Suicidality and mismanaged care
Suicidality and mismanaged care

Summary/Abstract: A 24year old man bolts from his home after threatening to kill his parents and himself. After a brief standoff with the police, he is taken a community hospital and discharged the next day. A 14year old female inexplicably ingests 30 extra strength Tylenol and goes to sleep for the night, never saying a word to her parents. Remarkably, she awakens the next morning. Violently ill, she is taken to the hospital and released to her parents after being medically “cleared.” Lastly, a 30year old man with a history of bipolar disorder and chronic opiate abuse is brought to the emergency room after an overdose. He is given Narcan and released the following day. What do these individuals have in common? A hospital stay of less than three days. Importantly, these stays were abbreviated not because the treating clinicians disputed the seriousness of the risk these patients posed, but because the insurers denied any further coverage for inpatient services. It made no difference whether the violence was directed at self or others, whether the patient was an adult or a minor; in what has now become a frequent refrain from insurance reviewers, continued inpatient treatment was not deemed “medically necessary.”

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