Suddenly, hospital says she’s a mental patient

By Marshall Allen

Sunday, June 17, 2007 | 7:01 a.m.

At her insurance company's suggestion, Michelle McCutchen dropped by Montevista Hospital to get the name of a therapist in the community to treat her for depression. Nobody mentioned, she says, that Montevista is a private mental hospital. She never got the name of a therapist. She didn't even make it back to her car.

What she did get was committed for five days - against her will, she says - because the staff considered her suicidal. While in the hospital, she says, she was drugged and denied care and medication for the multiple sclerosis that was the root of her depression.

"They basically took my wife hostage," said Mark McCutchen, who was with her during the admission process. "We defined our situation very clearly when we sat down. We just got forced through the system, chewed up and spit out."

The McCutchens released Montevista of all patient-privacy obligations and asked hospital officials to speak with the Sun for this story. They refused.

Now the McCutchens are wondering whether their nightmare was the result of greed. Her insurance company promised upfront to pay all of her hospital bill, which totaled $6,000 for the five-day stay.

Michelle McCutchen, 42, was diagnosed with multiple scleroris seven years ago. She's disabled by the chronic neurological disease, which attacks her nerves, making it difficult to walk, sapping her strength and causing constant pain: sharp shocks, dull aches and pins and needles over her entire body.

McCutchen has no history of mental illness, but in the past year the pain and disability led to depression, a common problem for MS patients.

For three months, McCutchen sought an appointment with a therapist who would take her insurance. But none was taking new patients.

So her insurance company sent McCutchen to Montevista for an outpatient referral. Angela Silla, a registered nurse and patient advocate representing the McCutchens, said the insurance company should have told the McCutchens that Montevista is a crisis inpatient facility.

By the McCutchens' account:

The couple had no idea what they were walking into on April 25, when they pulled up the circular drive of the 80-bed facility near South Jones Boulevard and West Flamingo Road. They expected a quick referral to an expert on depression. Instead, they were interviewed by a woman named Tiffany, who probed into the depression. The McCutchens and Silla have since asked Montevista for Tiffany's full name and credentials, but the hospital has not complied.

Tiffany asked whether Michelle McCutchen has ever been suicidal. McCutchen said she acknowledged that as a multiple sclerosis patient she had considered death as an alternative to the pain she suffered. But she had never, she said, considered killing herself.

Well, if you were to ever think about killing yourself, McCutchen said she was asked, how would you do it?

With sleeping pills, she said. But I wouldn't.

According to hospital records completed by Tiffany and obtained by the Sun, "Client stated they came in because she has 'been wanting to die.' Client stated she would take a bottle of sleeping pills."

The McCutchens say the records do not reflect the truth of the conversation. Montevista officials' concerns may have been heightened when they learned that two of Michelle McCutchen's siblings had committed suicide, but the couple say they continued to insist Michelle would never do the same. It would, she said, be a sin.

The McCutchens said the interview took about 40 minutes and included Tiffany consulting with several hospital workers. Mark McCutchen said every time they acknowledged Michelle had sometimes thought of suicide, they gave a litany of reasons why she would never do it.

Mark McCutchen feels the intake workers were trying to lead them into saying Michelle was despondent.

Finally, the McCutchens asked whether they could please get the referral they came for.

No, the staff said. We need to keep Michelle at the hospital for three days - the minimum time required by state law to detain mentally ill patients - because she is a "clear and present danger" to herself.

The McCutchens protested, but were told she would be arrested if she tried to leave.

The assessment made by Tiffany - that Michelle McCutchen has been wanting to die and had the pills to do it - seemed to seal her fate. After three days at Montevista, she said the doctor held her two more, without explaining why.

The nights at Montevista were frightening, McCutchen said, with mental patients screaming and being restrained. One day in the community room a female patient went into a rage, picking up McCutchen's walker and swinging it wildly at her head before calming down. There were other anxious moments, including a fight between two patients that required paramedics to treat injuries.

Michelle McCutchen said she never received a psychiatric evaluation, and the staff made little accommodation for her MS. Mark McCutchen visited his wife every evening, bringing her clothes and dropping off her medication, but the couple say the needed medications were not administered for several days, and one was never administered.

McCutchen must take the drug Dulcolax, a laxative, because she suffers from chronic constipation because of the effects of MS and medication used for pain management. She says she pleaded every day for the laxative, but was given none. On the fourth night her husband smuggled it to her. On the fifth day her record shows Montevista officials tried to give her the drug. By then, she has already taken it, so she declined.

"I think there was a serious lack of communication between the patient and the staff, and the staff and the physician," said Silla, McCutchen's patient advocate. "There was a breakdown in all areas."

McCutchen said the staff psychiatrist, Dr. Adekunle Ajayi, seemed interested only in putting her on other drugs. She refused many, but when told she might be detained longer if she remained obstinate, she allowed herself to be given several she thought she did not need. They included morphine, which Silla said is not a primary choice of drugs to treat the neurological pain caused by MS. Another drug caused an adverse reaction that required McCutchen to be taken to a nearby hospital.

McCutchen says she became more cooperative to get released. Her discharge papers describe her as "pleasant," compliant with her medication and "interacting with staff and peers."

But she was sent home with another patient's medications, in bottles marked with the other person's name.

There are serious gaps in Montevista's record of McCutchen's stay, according to James Osti, who audits medical records and has 30 years of experience as a psychiatric nurse. At the Sun's request, and with the couple's permission, he reviewed McCutchen's medical records.

Page 7 of the nursing assessment, a form completed at admission, is supposed to detail her risk of suicide or self-harm. It is blank. The form's next page is supposed to include the name, date and signature of the nurse doing the assessment. It also is blank.

Furthermore, Osti pointed out that the two blank pages are missing a stamp that contains McCutchen's name and birth date - information that is supposed to be on every page to keep the record intact.

"Those are not the original pages from the chart," he said. "They were changed or deleted or lost or something. I don't know exactly what it is, but that's a pretty serious problem with the chart if we're doing a chart audit."

There are other problems with the medical record, Osti said: no notes documenting nurses' observations and care.

"I've never seen that before," he said.

Osti said the quality of McCutchen's medical record would "fail miserably" if it were examined by the Joint Commission, the predominant standards-setting and accrediting body in health care.

When the McCutchens finally had a chance, weeks later, to read her medical records, they were stunned that Montevista had classified her admission as voluntary. The records include consent forms signed by McCutchen, which she says she thought were part of the legal admission process.

"I thought I had to" sign it, she said. "I didn't think I had a choice in the matter."

The couple and Silla met Monday with Montevista's administrators to learn the hospital's justification for holding her, and for explanations about the incomplete medical chart and what they say was poor quality of care. They say hospital officials provided no clear explanations. They said they have no interest in suing the company that owns Montevista, Tennessee-based Psychiatric Solutions Inc.

The McCutchens say they want nothing more than an apology and the payment of all medical bills related to Michelle McCutchen's stay. They also want what they say are flawed diagnoses by Ajayi - that she was mentally ill and histrionic - expunged from the record because it could prompt doctors to discount her legitimate complaints in the future.

They've received no promises from the administrators.

Wednesday, the couple received an $884 bill from the other hospital McCutchen was taken to.

McCutchen was finally able to get her depression treated by a psychiatrist , thanks to a referral from a church friend.

They paid out of pocket for his services and hope to be reimbursed by their insurance company.