Court hearings from the hospital

By Teddy Rosenbluth -Concord Monitor – Published: 4/23/2022 2:50:09 PM

Circuit courts have begun holding hearings for psychiatric holds in emergency room departments, a change New Hampshire hospitals have long fought against. However, in order to ensure patients are receiving mental health care, hospitals acknowledge it may be a necessary evil for the time being.

Lawyers and emergency rooms are not an ideal combination, said Riverbend CEO Lisa Madden, who also oversees mental health care at Concord Hospital.

“We’ve got traumas coming in. We’ve got injured children. We’ve got COVID patients,” she said. “It is not where those hearings should be occurring.”

Up until last year, Granite Staters deemed to be in mental health crisis often waited days or weeks in the emergency rooms for a bed at a psychiatric facility to open up without an opportunity to challenge the involuntary admission. That practice was deemed unlawful last May when the New Hampshire Supreme Court sided with a plaintiff, identified by the pseudonym Jane Doe, who said she was involuntarily held in an emergency department for 17 days before she received a probable cause hearing.

The court determined that the state either had to offer court hearings within three days of the patient being admitted, or discharge them.

Circuit Court Administrative Judge David King said over the last year, many petitions for involuntary emergency admissions have been dismissed solely because the state didn’t have the resources to get a hearing before the three-day time limit ran out, a practice King calls “Doe dismissals.”

That meant that people who may have posed a threat to themselves or others were released without receiving psychiatric help.

“If the three days have expired and there’s no new, dangerous act, we really didn’t have a choice but to dismiss the petition,” he said. “We’ve got a person who’s potentially in a mental health crisis who needs help, and the only response we’re giving them is we’re dismissing the petition because you can’t meet the deadline.”

Since shifting to the new system, in which patients virtually attend probable cause hearings from the emergency room, only two of 190 IEAs have been dismissed due to logistical problems, King said.

“This seemed to be the only way that we could meet that 72-hour deadline with any regularity,” King said. “The success has been beyond what I would have expected.”

Madden said Concord Hospital has been able to provide about 25 hearings to date in the emergency room.

“It still remains the truth that we don’t really want to have legal proceedings happening in the middle of an ED, but that is the expectation right now,” she said. “So that’s what we’re making sure we do for the patients so that they have a due process.”

Last week, the Joint Legislative Fiscal Committee voted to spend $2 million to expand emergency room hearings even further. The funding would create a centralized filing system and fund the salaries of circuit court judges, staff and counsel for patients subject to an involuntary emergency admission.

Melissa St. Cyr, the chief legal officer for the Department of Health, said holding hearings in the hospital is a temporary fix that the department hopes to phase out as fundamental problems with mental health capacity are addressed.

“It’s not the best environment for someone to receive a probable cause hearing, but it’s certainly still a good environment,” she said.