AltaPointe Health System CEO Tuerk Schlesinger warned of an impending mental health “crisis” if his organization and Mobile County Probate Judge Don Davis don’t resolve a disagreement involving commitment hearings for mentally ill patients submitted for involuntary evaluations at EastPointe hospital in Daphne.
About two years ago, Davis began requiring attending physicians at the hospital to testify at merit hearings to determine patient statuses after at least seven days of observation. Schlesinger said physicians complained about their treatment at the hearings by the presiding judges and attorneys, as well as the amount of time it took away from 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 its system. A total of five psychiatrists rotate at EastPointe.
The problem escalated Nov. 12 when none of the hospital’s doctors agreed to testify in nine merit cases and the nine patients involved were sent back to the hospital unit, where beds are limited, Schlesinger said. AltaPointe filed a motion on Nov. 11 to have Davis’ ruling changed to allow master-level clinicians to testify instead of physicians.
If the ruling is reversed, Schlesinger said some patients in the continued cases could be released. If the ruling stands, Schlesinger said the hospital would be forced to stop admitting patients for evaluations.
“As soon as the physicians took the stand, I knew this day would come,” Schlesinger told reporters. “(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.”
To the contrary, 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.
“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 an event is taking place.
In hearings two years ago, Davis said attorneys discovered 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 last week, 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.”
Brian Murphy, an attorney for respondents in merit hearing cases, said he hasn’t received complaints about his treatment of doctors, who he routinely cross-examines during cases. He said it’s never hostile, but the doctors are asked to explain treatments to the court.
“The job of the attorney is not to dispute what they’re saying,” Murphy said. “It’s to get them to expand on the diagnosis.”
Murphy said having doctors testify is key to the hearings because it allows the court, the respondent and his or her family to better understand the reasons behind the next course of action.
Schlesinger said Davis is the only probate judge in AltaPointe’s coverage area who requires physicians from the Daphne hospital to come to court and testify each week.Schlesinger went a step further, saying that of Alabama’s 67 counties, 65 don’t require psychiatrists to testify at 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.
Mobile County Probate Court General Counsel J. Michael Druhan said they don’t want to cut any corners when it comes to patients’ rights and that’s why doctors are called to testify in each of the hearings.
“It’s often said the rest of the state is doing it a different way,” Druhan, a temporary probate judge, said. “The rest of the state is doing it wrong.”
Rick Trawick, former general counsel for the Alabama Department of Mental Health, said there is no requirement in state, or federal law to have doctors testify in merit hearings. He added that the Alabama Supreme Court has ruled it doesn’t take a doctor to testify.
In the motion filed Nov. 11, AltaPointe argued state code allows for depositions to be taken at the hospital if a probate judge requires expert testimony from the facility’s doctors.
Druhan said allowing the depositions wouldn’t be a problem, but it would be much more expensive and time consuming than calling the doctors to testify.
While Schlesinger said AltaPointe will have to stop taking in patients unless Davis’ ruling is overturned, Druhan said the court could hire an independent doctor to evaluate patients if the issue isn’t resolved. State law allows the court to hold patients for a maximum of 30 days for involuntary evaluations.