Whose Quality & What Management?: One Consumer’s Travails
I don’t fear death; I fear life, in spite of the enormous professional success and moments of joy I have experienced in the last 24 years. Having the mental health community tell me I suffer from Panic Attacks (rapid heart rate, sweating, trembling, shortness of breath/hyperventilation, chills, hot flashes, nausea, abdominal cramping, chest pain, dizziness, tightness in throat, trouble swallowing, and a sense of impending death) and Agoraphobia causes an individual to avoid certain situations and jobs. The fear increases until the individual becomes depressed, housebound, and too fearful to come in for treatment. If this is the grand prize for the horrors of my personal history (they call it a predisposition or Borderline Personality Disorder), it seems hardly inspiring.
This disposition brings me to the Psychiatric Emergency Services at San Francisco General Hospital in October 2004. Living with an unrelenting fear of imminent danger 24/7 alone suffices as reason to take one’s life. Being subjected to verbal abuse for being mentally disabled simply nails the coffin shut. My son has been operating from a place of anger for so long now he doesn’t even remember what he got angry about. His father is simply a shadow of a man walking the paces of life void of any joy and delight. Forget about cognitive processes and problem-solving abilities. The idea of going from pillar to post conjures up the pain and suffering in my past of beatings, rape, torture and murder. I don’t fear death; I fear life.
It’s PES or death for me.
The staff at Psychiatric Emergency Services recommends me for an acute residential treatment program where I am told I will be housed in a safe, undisclosed location, surrounded by counselors and doctors 24 hours a day, where a treatment plan will be established and implemented. A glimmer of mental health restored.
I am into the program for five days where I am responding well and getting stronger, when an assistant director comes on duty with a bad attitude. The focus of the house shifts from our treatment plans to one of her being “in charge.” Everyone who is able to leave the house does. I run to my bedroom where one of her cohorts comes in and promptly removes some personal belongings—items that I had approved prior to my intake enabling me to feel safe in a strange environment. I did everything I could within the possibilities offered by the program’s staff to rectify this situation with a positive and proactive disposition. They wouldn’t have it. Not their problem. They left me no choice but to gain permission to invite my son and his father over to explain the importance of these safety items to my recovery efforts—which had been working so well for me these past five days. My hope was that their dismissal of my need for safety would change by dealing with someone outside the program. That somehow, professional, mutual respect, and common courtesy would, once again, prevail. It was not meant to be. A counselor verbally and physically assaulted my son and his father, threatened to have them forcibly removed and slammed the door in their faces.
Shock just doesn’t quite describe my feelings of horror. This was not the intended result I had hoped for. I was told to leave immediately because this counselor stated that he was the one who felt violated. My sense of hope was, once again, encased in a cement coffin of sorrow surrounded by a tooley fog of despair. This coffin is then placed in the middle of Union Square where I am yelling, “Could someone get me a crowbar or a jackhammer? I’d prefer a jackhammer, but I will take a crowbar.” No one hears me. There are only shadows of life passing by where this glimmer gets snuffed out—only this time over coffee and cigarettes.
I am back on the couch at my ex-husband’s house with my son and his long-standing anger management issue; my refuge from the streets of San Francisco since April 2004. Joy, joy, happy, happy. Of course, cooler heads of authority prevail. All is forgiven; the process of being placed in another acute residential treatment program gets under way. Only this time it’s going to take six to eight weeks. In order to expedite this process, all the authorities involved in decision-making insist that I return to Psychiatric Emergency Services at San Francisco General Hospital. My mental disability is exacerbated and acute due to my unsuitable living condition. I do as I am told. I now want that glimmer of mental health restored as if it were sanctity itself.
Four more weeks pass when the day of final processing arrives. PES, which now feels like my second home, has graciously provided me with taxi scrip to make my final destination—a meeting with the director of another acute residential treatment program. I like the house. It is in a very safe neighborhood. It is close by to the treatment center that specializes in my mental disability. That glimmer is strengthening. I meet the director, yet something has gone terribly wrong. I am told there has been no communication, no approval and authorization process, nothing in writing and another two weeks of extensive investigative processing must take place. Then, the director calls me after two days and tells me that I have been denied care because of a discrepancy in my statements. Shadows of life passing by where this glimmer of mental health gets snuffed out. She recommends a homeless shelter and that I get to this treatment center of my own volition.
Thus begins the dance—of which I am thoroughly unaccustomed—with the Quality Management Section of the San Francisco Department of Public Health. Despite the fact that two prior grievances went unresolved as I did not have the strength to follow through—I have steadfastly declined in my mental health due to these obstacles—I am left with no choice but to be a thorn in the side of the San Francisco Department of Public Health. I now know that there are facilities and programs available for someone in my straits to help me reclaim my quality of life. I want that sanctity. So it should come as no surprise to me that I stumble upon enormous legal improprieties that have been instituted for I don’t know how long to support and favor the mental health facilities contracting with the County, and not the citizens of San Francisco of which they have the honor, privilege and funding for healing mental health issues.
This Quality Management Section of the San Francisco Department of Public Health is comprised of a myriad of strange bedfellows: law, billing, and certification/recertification of health facilities. All this is governed by one person who holds a master’s degree in “social work.” As a paralegal in good stead for more than 16 years, it was my understanding that one needs a license to practice law to interpret and make legal decisions. Most private facilities require a master’s degree in public or health administration for billing and certification.
Having fought the good fight as a career choice, naturally I now want to propose to all the powers and authority reigning in San Francisco that such sanctity glimmering with the possibility of mental health restoration, be rectified. And I believe it can be without much administrative and financial maneuvering if function of the Office of Patient’s Rights is set up to mirror that of the Office of Citizen Complaints. As I understand from their website, this office is a voter-initiated amendment in order to investigate officer misconduct. Clearly, the law states it is the Office of Patients’ Rights that investigates legal infractions and code violations; not the San Francisco Department of Public Health. The City and County of San Francisco can provide a good mental health delivery system if the grievance process is lawfully implemented and a viable, proactive problem-solving entity established as the State of California intended.
I am asking you to join me in restoring that glimmer of mental health. Such sanctity can be available to all the citizens of San Francisco that face homeless and mental disability challenges through this voter-initiated amendment.
I had my State Appeals Hearing February 2nd and judgment was rendered in my favor that the San Francisco Department of Public Health was willfully negligent. They have chosen not to comply with the court’s order to provide mental health services, and contempt proceedings will now be underway.
Leanne