Protecting Patients’ Rights in Michigan

The 7 Investigators have been exposing problems in the psychiatric hospitalization process in Michigan, raising serious concerns about the system’s integrity and the treatment of patients. In light of these issues, some MI lawmakers are attempting to make changes regarding who is allowed to fill out crucial court forms that can result in involuntary hospitalization of patients.

A clinical certificate is a key component of this process when someone is hospitalized against their will. While these documents may appear to be harmless pieces of paper, they hold immense power within Michigan’s mental health system. They can determine whether an individual can be detained for treatment without their consent, significantly impacting their rights and freedom.

“I’ve never been treated so poorly, like I wasn’t a human being,” said Bri Jackson. Her experience highlights the serious implications of these clinical certificates. Jackson claims she was held against her will at the Ascension Providence ER back in 2022 due to depression. One of the documents that contributed to her involuntary hold was a clinical certificate filled out by a doctor who alleged that she was experiencing psychosis—a diagnosis she had never received prior to that incident.

Jackson’s ordeal didn’t end there. According to her, the doctor who signed the certificate never actually examined her, and his name was absent from her medical records. “And I’m like — I didn’t see this doctor. I don’t have psychosis — what is this,” said Jackson. This raises troubling questions about the reliability and accountability of the professionals involved in the process.

Further investigation by the 7 Investigators uncovered alarming practices within local psychiatric hospitals. They obtained copies of clinical certificates that had been pre-signed by psychiatrist Dr. Nagy Kheir, long before any patients were examined. This raises significant ethical and legal concerns about the validity of the certificates used to justify involuntary treatment.

When questioned about this practice, Dr. Kheir admitted to pre-signing blank clinical certificates. “Before patients are examined,” asked Catallo. “Yes,” responded Dr. Kheir. This admission is troubling, as it suggests that patients may be subjected to hospitalizations without the necessary due diligence.

“Doesn’t that violate their rights?” pressed Catallo. Dr. Kheir argued that his pre-signing was merely a way to expedite the process, stating, “Not uh, we examine them but I sign it to be ready for the time factor.” However, this practice is heavily criticized by experts in the field. “That is not allowed. That is not regular practice. And that is not how the majority of psychiatrists practice,” stated Dr. Theadia Carey, President of the Michigan Psychiatric Society.

The alleged abuses of clinical certificates are among the many reasons why the Michigan Psychiatric Society is opposing a proposed change to the law that would allow more professionals to sign these critical documents. Dr. Carey expressed her concerns: “I’m concerned that we would have a greater number of patients being evaluated, being involuntarily hospitalized inappropriately.”

House Bill 5114 aims to expand the range of mental health professionals authorized to fill out clinical certificates, including Physician Assistants (PAs), Certified Nurse Practitioners, and Clinical Nurse Specialists. Rep. Carrie Rheingans (D-Ann Arbor), who sponsored the bill, explained her motivation: “Adding these professionals will allow for expanded access to care in those other kinds of settings.” While this may address accessibility issues in underserved areas, it also permits PAs and certain nurses to sign off on involuntary hospitalizations.

In Michigan, for a court-ordered hospitalization, two clinical certificates are required—one completed by a psychiatrist and another that can be filled out by a psychologist, physician, or another psychiatrist. Although the proposed legislation mandates that at least one certificate must be signed by a psychiatrist, Dr. Carey warns that this could lead to a deterioration in the quality of care provided. “Psychiatrists in general are not a fan of expanding the scope of individuals with 1 or 2 years of training, to act as a physician in that situation because we’re concerned about the quality of the care,” she said.

The risks associated with these changes raise critical ethical questions. “For something as serious as taking your civil rights away and hospitalizing you against your will, what can we do to make sure that all the rules are really being followed?” Catallo asked Rep. Rheingans. In response, she acknowledged the concerns raised by various stakeholders during discussions on the bill. “I convened a working group that included folks from the payer community, different providing institutions, the different provider types and disability advocates and autism advocates. And we’ve sat down and talked,” said Rep. Rheingans. “I think the intent to expand mental health access, the intent to protect patients — we do all agree on those things, but we want to make sure that we’re not doing damage if we can avoid it..”

Another controversial aspect of the bill is the addition of PAs and certain nurses to the limited list of professionals authorized to physically or chemically restrain patients. Brian Calley, a former Lieutenant Governor and mental health advocate, voiced strong opposition to this bill. “It sounded like it was meant to expand mental health, mental health care and mental health particularly in rural areas. So it sounded like a good thing. When I really dug in, when I read the language in the bill, all it really does is expand the use of restraint and seclusion and expands the number of people that can authorize involuntary treatment,” Calley stated.

Calley further expressed his concern for individuals with disabilities and mental illnesses, arguing that the proposed legislation places them in a position where they have fewer rights than incarcerated individuals. “This was a vast and I think very substantial expansion in the use of restraint and seclusion practices that are inhumane and barbaric and should only be used in emergency situations. It expands them in a way that I find just shocking and disappointing,” he said.

Rep. Rheingans stated that discussions on the bill are ongoing, and additional legislative measures may be needed to address concerns surrounding restraints. She emphasized her commitment to increasing the number of mental health providers in Michigan, acknowledging the state’s desperate need for professionals in this field. However, opponents of the bill remain adamant that the risks outlined in the current proposals are simply too significant to overlook.