behind the scenes

i always listen acutely--to the reasons they give me for their "side" of the case they will be presenting to court. last time it was nothing to do with my daughter. the doctor (same one ironically 2 years ago)said residential vs. the state institution would only "give grieving parent false hope", and he called her "poor prognosis". i listened, and then took action to represent her. she, did have the right to reside in a least restrictive environment. i found a place, and i alongside the attorney won in court and she was discharged.
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the doctor's voicemail yesterday

gave reason as :

1. hospital is an acute care facility only

in the past she has been there almost 4 months before being discharged

2. she skipped a few meds

3. her clozaril level is low and he will look that over

4. basically no good reason except "time's up here"
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today

discharge planner finds me

i talk in length to -planner who is in charge of calling the state hospital after monday's proceedings.

key words he used:

"we're up for utilization review"

not much more about my daughter's wellness. it, again appears to be all about the hospital, the review process and what he said, "we're under a lot of pressure" (to conform to controllers of the hospital)

i state my concerns:

1. moving my daughter causes a transition set back to wellness
2. just as we see her begin to improve this week, why move her?
3. extend/continue the care there for at least 2 weeks more, give her a chance to stabilize even further and then review her case again

so, as usual, i listen and process it all. then i look it up:

Tips to Help Take the Hassle Out of Inpatient Utilization Review

"There are also a couple of things you should be sure that no utilization reviewer ever sees or hears. Never state that a patient should be discharged if certain criteria are met and then fail to discharge when those criteria are met without explaining why. And finally, never state that "the patient wants to stay."

"The time still will come when you disagree with a utilization reviewer's decision. What then? First of all, don't take it personally; the reviewer isn't criticizing you but is exploring more cost-effective paths to the same destination you want to reach."
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there is nothing this time just like last time that they have said to me to "prove their case" as a good reason to send her to the state institution. they do not talk about her success in the community, about her wellness, they do not and did not include her in a meeting, they did not give me a formal meeting. the doctor left a voicemail the day before a holiday and the discharge planner confirmed he is gone all weekend. no possibility for a discussion. court on monday, where the hospital reps will present there "case" to the judge.
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last time, i had one phrase: "she has the right to reside in the least restrictive environment".
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1.she is not a danger to self or others

2.she has the right to reside in an appropriate setting, and sending her to a long term facility that she was discharged from via a letter to the Governor is not an option.
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it's all about the money--move them out, intake new patients--they come back, again and again. it's not about her care, it's not about her.

it is about a system, politics and money.

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last time i didn't write about this part. this time i am. understand how the system works and wonder why i criticize it. do i believe this place is that great where she is at? it is better than the state institution, where and i quote a nurse 2 years ago:" Oh my God, if she would have been sent there she would be dead by now". when i told her how i won in court last time. she's right. it's a snake pit she won't survive in, she barely did for 21 days the last time a psychiatrist did this to her.
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my daughter is more important that their internal politics. do the right thing.