Involuntary psychiatric ED boarding ruled unconstitutional by federal court
Also: Scope of PA practice, insurers’ profit bonanza, Rural Emergency Hospital growth, and medical debt in the South.
Top of the Week
A federal court in New Hampshire has ruled that prolonged ED boarding of involuntarily committed psychiatric patients violates private hospitals’ fourth amendment rights.
Quick summary of the case:
Four patients and a group of private hospitals in New Hampshire sued the state’s Department of Health and Human Services (DHHS), claiming that compelling the hospitals to board psychiatric patients in their EDs infringes on the hospitals’ fourth amendment right against unreasonable seizures.
The hospitals argued that the patients were legally in the custody of the state’s DHHS, which has the responsibility to provide appropriate psychiatric care to the patients. For DHHS to compel private hospitals to keep the patients in their facilities is a form of seizure of those hospitals’ property (space, food, medicine, workforce, etc).
The judge sided with the hospitals. Key excerpts from the opinion (quoted at length due to its potential impact on EDs):
“The Hospitals have a strong possessory property interest in their emergency departments. The emergency departments allow the Hospitals to fulfill their mission and obligation to provide emergency medical care in the communities where they are located. Even after viewing the record favorably to the Commissioner, the Hospitals have shown that the Commissioner's current practice of boarding her patients in private facilities stems from her failure to receive her [involuntary emergency admission]-certified patients into designated receiving facilities. The record is clear; the Commissioner's boarding practice commandeers space, staff, and resources in the Hospitals' emergency departments that are needed for other patients and services. In light of the statutory obligations imposed on the Commissioner under RSA 135-C:27-33, the Commissioner has no governmental interest in failing to receive IEA-certified patients in designated receiving facilities. The record establishes that the seizure is illegal under state law and lacks any legitimate governmental interest that justifies it…
The Commissioner has violated and continues to violate the Hospitals' Fourth Amendment right (made applicable to the states through the Fourteenth Amendment) to be free from unreasonable seizures of their emergency departments through her conduct, policies, and practices that fail to allow IEA-certified patients to be immediately transported from the Hospitals' emergency departments to designated receiving facilities.”
This case is a call to action for emergency medicine and hospital leaders. Unconstitutional state seizures of private hospital property may be occurring in your ED right now.
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