The Rights of Patients with Opioid Use Disorder

 

 

I’ve been notified of an alarming development that’s come to pass at Mission Hospital in Asheville, NC.

Recently Mission Hospital decided that patients with opioid use disorder will be unable to have visitors while they are hospitalized, and they will also be unable to have any electronic devices with them. The hospital will provide “sitters” to stay in patients’ rooms at all times, for patients with opioid use disorder. It’s unclear to me if this policy also applies to all patients with substance use disorders. It’s also unclear if their policy applies to all patients with opioid use disorder, or just those in early recovery.

These measures have been imposed to prevent hospitalized patients from using illicit drugs.

The first edict – that patients with opioid use disorders can’t have visitors – isn’t absolute. Apparently potential visitor candidates must be pre-approved by the Chief Medical Officer of the hospital.  I don’t know what criteria this CMO uses, but it would seem this policy would have the effect of isolating a hospitalized patient.

I’ve only been hospitalized once, with a broken leg, but without the presence and support of my fiancé, I would have been distraught and more frightened than I already was (and I’m a doctor!). And that’s just a broken leg, completely fixable. Imagine how much worse it would be for patients hospitalized with severe or life-threatening medical problems. Isolating patients at such a time is cruel, even if it may be legal.

Banning electronic devices also has the effect of isolating the patient. Think of it – no email, no cell phone calls, no Facebook, no surfing the net to pass time…this measure also seems unnecessarily harsh.

Mission Hospital’s administrators probably instituted these actions because visitors brought drugs to patients in the past. Of course this happens, and it’s vexing to staff and dangerous to the patients. But surely some sort of common-sense measure can be taken short of barring all visitors and banning electronic devices.

As far as having a sitter in the room – I, for one, would be most annoyed if the hospital where I’m paying to get treatment decided I needed the constant companion of an utter stranger.

Frightened hospital patients with life-threatening illness need to discuss treatment options with loved ones. A random person sitting in the room will not serve as a substitute. The wrong kind of person could even increase patient anxiety.

These new measures taken by Mission are likely to increase the risk of a patient leaving against medical advice (AMA). The cynical side of me wonders if that’s the hospital’s intent. Many people with substance use disorders don’t have insurance, and often need long hospital stays. Are these new measures, which isolate patients with substance use disorders, intended to get rid of these “bad” patients?

I hope not.

As good as their intentions might have been, Mission’s actions might be a violation of the Americans With Disabilities Act (ADA).

I saw a presentation at the spring American Society of Addiction Medicine (ASAM) conference, given by Elizabeth Westfall, an attorney who works at the Department of Justice (DOJ). The topic of her lecture was the new Opioid Initiative started by the DOJ. Right now, there’s a push to investigate and eliminate unnecessary and discriminatory barriers for patients with opioid use disorder who are in treatment and recovery. She said the DOJ was doing an outreach to stakeholders to spread information about what counted as discrimination, and to offer technical support when needed.

She said the DOJ works with U.S. Attorneys across the country to look at these cases of discrimination. She says they can usually negotiate settlements where part of the agreement is to make sure discriminatory practices are ceased. If settlements can’t be agreed upon, the DOJ assists with litigation when needed.

Ms. Westfall told the ASAM audience that the ADA prohibits discrimination based on disability in different areas: employment, services from state and local governments, and public accommodations. She said that patients with opioid use disorder are protected under the ADA if they are not currently using illicit drugs.

That last part is what makes ADA claims tricky. Who is to say what is “current use?” Clearly, she told us that patients in medication-assisted treatment are not considered to be current users. These patients are taking medications prescribed by a physician for a specific purpose. These patients are covered under the ADA, so long as there is no current illicit drug use.

Elizabeth Westfall also gave information about how to file a claim with the DOJ. Of note, employment discrimination claims need to go to the EEOC, but even if you send them to the DOJ, she said they would be forwarded to the appropriate agency.

There is a specific case at issue right now. I will change some data to protect patient identity, but here’s the story: A patient entered medication-assisted treatment on methadone about two weeks ago. He did well, and got up to a dose at which he stabilized. Then he became ill with malaise and fever, and went to Mission Hospital’s emergency department. He was found to have a potentially life-threatening medical disorder, and was admitted for treatment.

He has not been permitted to have visitors, and his mother was apparently refused permission to visit him. He’s been isolated from any support network he might have, due to Mission’s new policies in place to prevent illicit drug use among their hospitalized patients.

Is this a violation of the ADA? Since I’m no lawyer (despite having watched every single “Law and Order” episode from the twenty years it aired), I don’t know.

Bu it doesn’t seem right to me, separating the patient from critical support during a life-threatening illness. I know the medical staff at the OTP he goes to has been talking to hospital officials, trying to negotiate a compromise.

Here is the information given at the ASAM meeting, should any of my readers know of a case of discrimination against patients with opioid use disorder:

File a complaint:
http://ada.complaint@usdoj.gov

Great website for further reading/information:
http://www.ada.gov

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8 responses to this post.

  1. Posted by Interested Citizen on September 17, 2018 at 12:38 am

    I would be curious to know who pays for these “support services” that sit with the hospitalized individual. Is this a billable service or is this a service they offer free of charge. Is this service offered to people with any condition or just those with opioid use disorder?

    Reply

  2. Posted by Mary Anne Hughes on September 17, 2018 at 1:22 am

    This policy reeks of stigmatization at worst and ignorance at best. Who in their right mind would want to be isolated from their support system at such a vulnerable time, when most support is needed? A comensensical approach is always in order and visitors are banned at patient’s or staff request for many reasons, not just for the risk of smuggling drugs in. I couldn’t help but think while reading this, that the only element missing was shackles. But maybe the shackles are the ones you can’t see.

    Reply

  3. Isn’t it also possible that a patient in pain management could be misdiagnosed as having OUD, then illegally prevented from having hospital visitors?

    Reply

  4. Posted by Brooke Stanley on September 17, 2018 at 4:29 pm

    This makes me incredibly sad. Such a cruel and unnecessary measure.

    Reply

  5. Posted by Steve Straubing on September 18, 2018 at 5:19 pm

    When I worked as an Addiction Medicine Fellow in an acute care hospital, we saw many instances of in hospital drug use including surreptitious injection of smuggled drugs and several OD’s in house, usually in a public bathroom in the hospital. So on one hand, I can appreciate the hospital’s desire to limit their exposure from a risk management standpoint.
    On the other hand, their approach is uber draconian and surely other less isolating, stigmatizing and prejudicial plans can be put in place with just a little planning!

    Reply

  6. Posted by Greg on September 18, 2018 at 8:34 pm

    Absolutely the stupidest thing to ever put in place at a hospital,I would sue the hell out of them then I would get up and transfer to another hospital at their expense,republicans are gonna ruin this country yet if we let them keep this nonsense up

    Reply

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