When the Hospital Becomes Your Prison

For over a year, I have had the not so unique ¹ experience of volunteering at one of New York’s largest hospitals. I thought it would be a great way to get some more recent medical experience given I had been working in construction for the last 6 years. Because I had volunteered extensively at doctor offices, hospitals, and as an EMT-B I didn’t have much hope for the experience to be very enriching. Fortunately, I was wrong.

During the month long period of background checks, interviews, and waiting for an available time slot to be trained in my assigned unit I built up quite a few expectations. Given the reputation of the hospital and my dealing with “big companies” in my professional life, I envisioned an efficient, well oiled machine. Instead, I was met with a Rube Goldberg machine where most mundane of actions seem to involve 4 or more parties. I never got onboarded or trained, I never built any strong connections with the staff, but I did learn an enormous amount about medical bureaucracy.

There was a specific outcome of this bureaucracy that I wanted to shed some light on - the situation in which your doctor becomes your jailer². In my experience, once a week for a year, there have been three situations where an able bodied, middle aged man has a stand off with with security and nurses because they were not allowed to leave. After a few hours of searching, I found a multitude of articles about the patient’s right to stay in the hospital but very few about their rights to leave.

On its face, this likely seems rather mundane. It makes perfect sense for a doctor to be able to tell someone they can’t go home because they’re too sick or not in a state to make decisions for themselves. Except, in the absence of an “emergency”³ there are no legal precedents for this to happen. As far as I can tell, the “held against your will situation” is only ever legally allowed in psychiatric situations - in New York this enumerated in Section 9.27 of the Mental Hygiene Law. ⁴ While the situations I have seen took place on a unit where mental states could be altered, the men being “detained” were able to communicate, walk around, and had a clear plan as to where they were going once they did leave the hospital. Even the nurses seemed to feel the men being forced to stay was wrong, some even shouting “That man needs to go home” during the altercations.

The biggest surprise to me was that the doctors were nowhere to be found during these situations. The decision to hold a patient was often done by two professionals the patient had never met prior (they called it a wellness check) and it didn’t seem the results of this check were ever really conveyed to the patient.

So, given all this information, I’ll defer to narrative. Your nurse informs you you’re going to be discharged soon, they’re just waiting for some paperwork to be finalized. Two people you haven’t met before enter your room, ask you a series of questions, and proceed to leave. You wait the remainder of the day and your nurse informs you that the paperwork didn’t go through so you’ll have to spend another night. The next day comes, it’s the middle of the afternoon, you decide to try and leave the unit. Security is called and you express “I’m not waiting anymore, I want to go home”. You then receive a litany of explanations as to why you can’t leave except for the truth - you have been deemed incapable of caring for yourself. Not seeking to get into a physical altercation, you return to your room. I have no clue what follows, but these people were not on the unit the following week.

Telling that story terrifies me. Many of the patients made to stay likely never understood why. They likely never knew their rights as patients. Were they able to care for themselves? Based on my conversations with them and the aforementioned declarations by the nurses, I would give a definitive yes. So why were they held in the hospital against their will? It’s likely exactly because these were the types of patients that would never “come after” the hospital for the event. I don’t even think a well equipped patient would be excited at the prospect of going after a company that employs thousands of people and has a dedicated legal team. From the outside, it seemed that the hospital wellness check translated to an IQ test. If you failed, you were stuck until the wheels spin long enough to get you out with no real change to your status.

While the entire situation has left a sour taste in my mouth, my intent is not to imply there is a nefarious ulterior motive. It is also not to denigrate the hospital staff and doctors who undoubtedly work hard and deal with an inordinate amount of stress. The experience just showed me how hard decisions become too easy to make when there’s very little chance being wrong will impact you negatively - when bureaucracy begins to cause recklessness.

Truthfully, the solution is elusive. In Kersten’s paper, she determines that legislation needs to become more concrete regarding these matters, laying out the guidelines that must be met to instigate a medical hold in hopes to guide change. As most will utilize gray areas in medical legislation to avoid liability or out of a sense of altruism, it seems reasonable that improving these guidelines is a reasonable approach. From my perspective, it seems inadequate. These situations showed me an unfortunate reality of our medical system and society at large - oftentimes the individuals on both sides of decisions in the hospital setting feel powerless. Both parties allowing decisions they should be capable of making to be performed by parties removed from the situation as a whole.

1. Turns out this is something effectively every student with the intent to apply to a medical related program does in New York. As a result, the mass majority of volunteers are under the age of 21 and there is a large turnover. ↩

2. The doctor as jailer: medical detention of non-psychiatric patients. This paper inspired the title of the article and is fantastic read on some insight into the complicated nature of medial legislation. ↩

3. “An unforeseen combination of circumstances which calls for immediate action” According to Wheeler v. Barker, 208 P.2d 68, 73 (Cal. App. 2nd 1949) ↩

4. Section 9.27: Involuntary admission on medical certification ↩