several unanswered questions. The first question is even if the conservatee is detained who makes the decisions? The conservator may be unavailable for several reasons. Especially if it is the PC and it might be the weekend when people are not working., who would authorize treatment. Although the patient is not facing risk of bodily injury or death, they may need medication adjustment due to psychiatric outbursts or their current regimen may not be providing therapeutic effect. In these cases who authorizes non bodily injury or death related medical decision making? Also what happens if the conservator cannot be reached after the 72 hour hold? Does the treating facility put the person on a 14 day hold? Do they discharge them again? If the conservatee needs to be transported after their 72 hour hold to a different facility and the conservator is not available who provides the copy of certified letters and orders? Finally what if the conservatee does not have evidence that he or she is under an LPS? What if they are detained in a different county and the county does not have access to a database that complies a list of LPS conservatees? What happens then? Is the hospital liable for discharging them on their own without prior knowledge of an LPS conservatorship? Although this a rare case, it is important that practitioners know of this issue since many people come in for 5150 evaluations but no everyone knows their background and legal status.
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