This is an Introduction to PC Hearings conducted in the psychiatric inpatient setting. This guide is primarily for medical student/resident rotators and/or Psychiatry Interns beginning their residency. Note this applies to the state of California. The process may or may not deviate significantly in other states and/or countries.
72 Hour Involuntary Hold (5150):
- Goal: Legal document written by a qualified clinician or officer to place a patient on an involuntary hold due to suspected mental health disorder under the premise of Danger to Self (DTS), Danger to Others (DTO), and/or Grave Disability (GD) in the state of California
- Allows for a time period to conduct a thorough initial psychiatric evaluation and follow-up to determine whether patient needs further inpatient admission vs can be safely discharged to a lower level of care
- No hearings are conducted while a patient is on a 5150
14D Hold (5250):
- Goal: Provide evidence for continuation of involuntary hold in the acute inpatient psychiatric setting
- Before attending the hearing:
- Bring Patient’s Paper Medical Chart with you
- Check to see that both the 72 hour hold (5150) and 14 day hold (5250) are in the chart
- Be familiar with the circumstances that brought the patient into the hospital
- You may bring Progress Notes/Initial Evaluations with you for reference
- During the hearing:
- Begin by reading the 5150 hold: include date, time and reason for patient being placed on the hold verbatim
- “Per 5150 beginning February 20th, 2018 at 1100, ‘Client was endorsing thoughts of harming self…’”
- Next read the 5250 hold: include date initiated and reason for patient being placed on current hold verbatim
- “Per 5250 initiated February 24th, 2018, ‘Client remains acutely psychotic and cannot provide a viable plan for self care…’”
- Allow time for Court Hearing Officer to write down the information
- Now begin crafting the story and providing evidence
- How has the patient been since arriving on the unit?
- Has the patient required behavioral PRNs (IM or PO) since being here? If so, what were they? (Give medication, dose, and frequency) and what was the reason? (Agitation, depression/anxiety, suicidality, etc)
- Ex: “Pt was acutely agitated, attempting to assault staff, requiring 5 haldol / 2 ativan / 50 benadryl injection last night”
- Has the patient been placed into seclusion/restraints? If so, why and how long?
- Has the patient continued to endorse SI/HI/AVH vs when presenting in the ED?
- How has the patient behaved with nursing and other members of the team? (verbally abusive vs calm/cooperative/behaving appropriately?)
- For GD: Can the patient provide a viable plan for self-care outside the hospital?
- Can patient provide him/herself food, clothing, shelter, and other basic needs (eating/showering/sleeping) under the premise of mental illness?
- List all psychotropic medications including medication name (trade name or generic), include dose and frequency
- Example: “Haldol 5mg twice a day, Depakote 500mg twice a day, Prozac 20mg daily”
- Do not include non-psychiatric medications (don’t need to know pt is on insulin)
- What is the current disposition plan? (Home, B&C, FSP, Shelter, etc)
- Finally, what is the patient’s current working diagnosis?
- It is okay to say “unspecified mood/psychosis” if we aren’t sure
- At the end of the hearing:
- If you win: Patient’s Advocate will provide patient with option to File a Writ of habeas corpus and have a second hearing that can be done in Downtown Superior Court in LA
- If the patient says he wishes to pursue this, then you must inform the resident/attending as the second court hearing must be done by them in DTLA
- If the patient wishes to cooperate with treatment team, then you are done, notify resident/attending about the result of the hearing
- If patient did not attend the hearing, you are done, notify resident/attending about result of the hearing
- If you lose: notify resident/attending ASAP!
- Take the chart back to the nurse station
- If you win: Patient’s Advocate will provide patient with option to File a Writ of habeas corpus and have a second hearing that can be done in Downtown Superior Court in LA
- Begin by reading the 5150 hold: include date, time and reason for patient being placed on the hold verbatim
30D (5270) Hold:
- Goal: Provide evidence for continuation of involuntary hold in the acute inpatient psychiatric setting on grounds of ONLY grave disability
- Read the 72 hour (5150) hold as above
- Read the 14 day (5250) hold as above
- Read the 30 day (5270) hold including date initiated and reason for placing patient on hold
- General guidelines similar as 14 day (5250) hearings, but must provide strong enough evidence for Grave Disability to justify continued hospitalization
RIESE Hearings: Only residents/attendings can attend these
- Goal: Provide evidence to determine whether patient has the right to refuse psychiatric medications
- Information considered:
- Has the patient been >50% compliant with his/her medications? (Number of refusals / Number of total doses offered)
- Has the patient been refusing consistently for x amount of days?
- What is the current mental state of the patient?
- What medications will we be forcing the patient to take?
- Has the patient been informed about the Risks/Benefits/Alternatives/Side Effects of the refused medications?
- Why do we think Riesing the patient will benefit him/her?
- What will happen if patient does not improve? What is the long term plan?
LPS Conservatorship (5350):
- Above all legal holds, if patient is on LPS conservatorship, then there is no need for 5150/5250/5270 assuming paperwork and legal documents are obtained and placed in patient’s medical chart
- What is the difference between LPS Conservatorship and Probate Conservatorship?
- Under a Probate Conservatorship, the conservator may not place the conservatee in a locked mental institution against his or her will
- Deemed unable to care for self or his/her own finances due to medical condition (Ex: Dementia)
- Under a LPS Conservatorship, a person who has been found to be “gravely disabled” due to a severe mental illness and can be involuntarily committed to a mental institution.
- Under a Probate Conservatorship, the conservator may not place the conservatee in a locked mental institution against his or her will
**Final Points**:
- Assume the hearing officer doesn’t have background in psychiatry or medicine
- Use layman terms as much as possible (instead of “PO BID,” say “twice a day by mouth”) with the exception of the working diagnosis (Ex: Schizophrenia) and medication names
- Do not provide false information, be honest, but convincing and state intentions of why you feel strongly to keep patient in the hospital
- If a patient has a combination PC hearing & Riese hearing, please notify the resident/attending as both must be done together and thus medical students cannot do these
- If a patient attends the hearing or is contesting the hearing, there should always be a Nurse attending the hearing for safety of everyone in the room
- It’s okay if you lose the hearing (it happens), if you do lose, please notify your resident/attending ASAP to discuss plan going forward
PC Hearings in California