VIOLATIONS OF ARIZONA ADMINISTRATIVE CODE R9-21-312:  UNLAWFULLY CONDUCTED INPATIENT  TREATMENT AND DISCHARGE PLANNING MEETINGS, DENIAL OF PATIENTS' RIGHT TO A REPRESENTATIVE; February 09, 2012: Wherein my primary attending physician at the Arizona State Hospital, Dr. Sylvia Dy, in Complicity with Veneranda Heffern and Robert Washington of ASH Social Services tried to unlawfully subject me to a procedurally invalid inpatient discharge and planning meeting, and refused to allow me to invite a representative of my choice to attend.

      At 3:00 p.m., February 09, 2012, my then assigned Arizona State Hospital social worker, Robert Washington, advised me that "Several people want to talk to you at this time in the Desert Sage East conference room. I immediately asked him to clarify who these people were, but he refused to do so. After several minutes of discussion during which I advised him that I was very uncomfortable with any such unscheduled meetings, particularly given his unwillingness to be forthcoming, I agreed to at least look into the nature of this meeting. We then entered the conference room, where my current primary attending ASH physician, Dr. Sylvia Dy, and a managerial social services staff member, Veneranda Heffern, as well as a Desert Sage East charge nurse named Gladys, were already waiting for me. I immediately inquired as to what was going on, but neither of them would respond, at which point Mr. Washington stated: "Patrick, I am going to show you a document." Needless to say, I found the goings on very suspicious, and I respectfully asked for a clear description of the nature of the meeting, but again, the three of them refused to offer an explanation, and Dr. Dy refused to even look me in the eye. I then stated in very clear terms that I wanted to invite a representative of my choice to this unannounced meeting, and asked to have them use the available conference phone to call this person. They were initially reluctant to grant me this request, but when I told them that I wanted to call a hospital liaison named Lori McGoffen, they all looked at one another, and Ms. Heffern said "Well, that's ok. She already knows, right?" Ms. McGoffen was unavailable, however, so I then requested that another representative of my choice be called, and gave them the number of a patient advocate who had to date been assisting me with my treatment planning, but Ms. Heffern, Dr. Dy, and Mr. Washington all flatly refused to grant me the right to have this advocate present at the meeting. This was a criminally unjust action on the part of all three of these individuals, and should, at a minimum, have consequences in terms of their respective licensure.

         As it turned out, the document that they unlawfully insisted that I look at was a one page Arizona State Hospital pronouncement stating I was to be discharged from ASH on February 20, 2012. The significance of this issue has to do with the fact that at least three other parties were centrally involved at that time in my discharge planning (agency representatives, including my outpatient case manager, and at least one other member of my outpatient clinical team, as well as an ASH liaison) , and the intent of ASH administrative and clinical staff to unilaterally issue my discharge date without fully involving these parties is in clear violation of Arizona Administrative Code (AAC) specific to such matters. As such, my flow of ongoing treatment and discharge planning was severely disrupted, and I was forced to experience unreasonably high anxiety over the fact that I was going to be sent out the front door of ASH on February 20, 2012, regardless of whether or not all of the logistical planning had been adequately established. 

        The Arizona State Hospital is required to ensure that all involved parties in these sorts of processes are granted the opportunity to participate, and the decision by ASH to put me through this unlawfully conducted meeting while refusing me the right to bring in a representative of my choice was egregious to the extent that no patient/client should be so burdened by any of these conditions, and there are numerous provisions of the AAC that apply, as follows:    

Arizona Administrative Code Title 9-Chapter 21- Article 312 (R9-21-312)
Department of Health Services – Behavioral Health Services for Persons with Serious Mental Illness

Inpatient Treatment and Discharge Plan

A. General provisions

1) Every client of an inpatient facility shall have in Inpatient treatment and Discharge Plan (ITDP)
2) An ITDP shall be developed by the inpatient facility, the case manager and other members of the clinical team, as appropriate.
3)  The ITDP shall include the most appropriate and least restrictive services available at the inpatient facility, as well as a plan for the Client's discharge to the community.
4) The ITDP shall identify those treatment interventions and services which maximize the client's strengths, independence, and integration into the community.
5) The ITDP shall be developed with the fullest possible participation of the the client and any designated representative and/or guardian.
6) The ITDP shall contain goals and objectives which are measurable and which facilitate meaningful evaluation of the progress toward attaining those goals and objectives.
7) The ITDP shall be written in language which can be easily understood by a lay person.
8) Delays in the assignment of a case manager or in the development or modification of an ISP or ITDP shall not be construed to prevent the appropriate discharge of a client from an inpatient facility.B. The Individual Treatment and Discharge Plan (ITDP) meeting.

     1) The case manager shall encourage the client to have a
designated representative assist the client at the meeting
and to have other persons, including family members,
attend the meeting. The case manager shall ensure that
the human rights advocate is notified of the time and date
of the ITDP for clients who need special assistance.
    2) The following persons shall be invited to attend the ITDP
meeting:
  a. The client;
  b. Any designated representative and/or guardian;
  c. Family members, with the client’s permission;
  d. Members of the client’s inpatient facility treatment
      team;
  e. The case manager and other members of the clinical
      team, as appropriate;
  f. Other persons familiar with the client whose pres-
     ence at the meeting is requested by the client; and
  g. Any other person whose participation is not objected
      to by the client and who will, in the judgment of the
      case manager, contribute to the planning process.

     As a matter of clarification, Dy. Svlvia Dy, Veneranda Heffern, and Robert Washington did not even inform my case manager , or anyone else from my ITDP team, about their intent to assemble the February 09, 2012, treatment and discharge planning meeting that I have described above. As such, they engaged in an attempt to unlawfully assemble this meeting in direct defiance of aplicable codes of procedure and practice. I cannot speculate as to whether these individuals engaged in this action because they are unaware of the statutory standards in such cases (which effectively tells me that they are unqualified in terms of meeting the responsibilities of their respective licensureship, much in the same way that ASH Chief Operating Officer, Donna Noriega, was recently exposed as being [see this blog, 04/17/12: "News Flash: Busted!), or they blatantly disregarded these standards (in which case I feel they should be held fully accountable under the law).
           The existence of standards such as these, as applicable to a patients' ongoing needs and interests at all phases of their respective treatment and discharge planning, are critically important in terms of all patients fundamental (constitutional) right to self determination in the context of participating in their own treatment. In my experiences, however, the conceptual foundation underlying this theme is one of the most commonly abridged element of any mentally ill persons fundamental right(s), this by virtue of the fact that discrimination against mentally ill persons is largely based upon the belief that mentally ill are cognitively incapable of managing their own personal life affairs. Worse yet, many people in society today- including numerous medical professionals that I interacted with at The Arizona State Hospital- actively deny mentally ill persons the right to participate in their own treatment due to the belief that mentally ill people are less than human, and not deserving of such opportunities.
      Below is a copy of a letter that I put in the outgoing mail at ASH on February 12, 2012. To my knowledge, however, the letter never made it out of the hospital,  which very strongly suggests that it was unlawfully seized; the illegal seizure of my outgoing mail was a regular thing for the entirety of my time at ASH (something I verified through USPS and ACLU participation) and with respect for this specific event, it stands to show that my fundamental rights were violated at ASH in every sense of the term, from the very first day that I entered the environment of The Arizona State Hospital (at which time some of my personal belongings- medication- were stolen) until that time at which I was finally discharged (near literally).           

       I am aware that my various allegations and assertions sound extreme at times, but as a matter of keeping things in reasonable perspective, the case of Audrey P. is extreme, too! (see this blog, 4/12/12, "No Electric Wheel Chair For You, Audrey P.!"). Wherein, a primary attending physician, Dr. Ramos-Roxas has, to date, denied a female ASH patient (who lost three out of her four limbs in direct relation to her mental disability) access to the most modern technology available today on the basis of an electric wheel chair being inconsistent with the woman's "treatment needs." Abuse of authority in that particular context is something that I witnessed and experienced ASH physicians, and staff in general, engaging in on a day to day basis, effectively using the justification  of "treatment needs" every time they choose to do whatever the heck they want to, regardless of the legality or true therapeutic benefit to the patient. It is one of the easiest ways for for state hospital staff (and beyond) to pull their vast array of clinical misconduct without attracting attention, and arguably the oldest trick in the book in terms of sanctioned medical malpractice. The reality, however, is that for a doctor to say "we know best" in contexts and circumstances that are entirely outside of their given authority amounts to criminal abuse of power and related authority. In the case of Audrey P., who has the constitutional right as a citizen and consumer to be made aware of the fact that a philanthropic entity of some sort wants to gift her an electric wheel chair, Dr. Ramos-Roxas' decision to restrict Audrey's awareness of the individuals who offered to gift her the electric wheel chair was an absolute attack on the fundamental liberty of any American citizen to benefit from the generosity of her fellow citizens, and in my honest opinion, this sort of mistreatment directly contributes to my friend Audrey's struggle with self esteem and related sense of worth as a human being, as well. Bottom line.

      As I have already made clear in my prior entries, the administrative and clinical staff at ASH conduct this sort of unlawful business conduct as a standard matter of practice, which utterly exacerbates the presence of patient abuse at every other level of inpatient treatment at ASH. In the case of my experiences on February 09, 2012, Ms. Heffern and Dr. Dy's only response to my concern over being denied my rights amounted to each of them denying that this meeting was a legitimate individual treatment and discharge planning meeting, which is ludicrous, given that there is no single element of such planning then the planned date of my discharge itself. This action posed the very real risk of me being discharged into homelessness in the metro district of downtown Phoenix, AZ, despite there having been a substantial bit of invested effort put out by my outpatient providers, an effort that was still in the works and as of yet uncompleted at that point of my discharge planning process. ASH' action in this regard very nearly threw my entire immediate future into literal disarray, and when I stated this in no uncertain terms a that time, Mr. Washington made it clear that in the opinion of himself and ASH administrators, this risk was "not something that the Hospital is responsible for," a statement that amounts to a blatant disregard for the language of the applicable procedural codes.  
      I cannot emphasize enough how disturbing these issues are when a patient such as myself does everything he can to state his given preferences and related rights, only to have ASH staff blatantly disregard these expressions as though the patient doesn't even exist in these sorts of very practical terms. ASH conduct in this context flies in the face of clearly established procedural standards that are designed to grant patients a full and meaningful opportunity to be involved in all aspects of their treatment, and all of the persons involved in this described incident are fully aware of these standards, as per their training and professional licensing.
      
paoloreed@gmail.com