Category Archives: appeal

Compliance – Continued Medication Issues

Compliance – Continued Medication Issues

We are in week two of David’s not getting his medication as prescribed.  Thus, he is out of compliance, though it appears to be a systems issue. 

Either give him the medication he was prescribed or tell me how to fix it.  It’s not difficult.

Today, I contacted the detention unit, asked to speak to the medical person, and was transferred to him.

When I asked what the issue was, the nurse said “he is not in compliance.”

I asked, if he was refusing to take the medication, and rather than providing me an answer, he said “who is the probation worker?” (I use probation worker as a loose descriptor for the person involved in David’s case.)

I explained who we are working with, and gave the nurse that information, as well as contact information for the worker.

The nurse then said “thank you” and ended the call.

So I called and left a message for the probation worker.  I also called our watcher with Social Services.  (the person from Social Services who is keeping an eye on the case)  Since her voicemail isn’t setup, I had to draft an email. In reality, I don’t mind sending email.  I prefer that in a lot of ways because it leaves a trail and lets us hold people to their word. It also allows people to hold me to my word.

Reaching out to the chain of command

We then reached out to the top person at the correction center for youth.  The superintendent guy.

He took my call, I explained the issues, explained the steps that I was trying to take to resolve it, and that we had given all new prescriptions that were filled at the pharmacy since they don’t do that for kids in David’s situation.  In addition, I explained that David continues to be out of compliance and I couldn’t get anyone to help correct it. As well as, I told him about how it’s been two weeks since David had all of his medication. That you can see the agitation in his body.  David isn’t sleeping very well.  He for sure isn’t getting the REM sleep that his body needs.

Possible issues related to medication denial

All of this bodes for problems.  Tentatively, he is due back in court on Tuesday next.  If foster care is the plan, he will have to spend his first month there getting his body attuned to the medication.  Same will happen if he goes to residential care, or another facility placement.  We will see an increase in behaviors related to his mental illness.  He will be easily agitated and angered for no apparent reason.  There will need to be an increased vigilance in those who provide his care.

It’s simple really.  Either give him the medication he was prescribed or tell me how to fix it.  It’s not difficult.

Because medication compliance works two ways.  Please get in compliance with the medication that David needs.

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Destroying Success – please pray that we aren’t

I title this post “Destroying Success” for a simple fact.

English: Causal loop diagram - system archetyp...

English: Causal loop diagram – system archetype “Success to successful” (Photo credit: Wikipedia)

David has been in facility based care before.  He has been discharged from such a care to home three times out of the 5 placements he has had.  Each time home has resulted in behaviors so volatile that he experiences frequent trips to the mental health unit at the hospital in the city, frequent visits by law enforcement and many trips to safe bed.

By volatile, I mean violent aggressive behaviors, not to mention stealing, forging and other activities like trying to kill pets.

So he transitioned to his current placement in late June of this year.

He is successful.  He is always successful in placement.  Sure he has rough periods, but what teen doesn’t?  Heck, I would wonder what was wrong if he didn’t have rough periods.  So why would you destroy the safe world that he is in right now by sending him home?

I get least restrictive environment.  Believe me, I know what the phrase means.  When it comes to the success or failure of his life experience, I would much rather see him be successful.  Right now success occurs in care.

Today we were told that since the goal of the new placement is reunification, that if we didn’t bring him home for passes and visits, then they would just discharge him.  Passes and visits aren’t the issue here, the issue is two fold.

If he gets violent.  What do we do?  The only people he regularly attacks are family.  We call law enforcement.  Sure.  Great.  If they are on the other side of the county it can take them an hour to respond.

So they say we can bring him back early, if we have difficulty or he misbehaves.  Right?!  because transporting an angry, upset and hurt child 60 miles is a good idea?  Hey, lets get law enforcement to do it.  Because they are mental health professionals – right?!

I know. I am making excuses.

The other issue.  David knows exactly what he has to do to get out of care. How can they not see that?  He was discharged 18 months ago from a facility against doctors orders because insurance and medicaid wouldn’t cover.

I get that he isn’t exhibiting behaviors, and really, I am quite happy that he is doing so well.  But please, for his sake, don’t sabotage that.

In fairness to David, we, meaning both at home, and him in the facility, really need to work on our communication skills.

So we are going to try.

We will bring him home on pass.  Please pray that he continues to be successful.  Because in the end, all I want is for him to be able to live a happy well rounded life that is generally trouble free.  Don’t be destroying success because he doesn’t fit your mold of what should be in your facility.  I don’t know that this is what staff are doing, but he really hasn’t been there long enough to get an idea of who David really is.  Right now he allows them to see what they need to see.  Hear what they need to hear.

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Feelings of Futility

We are pending approval for placement in a psychiatric facility.

Placement is dependent on the insurance company approving the need.

  1. Certificate of Need is generated by the insurance company.  This allows placement.
  2. Certificate of Need is based in part on the last psychiatric appointment that David had with his doctor.

So, we finally received the notes from his last psych appointment.  Again, the record is inaccurate.  Every time we have to argue with medical records to get copies of the record, the notes have been inaccurate.  I understand that doctors are busy people, but when placement hinges on accurate notes, writing things like this destroys any chance of placement.

The doctor wrote that “patient swung a shovel at his father and broke the sewing machine, after his father washed his mouth out with soap.”

Among other things, David is a known liar.  The shovel incident happened because we were holding David accountable for his behavior.  Because David thinks that he is above the rules of society.

One other thing that may hamper his ability to get placed in residential care?  The number of placements in residential care that he has already had.  Coupled with the number of times he has been in psychiatric acute care this year, we are talking a lot of placements.  Eleven for acute care, and three for residential care.  To me, this is a sign that he needs more care than what he is receiving.  He has had many placements in part because he was discharged against doctors recommendations by insurance.

I hate that insurance companies can dictate the level of care that the mentally ill can receive.  If placement through insurance doesn’t occur then we will need to go the judicial route to get him what he needs.  Damn shame to have to use the courts in such a manner.

You can bet that if we are denied a certificate of need, I will be working to find an attorney.  For the purposes of this post, insurance is North Dakota Medicaid.  The certificate of need comes through a place called Ascend Management Innovations out of Tennessee.  The last time a certificate of need was denied it was because of the doctors notes.  Ascend blamed it on a computer glitch.