Part 3: Fairview The Psychiatric Hospital

A Closer Look:  Constitutional, Dignified and Proper Care for Mental Health Situations and Patient and One Person at a Time- Processes of Care at Fairview U of MN Health, one woman's journey and the role of Trauma

As we work to make psychiatric and mental health care legal, safer, more grounded in truth and more dignified for all, one person and one patient at a time, I invite you to read the third report on the processes of care at Fairview U of MN Health, one woman’s journey and the role of trauma.

Recommendations:

I recommend that under Dr. Vinogradov’s leadership the hospital and medical school set its sights on transforming itself into an institution that provides the best consensual care possible in an atmosphere that promotes healing and growth.

Walmart has “Centers of Excellence” in care for various maladies whereby it evaluates the care provided by various institutions and works with those that have excellence to the point that it is willing to fly its patients or assume other aspects of care from the institution for its nationwide employees.  It is an honor and financially lucrative to be seen as a Center of Excellence.  Walmart also has knowledge of best practices and can share insights with the Centers of Excellence.  I recommend that Fairview U of M Health strive to become a Center of Excellence, a real leader and provider of excellent care. 

As previously recommended in my Abilify report, I recommend that the medical school and hospital become the first in the nation to come out with a policy of no longer recommending Abilify to new patients/first time prescriptions.  There are plenty of alternatives that are safer and have greater efficacy.

To teach and strengthen the capacity of building a therapeutic bond between doctor and patient, I recommend that:

• The hospital have experienced private practice psychiatrists (old school) mentor their interns on developing trust and building rapport.  Many of the current doctors regretfully have developed bad habits of readily resorting to the Civil Commitment process and there is a need to break this habit with new instruction and processes.
• The hospital allow the interns and doctors to see patients in an after care mode for constituency of care for both the benefit of the patient and the doctor.  It teaches doctors to care and reinforces caring and the importance of trust and respects human dignity.
• Instead of the 4-1 or 6-1 ratio of doctor to patient which can be overwhelming and redundant (unnecessary redundancy diminishes quality as a general principle) it is inefficient and disruptive to the establishment of doctor patient trust and is intimidating to patients and results in very superficial care and communication.

It would be better to assigns interns to a patient to develop rapport and trust and they can report the information to the group of doctors when they meet for further counsel when need be.  This is a common private practice model of care.

• As soon as possible determine if there is current trauma or a history of trauma.  Ask the patient questions.  Listen to the patient.  Respect the patient.
• Be open to considering that many issues are more sociological in nature than a brain deficiency and yet you are to treat them.  Short term tranquilizing drugs may be a better and safer alternative than jumping to the conclusion that a life time of medication is needed and prescribing drugs that have serious side effects and may not address the problem.

Offer and have expertise on family treatment.

• Be patient.  Mental health with the right support and encouragement can change quickly and positively.
• Be aware that it is not unusual for a patient to have a psychotic episode when first being placed on powerful drugs.  It is a common effect of the drugs and not something wrong with the patient.
• If a patient has a psychotic episode, ask about it once the patient is calm.  You and the patient may learn something.
• Ask about spiritual needs.  If the patient is Christian, see if the patient would like to see a Priest or Minister.  Some patients may want to go to confession and this can help.  This should be respected and encouraged.  It is part of care.  Have clergy available.
• Acknowledge and realize that Fairview has had very poor care and many mistakes have been made and many people have been put through the civil commitment process without valid justification.  This is tragic but as such, do not rely on old medical records exclusively.  They may be incorrect.  Ask the patient to share their history and current circumstances and goals.  Make your own judgements and trust the patient.  Believe that the patient wants to get better and is capable of making decisions to make this possible.
• Don’t be afraid of new findings.  Don’t be afraid to change course or admit you made a mistake.  The important thing is to assure the patient receives the best care possible and that the care is consensual.  In many cases assurance and encouragement and support and time and rest may be more helpful than pills.

For the general care of the patients, it is recommended that the hospital offer educational videos or classes on:

Diet, brain exercises, assertiveness training, virtues, forgiveness, patients, honesty, art and music.  Have sufficient equipment necessary for individual listening or watching of videos.

 

Many patients like to paint or draw for therapy and it would be nice to have subject matter for them to draw and beautiful things for patients to look at like seed catalogs for flowers, animal books, or bird books or art books.

Have a wide variety of suitable reading material available.  The hospital could work with churches of various denominations to be able to provide reading materials for patients.  In addition, churches or other religious organizations could provide visitors.

Have AA and Al Anon meetings in the building that patients can attend or have the book and a video about it.

Have RNs as staff.  The education makes a difference in demeanor and quality of care.

If a therapeutic bond is established there should be no need for the civil commitment.  Be patient, listen to the patients concerns and goals, respect the patient and realize the patient gets to direct their own life, that is part of human dignity.

If a doctor is unable to develop a therapeutic relationship, he should suggest that a new doctor take over care and this should always be done prior to invoking the civil commitment process.

The civil commitment is only to be invoked if the patient is a danger to himself or others.  Document and explain to the patient how they are a danger to themselves.  A reaction to a drug like a psychotic episode does not mean the patient is a danger to themselves, it means they had a reaction to the drug.

Doctors should see the civil commitment process as a failure and should work with the county to assure that the process isn’t further traumatizing.  The doctors should have to testify and provide evidence that other least restrictive means were tried, that the patient was uncooperative, and that the patient is a threat to self or others.  This should be very rare and a good doctor should hope and pray that he or she never encounters this in his or her career.

Remember the Hippocratic Oath “First do no harm” and abide by it.  The Civil Commitment process is harmful.

Believe in the infinite capacity of the human spirit and the grace of God.  Know that you and your efforts are being prayed for by many people every day.

Here’s why:

Processes at the Hospital - U of MN Fairview Health- one woman’s journey.  The role of trauma. 

“Our world is hungry for genuinely changed people.  Leo Tolstoy observes, ‘Everybody thinks of changing humanity and nobody thinks of changing himself.’  Let us be among those who believe that inner transformation of our lives is a goal worthy of our best efforts.” Richard J. Foster in Celebration of Discipline.

Fairview Health has a poor reputation with the community for its quality of care and especially for its quality of care in psychiatry.  This is long standing and has even been noted by an open letter to the Governor in the StarTribune in 2012.  The medical school has a relatively new Head of the Department of Psychiatry, Dr. Sophia Vinogradov, and I believe her to be a breath of fresh air and have hope for change, which is why I am writing this.  Please watch Dr. Vinogradov’s video "Breaking the Walls of Psychiatric Hospitals ".

Care must be given in giving a mental illness diagnoses and discerning that the condition is not due to other medical causes or just due to a crisis or trauma in order to ascertain that it is an issue of faulty brain networking.  To incorrectly tell someone that it is a brain networking issue when it is really other factors is a mistake that should be avoided by following a thorough procedure and corrected as soon as possible if done so incorrectly, for the sake of the patient and proper care.

In 2012 XXXX was so mortified by being put through the civil commitment process that XXXX reviewed XXXX’s medical records line by line with a board certified psychiatrist and we documented all of the errors.  The psychiatrist said XXXX was railroaded and that the doctors did more wrong than right.  He also stated that it was the worst treatment he had ever seen.  XXXX’s 2018 stay was worse but XXXX now realizes it is a systemic problem with the psychiatric staff and policies of Fairview.  It is never the less damaging and harmful.

At Fairview Riverside, U of MN, the doctors:

• Ignored patient input in both 2011 and 2018. In 2011 XXXX parlayed XXXX’s correct diagnosis of PTSD and obtained statements from XXXX’s providers and while in the hospital and in 2018 shared in writing diagnoses from a neurologists and a psychiatrist diagnoses of Abilify withdrawal and PTSD in an attempt to correct XXXX’s medical records.    In 2018 XXXX obtained XXXX’s written diagnoses too late to be shared with the courts by XXXX but shared them with the psychiatrist in charge and also shared with her XXXX’s trauma and core issue.

In 2018 XXXX declined to take lithium because lithium has damaged XXXX’s thyroid.  When XXXX expressed this to one of the intern psychiatrists the intern lectured XXXX on how lithium was good for the thyroid and when XXXX was in court my statement about lithium was portrayed as a delusion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568739/you will find that a study showing it is common for lithium to damage the thyroid.

In 2018, the doctor even petitioned the court to force medicate XXXX and put XXXX back on Abilify, a drug that damaged xxxx’s kidneys and nearly killed XXXX having suffered its withdrawal multiple times.  The doctors also requested a shot of risperidone for XXXX in lieu of the pills.  The shot caused $2000 every two weeks and the pills cost under $1000 for a year’s supply.  The doctors were aware of the fact that XXXX did not have health insurance, which was a matter of choice and conscience for XXXX as there had been no help for XXXX’s chronic complications from Abilify even when XXXX had health insurance.

XXXX informed the doctors that XXXX was very sensitive to medication and did not want the shot.  XXXX asked them to provide justification for the shot over the pills and they provided XXXX with a journal article that specifically concluded that the risperidone shot was not any more effective than the pills at keeping people from re-hospitalization.  XXXX cannot express how ill cared for you feel when you point this out to the physician and they proceed anyway. 

XXXX ended up with rehospitalization in January of 2019 due to lack of medication and the clinic that was giving XXXX XXXX’s shot refused treatment after October.  Pills would have been a better alternative.

When the patient’s voice is taken away from their care, the quality of care suffers because the patient is the one who cares the most about themselves and who ultimately lives with the consequences of the care.  In 2012 a psychiatrist diagnosed XXXX with Aripiprazole (Abilify) withdrawal and poisoning and lack of access to medical care after and as a result of my stay at Fairview.  Securing appropriate psychiatric care is now further complicated and very difficult.

• Disregarded XXX’s physical conditions as potential cause for my mental state in 2011 and 2018 and did not allow me to see a medical doctor, only a physician’s assistant.   In 2011 XXXX was suffering from Abilify withdrawal and had a strained stomach, and level three kidney damage and this information was ignored and not shared with the courts.  In 2018 XXXX’s thyroid was at 10 times the normal level which can and did induce foggy thinking. Most psychiatric hospitals allow you to see an MD for physical issues and most also have RNs exclusively as their staff.  This is not the case at Fairiview.

These physical impairments were not mentioned to me by the physician’s assistant or the psychiatrist while XXXX was in the hospital.  The thyroid issue was mentioned to XXXX by a nurse who urged XXXX to take XXXX’s thyroid medicine and the other issues XXXX discovered upon review of XXXX’s medical records in detail after my stay with a board certified psychiatrist.

In addition, one day in the hospital after having a bowel movement XXXX wiped pure red blood.  XXXX has had this happen before and it is likely a result of fistulas from toxins from complications from Abilify.  XXXX asked to see a doctor and was only allowed to see a physician’s assistant per hospital policy.  The physician’s assistant explained to XXXX she didn’t see anything.  She however, documented that the notion that XXXX’s fistula was a delusion and this was brought up in the court hearing.  It may have been incorrect but was not a delusion.  This spirit of condemnation instead of care quickened XXXX to the core.

XXXX will add too that in 2012 after xxxx’s forced stay at the hospital, XXXX’s kidneys were acting up and XXXX was in severe pain and XXXX begged in writing the CEO of Fairview Health to find XXXX a doctor to treat me at the hospital’s kidney center and XXXX had very good health insurance at the time.  Due to all of the complications it was difficult for XXXX to find care and explain XXXX’s situation and XXXX had yet to find the Abilify Animal studies which confirm that Abilify causes kidney damage and other maladies.  XXXX received no response to this request.

• Ignored trauma- XXXX clearly expressed trauma in 2011 and 2018,

According to the National Council for Behavioral Health, “Trauma is shrouded in secrecy and denial and is often ignored.  When we don’t ask about trauma in behavioral healthcare, harm is done or abuse in unintentionally recreated by the use of forced medication, seclusion or restraints.”

• Relied on incorrect information for the diagnoses of schizophrenia and didn’t ask XXXX about it or take time to give XXXX any tests for a diagnoses.  XXXX is not schizophrenic.  In 2018 they relied on the incorrect 2011 medical records.
• Failed to develop a therapeutic relationship even though XXXX was cooperative, and in 2018 employed procedures that made this difficult- seeing groups of doctors instead of one doctor trying to establish rapport and trust.

The therapeutic relationship of trust between doctor and patient is the bedrock of good psychiatric care.  XXXX was honest and told the psychiatrists the truth.  XXXX was never delusional.  XXXX was traumatized and XXXX basically expressed this to the doctor.

In addition, XXXX was never asked of XXXX’s goals and there was no plan developed for recovery.

There are art project or cooking groups and game groups and some “therapy groups” presented by staff personnel (not psychaitrists, psychologists or RNs) that may for example select a video from U tube done by someone suffering from bipolar for the group to watch.  There is no formal curriculum.

• Medicated XXXX without explaining why they were medicating XXXX or sharing with XXXX the side effects of the medication.  They also never asked if XXXX were experiencing any side effects.

 In 2018, in the “uptake process” of being put on medication XXXX had a psychotic episode where XXXX parlayed about a real experience XXXX had in France some thirty years ago.  This was ruminating in XXXX”s mind and had been written down by XXXX a few weeks prior in a self-inventory.  Psychotic episodes are not unusual when a person is first being placed on medication and this is what XXXX believe triggered the commitment process.  The doctors never even asked XXXX questions about the episode.  Never.  They just informed XXXX that they were starting the civil commitment process.

• Evoked the Civil Commitment process based on their own reactions and not on XXX’s condition or its need and did so without the conditions meeting statute. 

They didn’t pursue trying another doctor to develop rapport or encouraging XXXX to sign in as a voluntary patient.  They never documented that XXXX was a threat to myself or anyone else.  XXXX was never suicidal and never a threat to anyone. They and the courts mistook XXXX’s note which no one saw but only heard about as a suicide note.

• Showed callous disregard for the seriousness and potential damage and long term consequences to the patient of the Civil Commitment Process.

Evoking the Civil Commitment process is a failure on the part of the doctor to establish rapport and should be seen as such.

The county prosecutors are merciless and have no training or regard for the state of the patient who in most cases is traumatized.  The process and the way you are treated are further traumatizing.  Then to be expected to be friendly to the doctors who did this really suspends reality.  It really does.

We are now at a point where for XXXX the patient, the effects of all of this have been magnified and invade my privacy with incorrect statements about me every day.  Due to poor legal council and the lack of due process in the Civil Commitment process, XXXX’s appeal was lost and the decision which states that XXXX is  mentally ill and was a danger to self or others shows up on page 1 when you google XXXX”s name, despite the fact that neither the hospital staff nor the police ever accused me of being a threat and that the initial pretext for all of this was a misunderstanding about the nature of a note that XXXX wrote that was parlayed to the courts as a suicide note when it was simply a self-inventory.

• Have failed to extend an effort to correct their mistakes with the information they have provided the county.

The hospital led the county and the courts to believe that XXXX was like Bill in Dr.Vinogradov’s video, a paranoid schizophrenic that thought he was receiving messages from pigeons.  Nothing could be further from the truth.  In addition the hospital never presented or documented that XXXX was a threat to xxxx or anyone else because XXXX never was.  XXXX was in a short term crisis and XXXX was not uncooperative.  There were are other least restrictive ways of dealing with me, they just required honesty, patience and care, which should be in no short supply for psychiatric care.

In 2018 after the civil commitment process,  the hospital assumed the diagnoses given by the county by an examiner who never saw XXXX and disregarded its diagnoses of paranoid schizophrenia, yet the county and XXXX’s records with the after care agency still reflect this.

It was a mistake to ever put me through the process and XXXX asked that the hospital staff parlay this to the county and that the matter be corrected.

In 2011, due to a misstatement by XXXX’s brother when he called an ambulance in a non-crisis situation to take me to the hospital for what XXXX thought was my physical pain suffered as a result of withdrawal from the drug Abilify, XXXX have been labeled and portrayed to the courts as a paranoid schizophrenic.  One of the most severe mental illness diagnoses.  XXXX’s brother, who was known to be intoxicated at the time misspoke and told the police and ambulance team that XXXX had been diagnosed as schizophrenic.  During XXXX’s intake at Fairview this was noted and as more and more doctors saw me the statement transpired from “schizophrenic according to brother” to “schizophrenic”. 

On xxxx’s arrival at the ER in 2011, XXXX told the doctors that XXXX was not interested in psychiatric treatment that XXXX was a Christian and that XXXX had previously been diagnosed with bipolar but that diagnosis had been changed to post traumatic stress disorder and that XXXX was in severe physical pain.

XXXX’s physical pain was not addressed and the diagnoses of schizophrenia was perpetuated even though it was unfounded and incorrect.

When hospitals have the wrong diagnoses they cannot properly treat a patient.  In 2011 when XXXX questioned the doctor as to what he was writing about XXXX in his notes he informed XXXX he was going to put XXXX through the civil commitment process.  XXXX really didn’t even know what this was but it frightened XXXX.

It was not until XXXX met with Hennepin County that XXXX realized the hospital had made grave errors.  XXXX knew XXXX was not schizophrenic and had never been diagnosed as such.

XXXX believes it is quite possible that the doctors realized they had made mistakes but they had no impetus for correcting them and little concern regarding the damage caused to the patient by the civil commitment process, the damage of which cannot be expressed.  It is still on going with XXXX.

On the positive side, Fairview did have and provided XXXX with compression socks for my circulation as restless leg syndrome is a side effect from the medication and also a weighted blanket which can help the body relax and fall asleep. The food was adequate and was supplemented kindly by a nurse who regularly brought in the supplies on his own for root beer floats.

XXXX will add that the reading material XXXX had access to was good and this was because a nurse had brought in books from her home library and there was one bible on the floor provided by the Gideons.  The hospital also had a Koran.  The hospital did not provide access to a Roman Catholic Priest.

In short, many were eager to take control of the decision making processes for care and leave XXXX out of them despite XXXX’s eagerness to help myself and Fairview to date has not made efforts to correct this mess.

The anger at this invasion of privacy and bodily and mind care has torn XXXX’s family apart and left XXXX with great sorrow.  The fact that XXXX has witnessed that this type of care was common with the doctors at Fairview has led XXXX to speak out and in many ways not see it as personal, although it is a direct attack on XXXX’s personhood and XXXX’s wellbeing.  It has left XXXX’s reputation in shatters due to the incorrect statements used to justify committing me.  XXXX is wounded and looking for help.

Let’s hope Dr. Vinogradov will bring about help and change.  She is very capable and believes in the resiliency of the human body and spirit.  Let’s pray for a new day of care at Fairview.