For the EM physicians that work in CA, are you guys certified to write 5150s? If yes, is it standard to assume that you are certified?
5150
- Thread starter BJJVP
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I was going to get certified so I could speed up transfers at one hospital I used to work at that didn’t have psych, but I quit there. I now work at places with in house psych, so there is no need. I would not assume the ED physician is certified to write a 5150 in CA as the vast majority are not. They can still hold someone on a 1799, but the 5150 needs someone certified by the county. Other states have different laws.
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It's county by county in CA. 2/3rds of the counties I work in, ER docs do not write (or release) 5150s. This came up at CalACEP once and people voted against trying to lobby to make it statewide legal for ER docs to do so.
I would personally like the ability to rescind 5150s that I think are clearly nonsense, however I would like some legal protections if I do so and it's not entirely clear that Section 856 of the CA Code confers that. I think most people just don't want to deal with it and would rather turf it to mental health social workers and psychiatrists even if this means 100+ hour ER stays and demented/drunk patients being brought in on inappropriate holds.
I would personally like the ability to rescind 5150s that I think are clearly nonsense, however I would like some legal protections if I do so and it's not entirely clear that Section 856 of the CA Code confers that. I think most people just don't want to deal with it and would rather turf it to mental health social workers and psychiatrists even if this means 100+ hour ER stays and demented/drunk patients being brought in on inappropriate holds.
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What a lack of physician autonomy.
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No, and I work in two counties as well. I think this is county specific. I've heard in some counties docs can write 5150s.
We write 1799s
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I have told myself that I would like the ability to drop (and write) 5150s, that doesn't mean I would do it all the time. I'd say 90% of the time I would not use that ability and let mental health risk stratify. But about 1/10 to 1/15 patients I see it's clearly nonsense and I have no problem taking the liability of dropping the 5150.
It's kind of like giving EMS the ability to deny ambulance transport to the hospital. There is liability involved, but my guess is the vast majority of the time they would not take that on and transport the vast majority to the hospital. Only the clearly nonsense cases.
