Patient Hospital Discharge Quotes

in 1972 Governor Ronald Reagan with one bold, brilliant stroke abolished mental illness in California by not only closing the large state psychiatric hospitals but also eradicating most of the public aftercare programs. As a result hospital staffs were forced, day after day, to go through the charade of treating patients and discharging them back into the same noxious setting that had necessitated their hospitalization.

Patients are often taken by ambulance to emergency rooms, where they are boarded in general hospitals that lack psychiatric care. The hospitals then can’t discharge their patients to psychiatric facilities because more often than not, there are no beds available. It creates a logjammed system that fails everyone, as movement is stymied in almost every direction except to the streets or to jails and prisons, also known as “the beds that never say no,

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

In addition to including the voices of those most affected by mass incarceration in the conversation about ending it, we must pay attention to lessons from an earlier era of deinstitutionalization: that of mental hospitals in the second half of the twentieth century. It is crucial that we not repeat the experiences of the dismantling of that system - a system that at peak was of a scale on par with mass incarceration, affecting about 700 per 100,000 adults in the U.S. population. Deinstitutionalization of millions of mental hospital patients took place beginning in the 1950s and lasting through the 1970s, by which time more than 95 percent of all U.S. mental hospital patients had been discharged, and most of the large institutions that warehoused them had been shut down. That earlier process (also called 'decarceration' at the time) was publicly presented as a progressive initiative to get people out of the medieval conditions of many old mental hospitals. At the time, the plan was for mental health services and care to be rendered through community-based programs. Unfortunately, those programs never materialized due to the budgetary demands of the Vietnam War and the death of President John F. Kennedy, who had driven the initiative from the start. The earlier failure of public policy affected many of the same populations we see in prisons today, where about 50 percent of inmates carry major mental health diagnoses. We must certainly insist that prison decarceration not repeat the wholesale abandonment of follow-up care that occurred after the earlier decarceration.

Dr. Lydia Ciarallo in the Department of Pediatrics, Brown University School of Medicine, treated thirty-one asthma patients ages six to eighteen who were deteriorating on conventional treatments. One group was given magnesium sulfate and another group was given saline solution, both intravenously. At fifty minutes the magnesium group had a significantly greater percentage of improvement in lung function, and more magnesium patients than placebo patients were discharged from the emergency department and did not need hospitalization.4 Another study showed a correlation between intracellular magnesium levels and airway spasm. The investigators found that patients who had low cellular magnesium levels had increased bronchial spasm. This finding confirmed not only that magnesium was useful in the treatment of asthma by dilating the bronchial tubes but that lack of magnesium was probably a cause of this condition.5 A team of researchers identified magnesium deficiency as surprisingly common, finding it in 65 percent of an intensive-care population of asthmatics and in 11 percent of an outpatient asthma population. They supported the use of magnesium to help prevent asthma attacks. Magnesium has several antiasthmatic actions. As a calcium antagonist, it relaxes airways and smooth muscles and dilates the lungs. It also reduces airway inflammation, inhibits chemicals that cause spasm, and increases anti-inflammatory substances such as nitric oxide.6 The same study established that a lower dietary magnesium intake was associated with impaired lung function, bronchial hyperreactivity, and an increased risk of wheezing. The study included 2,633 randomly selected adults ages eighteen to seventy. Dietary magnesium intake was calculated by a food frequency questionnaire, and lung function and allergic tendency were evaluated. The investigators concluded that low magnesium intake may be involved in the development of both asthma and chronic obstructive airway disease.

Those transitions provide a lot of opportunities for things to fall through the cracks, so it shouldn’t come as a surprise that following hospital discharge nearly half of hospitalized patients experience at least one medical error in medication continuity, diagnostic workup, or test follow-up.51

The government-commissioned age-based ‘triage tool’ was the only guidance they had been given to deal with such difficult decisions, so they used it to systematically exclude the elderly, the frail and patients with underlying illnesses from critical care. Those patients would not be given life-saving mechanical ventilation regardless of the severity of their condition. This age-based criterion is alleged to have been applied by hospitals in London, Manchester, Liverpool, central England and the south-east. Many of those who died, after being excluded by the triage criteria, might well have survived if they had been admitted to intensive care. Of the few patients over the age of 80 who were given critical care treatment, close to four in ten were discharged alive.

A year later, Maurice Rappaport at the University of California in San Francisco announced results that told the same story, only more strongly so. He had randomized eighty young newly diagnosed male schizophrenics admitted to Agnews State Hospital into drug and non-drug groups, and although symptoms abated more quickly in those treated with antipsychotics, both groups, on average, stayed only six weeks in the hospital. Rappaport followed the patients for three years, and it was those who weren’t treated with antipsychotics in the hospital and who stayed off the drugs after discharge that had—by far—the best outcomes. Only two of the twenty-four patients in this never-exposed-to-antipsychotics group relapsed during the three-year follow-up. Meanwhile, the patients that arguably fared the worst were those on drugs throughout the study. The very standard of care that, according to psychiatry’s “evidence base,” was supposed to produce the best outcomes had instead produced the worst. “Our findings suggest that antipsychotic medication is not the treatment of choice, at least for certain patients, if one is interested in long-term clinical improvement,” Rappaport wrote. “Many unmedicated-while-in-hospital patients showed greater long-term improvement, less pathology at follow-up, fewer rehospitalizations, and better overall functioning in the community than patients who were given chlorpromazine while in the hospital.

almost twice as many remdesivir subjects as placebo subjects had to be readmitted to the hospital after discharge—suggesting that Fauci’s improved time to recovery was due, at least in part, to discharging remdesivir patients prematurely. Altering protocols in the middle of an ongoing study is an interference commonly known as “scientific fraud” or “falsification.

In the harbor beyond Kimmel’s window, a flotilla of motor launches and small boats spread out across the water like frenzied water spiders. They carried the wounded first to the hospital ship Solace and then, after its hastily enlarged trauma space overflowed, to the main medical facilities on Hospital Point and a triage area set up on 1010 Dock adjacent to the Argonne. Some of the wounded were carried aboard the Argonne, where the warrant officers’ mess was converted into an emergency operating room. By midmorning, personnel from the Argonne and other ships had also set up a field hospital at the nearby Officers’ Club. On Hospital Point, Naval Hospital Pearl Harbor was a state-of-the-art facility with about 250 beds, but the carnage quickly taxed it well beyond anything its staff had ever imagined. The first casualties arrived even as the second wave of attackers still pounded the harbor. As more poured in, ambulatory patients on the wards with far less critical conditions were discharged or evacuated to vacant outbuildings and hastily erected tents behind the hospital. Within three hours, the hospital received 546 casualties and 313 dead.

Fiscal Numbers (the latter uniquely identifies a particular hospitalization for patients who might have been admitted multiple times), which allowed us to merge information from many different hospital sources. The data were finally organized into a comprehensive relational database. More information on database merger, in particular, how database integrity was ensured, is available at the MIMIC-II web site [1]. The database user guide is also online [2]. An additional task was to convert the patient waveform data from Philips’ proprietary format into an open-source format. With assistance from the medical equipment vendor, the waveforms, trends, and alarms were translated into WFDB, an open data format that is used for publicly available databases on the National Institutes of Health-sponsored PhysioNet web site [3]. All data that were integrated into the MIMIC-II database were de-identified in compliance with Health Insurance Portability and Accountability Act standards to facilitate public access to MIMIC-II. Deletion of protected health information from structured data sources was straightforward (e.g., database fields that provide the patient name, date of birth, etc.). We also removed protected health information from the discharge summaries, diagnostic reports, and the approximately 700,000 free-text nursing and respiratory notes in MIMIC-II using an automated algorithm that has been shown to have superior performance in comparison to clinicians in detecting protected health information [4]. This algorithm accommodates the broad spectrum of writing styles in our data set, including personal variations in syntax, abbreviations, and spelling. We have posted the algorithm in open-source form as a general tool to be used by others for de-identification of free-text notes [5].

Employees who sit near windows report higher energy levels and tend to be more physically active both in and out of the office. In a study of elementary schools, students in classrooms with the most daylight advanced as much as 26 percent faster in reading and 20 percent faster in math over the course of a year. Hospital patients assigned to sunnier rooms were discharged sooner and required less pain medication than those in rooms with less light.

Unfortunately, the mental health centers legislation passed by Congress was fatally flawed. It encouraged the closing of state mental hospitals without and realistic plan regarding what would happen to the discharged patients, especially those who refused to take the medication they needed to remain well. It included no plan for the future funding of the community mental health centers. It focused resources on prevention when nobody understood enough about mental illnesses to know how to prevent them. And by bypassing the states, it guaranteed that future services would not be coordinated.

Runaway costs are crushing the American medical system. Hispanics are the group least likely to have medical insurance, with 30.7 percent uninsured. Ten point eight percent of whites and 19.1 percent of blacks are without insurance. Illegal immigrants rarely have insurance, but hospitals cannot turn them away. In 1985, Congress passed the Emergency Medical Treatment and Active Labor Act, which requires hospitals to treat all emergency patients, without regard to legal status or ability to pay. Anyone who can stagger within 250 yards of a hospital—a distance established through litigation—is entitled to “emergency care,” which is defined so broadly that hospital emergency rooms have become free clinics. Emergency-room care is the most expensive kind. Childbirth is an emergency, and hospitals must keep mother and child until both can be discharged. If the mother is indigent the hospital pays for treatment, even if there are expensive complications. Any child born in the United States is considered a US citizen, so thousands of indigent illegal immigrants make a point of having “anchor babies” at public expense. The new American qualifies for all forms of welfare, and at age 21 can sponsor his parents for American citizenship. In 2006 in California, an estimated 100,000 illegal immigrant mothers had babies at public expense, and accounted for about one in five births. The costs were estimated at $400 million per year, and in the state as a whole, half of all Medi-Cal (state welfare) births were to illegal immigrant mothers. In 2003, 70 percent of the babies born in San Joaquin General Hospital in Stockton were anchor babies. In Los Angeles and other cities with heavy gang activity, hospitals must deal with “dump and run” patients—criminals wounded in shootouts who are rolled out of speeding cars by fellow gang members. Illegal-immigrant patients often show up without papers of any kind, and doctors have no idea whom they are treating. Mexican hospitals routinely turn away uninsured Mexicans, and if the US border is not far, may tell the ambulance driver to head for the nearest American hospital. “It’s a phenomenon we noticed some time ago, one that has expanded very rapidly,” said a federal law enforcement officer.