A day or two after I was admitted to Crouse Hospital, someone from Care Management brought me three papers to sign. (What Crouse calls Care Management, St. Joseph’s Hospital called Discharge Planning.) Thereafter, every day a different person from Care Management would come in and ask if I’d signed the papers. I told them all the same thing: when my Power of Attorney (POA) gets back in the country, we will sign the papers.
So my POA arrived at my bedside on Memorial Day evening (we were not holding up Crouse’s discharge process; nobody does anything over a long weekend) and we signed two of the three papers. The third one, it was noted on the bottom, was page 6 of 7. The other six pages had not been presented to me. What I got was page 6, which had a box checked that I was seeking “restorative services.” No, I’m not. I’m seeking long term care. “Restorative” I take to mean rehab, and there ain’t nuthin’ you can rehab about me. Otherwise, it’s a blank sheet of paper they want me to sign.
The American medical industry functions on the belief that once you turn yourself into a patient then your brain ceases to function, so they hand you blank forms and expect you to sign them. Would you sign everything Time Warner put in front of you? Would you sign blank forms for your electricity provider? How about voting on a ballot that doesn’t list the candidates? Then why the hell are you signing blank forms for your medical providers? They are, first and foremost, businesses. Second, God willing, they are nice people who have your best interests at heart, but first they care about keeping their own pay checks coming and that may not be in your best interest.
You go to any medical care provider’s office—outpatient or in—and you will be handed forms you are expected to sign without reading, which is when Judge Judy stands up in the back of my mind and yells, “You signed what? Without reading it? Are you a complete moron?” No, Judge, I’m not, so I refuse to sign page of 6 of the unknown whatever.
The next day, two of the four Karens from Care Management appear at my bedside, with the second one producing the other six pages of the whatever. The whatever turns out to be SCREEN Form: DOH-695 (2/2009). Question 23 is “Does this person have a serious mental illness?” Karen has checked “Yes.” Question 28 is “Is this person seriously physically ill?” Karen has checked “No.”
Karen tried to slip past me the fact that she is saying I am crazy, not sick. How dare she? And “this person”—Anne C Woodlen—is absolutely outraged. Fortunately for Karen, Stevie the Wonder POA is present. He doesn’t have a horse in this race so he is free to be more rational about the whole thing. He asks who says I have a serious mental illness. Karen says her backup paperwork says it.
Her written instructions for filling out the paperwork say the answer to question 23 is yes only if I meet all three criteria: diagnosis, level of impairment, and recent treatment. Karen is basing her answer on her perception that I meet one criteria—recent treatment—not all three. Fact: I have no diagnosis. Fact: I have no level of impairment. Fact: The papers were filled out before Karen met me. She—secretly—claimed that I have a serious mental illness only because I was on an inpatient psychiatric unit a month ago.
The paperwork says that I must have received inpatient “psychiatric treatment” to qualify for the “serious mental illness” designation. I was hospitalized on St. Joseph’s inpatient psychiatric unit for two weeks but I was not treated. I received no medication or individual or group therapy. Being bedridden by physical illness, I didn’t even participate in the so-called milieu therapy. And I only ended up on inpatient psychiatry because I knew I was too sick to go home alone and, in the Observation Unit, nobody had any discussion with me about my home circumstances and who was or was not there to assist me.
So then Stevie the Wonder POA and I move Karen on to a discussion of how in the world she could possibly be claiming that I am not seriously ill. Uh, she says, I’m a social worker, not a nurse. She’s a social worker who is trying to get a patient placed in a nursing home while declaring that the person is not seriously ill. Okay, I am declaring that Crouse Hospital needs to do some serious re-training with their Care Management personnel.
Let’s back up here. What is this “Screen Form?” Well, there’s something called a PRI—Patient Review Instrument. “The Patient Review Instrument (PRI) is an assessment tool developed by the New York State Department of Health to assess selected physical, medical, and cognitive characteristics of nursing home residents, as well as to document selected services that they may receive. . . .The PRI includes assessment items in each of the following general areas:
- Administrative Data . . .
- Medical Conditions and Treatments . . .
- Activities of Daily Living . . .
- Selected Behaviors . . .
- Specialized Services . . .
- Diagnosis . . .
“The information collected from the PRI is used to determine Medicaid reimbursement for nursing homes in New York State.”
First the PRI is supposed to be done by a nurse who is specially trained and certified in the use of it. If the nurse decides the patient meets the criteria for mental retardation or mental illness then that triggers a stage-2 screening by a social worker. The “Screen Form” is stage two screening.
Crouse Hospital has yet to do a PRI with me.