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Patient rights vs. treatment: A complex question

By Bonney Bowman 6:08 AM February 28, 2014

Medical professionals say they're held to strict guidelines when considering involuntary commitment.

ANCHORAGE – Court documents shed more light on the case of Bret Bohn, a 27-year-old Alaskan whose parents claim he’s being held captive by Providence Alaska Medical Center.

Bohn’s parents took him to Providence in October, suffering from insomnia, delusions and seizures.

Soon after, doctors declared Bret mentally incompetent. He was stripped of all his rights and appointed a state guardian to oversee his care.

Court documents show his parents were denied guardianship due to concerns for his safety.

A witness claims she heard his mother say she’d rather he died than be institutionalized. Records show she was also overheard encouraging Bret not to take his medication.

Lorraine Phillips-Bohn denies the accusations, but the case shows just how complex mental health issues and treatment can be for doctors and families.

When a person has a physical illness, like heart disease or diabetes, the treatment options are usually straightforward.

But when a person is battling mental illness, they may not be able to clearly articulate their wishes, or get anyone to listen.

That’s when doctors start deciding what’s best for a patient, whether or not that person agrees.

Patients at the Anchorage Psychiatric Institute — API — struggle with a variety of mental illnesses.

Medical Director Dr. Jenny Love says the first step to treatment is getting to know the person.

“We’re looking for their symptoms, we’re looking for diagnosis, we’re looking for opportunities to help that individual, but ultimately we’re not treating their diagnosis, we’re treating them,” Love said.

Doctors at API use a patient’s decision-making process to diagnose their mental capacity.

They work to decide if the patient’s thought process is logical, or if they’re using a magical type of thinking leading to illogical conclusions.

If a doctor declares someone mentally incapacitated, the patient starts to have less of a say in their treatment options.

“I think it has to be an ongoing dialogue and it is a tenuous line that you have to walk and it’s a balance that you have to reach,” Love said.

Not everyone believes doctors work hard enough to find that balance.

Jim Gottstein is an Anchorage lawyer and president of advocacy group Psych Rights.

He says involuntary drugging and commitment have become the easiest route for doctors dealing with a difficult patient.

“This stuff is all hidden and when the light of day is not shone on these kinds of things, you really have abuses go on and that’s what we’re seeing,” Gottstein said.

Love says her staff has to meet strict guidelines when considering involuntary commitment.

Doctors have to be able to prove in court that a patient can’t care for themselves, or would hurt themselves or others.

“It is not an easy route to take whatsoever,” Love said. “It takes a lot of background work.”

Gottstein says he’s known doctors to exaggerate in court, and judges tend to trust medical professionals.

“The doctor walks in and says, ‘Oh, regrettably this person is mentally ill and dangerous to himself or others and we need to lock him up so we can drug him,’” Gottstein said.

Once a person is found “incompetent” by the court, a guardian is appointed.

It could be a family, friend, a private professional or a state guardian who is tasked with balancing their patient’s wishes with their best interest.

“Just because you have a guardian appointed, doesn’t mean that you’re not capable of expressing your wishes and then it becomes a question of whether or not what you are expressing could cause you substantial harm,” said Elizabeth Russo, the supervising attorney for the Public Guardian Section of the Department of Health and Human Services.

But Russo admits those wishes aren’t always honored, saying, “it’s difficult when you’re mentally ill to have your voice heard.”

What’s concerning for many in the case of Bret Bohn is how he went from seemingly healthy to medicated — with no right to his own person — in a matter of months.

It begs the question, could this happen to me? Absolutely, Gottstein said.

“This could happen to anybody and it does happen to people and I get calls at least once a week from someone who’s been impacted by something like this and said I had no idea this was going on,” Gottstein said.

Love could only speak to the practices used at Anchorage Psychiatric Institute, not the other hospitals in town.

Bohn is at Providence Hospital.

“To be clear, hospitals don’t control guardianship,” representatives for the hospital said in a written statement. ”The best source of information on guardianship is the Office of Public Advocacy.”

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