AltaPointe Health System CEO Tuerk Schlesinger warned media members Thursday of an impending mental health “crisis” if his organization and Mobile County Probate Judge Don Davis don’t resolve a disagreement involving commitment hearings of mentally ill patients who are submitted for involuntary evaluations at EastPointe hospital in Daphne.
About two years ago, Davis began requiring attending physicians at the hospital’s involuntary unit to testify at merit hearings to determine patients’ statuses after at least seven days of observation. Schlesinger said physicians complained about the way they were treated at the hearing by the presiding judges and attorneys as well as the amount of time it took away from their clinical work each week. The dispute came to a head recently when one of two doctors in the unit quit, in part because of the way he was treated on the stand and the length of time it took, Schlesinger said. AltaPointe employs a total of 24 physicians throughout the system. A total of five psychiatrists rotate at EastPointe.
The problem escalated yesterday when none of the hospital’s doctors agreed to testify in nine merit cases and those nine patients were sent back to the hospital unit, where beds are limited, Schlesinger said. AltaPointe filed a motion Tuesday night to have Davis’ ruling changed and once again allow master-level clinicians to testify instead of doctors. The motion will be heard in probate court Thursday, Nov. 20 at 3 p.m.
If the ruling is reversed, Schlesinger said some patients in the continued cases could be released from the hospital. Meanwhile, he drew a line in the sand and threatened to reject any new patients if Davis’ ruling stands.
“As soon as the physicians took the stand, I knew this day would come,” Schlesinger told reporters Thursday. “(Davis) is going to cause the biggest mental health crisis we’ve seen since 1992. Our beds are almost full now. If he sends us more patients, our doctors’ caseloads will double immediately.”
On the other hand, Davis said AltaPointe has claimed to have empty beds in the past. In addition, court rulings don’t require patients in need of involuntary evaluations to be sent to EastPointe. Davis said in the past, patients have been allowed to stay with family members while being observed on a regular basis.
“The responsibility lies with AltaPointe on where the evaluations take place,” he said. “It doesn’t have to be at EastPointe.
As for the ruling two years ago, Davis said the court previously allowed a master-level clinician from AltaPointe to use information from medical records to testify in merit hearings through an exemption stating the records were not considered hearsay evidence, or any statement made outside of court.
Medical records aren’t considered hearsay evidence if they are made or documented during the same time period that an event is taking place.
In hearings two years ago, Davis said attorneys discovered that some of the records used in court had been “pre-drafted.”
“For six or seven days in a row we noticed the same verbiage was used in records,” Davis said. “It was a copy-and-paste job.”
He said he told AltaPointe about the inconsistency, but it wasn’t addressed. Afterward, Davis decided to call the physicians to testify.
Davis also denied any “harassment” of physicians on the stand from judges and attorneys. He said most hearings last seven to nine minutes.
But speaking to the press Thursday, AltaPointe doctors said they are frequently harassed. Dr. William Billett, a 10-year veteran of AltaPointe, said when he takes the stand during the hearings he feels less like an expert witness than like he’s defending himself against the charge of malpractice. He also complained about the time the hearings take away from patients.
“The consensus is that it takes up so much of our time and resources,” Billett said. “It interferes with our ability to care for our patients. As much as a quarter of our time can be spent (preparing for testimony). By my calculations, I spend eight to 10 hours a week on extra stuff I have to do.”
Billett also complained that he has spent up to four hours in court on a single case before and was cross-examined for about two and a half hours of that time.
EastPointe Hospital Deputy Medical Director Dr. J. Luke Engeriser, an assistant professor in the psychiatry department in the University of South Alabama’s College of Medicine, said he remembers being cross-examined for over an hour in one case.
The time doctors spend preparing for court each week costs AltaPointe $1.5 million to $1.7 million a year, Schlesinger said. The figure includes fees for legal teams brought in on cases daily and weekly to defend “something that shouldn’t be defended,” he said.
Schlesinger added that Davis is the only probate judge in AltaPointe’s coverage area that requires physicians from the Daphne hospital to come to court and testify each week. He said neither Washington County Probate Judge Nick Williams, nor Baldwin County Probate Judge Tim Russell require it.
Williams said his court uses a licensed AltaPointe therapist, who has an office in Chatom, the county seat. He said the therapist keeps in contact with the doctors at EastPointe and comes to testify whenever needed for a merit hearing in Washington County.
Russell said the court works with AltaPointe on the hearings and allows a master-level clinician to testify. He added that judges also come to the hospital and interview the doctors in person there to get recommendations on whether more care is needed before a patient is released.
“We’re very pleased with how it works for us, but every county is different,” he said.
Schlesinger took it a step further, saying that of Alabama’s 67 counties, 65 don’t require psychiatrists to testify for the hearings. The only exceptions are Mobile and Jefferson counties, he said. In Jefferson, judges tour the county’s seven hospitals and ask the doctors for recommendations on patients in person.
In the motion filed Tuesday, AltaPointe argued that state code allows for depositions to be taken at the hospital if a probate judge requires expert testimony from a doctor there. Davis said he couldn’t comment on that because it was part of an ongoing case before the court.
For more on this story, please pick up next week’s issue of Lagniappe.