By Kelly O’Brien, MD, FACP, CCHP
Posted on January 14, 2009 – As the world is becoming more globally connected, so is medicine. Even those working in correctional institutions are part of this phenomenon.
A page from the psych nurse is rarely a good sign. We’ve got a guy here, very psychotic. Not talking, bizarre behavior. We think he only speaks German.
Ah. A psychotic German. He wasn’t causing problems, was eating okay, not getting in fights. Actually, it was surprising the psych nurse found him. Attempts to communicate through the language line were not successful. The frazzled German interpreter reported that Mr. Hansel wouldn’t respond, which was obvious watching from this end. A German speaking sergeant came to help, He won’t speak, and when he does, it doesn’t make any sense. The patient was sent from jail to the county hospital. Not the psych ward, the locked jail ward, while we tried to figure out what to do.
A passport in his property revealed he’d arrived through New York 4 months earlier. It was certainly reassuring to see the stamp of approval from Homeland Security. Now he was in Denver, in jail, mute, unkempt, unreachable and unknown. We began a multipronged attack on this problem.
The sergeant, distressed at the pathos of his countryman, called the German police. Apparently there’s one big force, and you don’t waste time on details like cities or states. As it happens, an APB had been out for our patient. He’d wandered away from a group home leaving his fellow patients and psychiatrist with a hole in their midst. His father was located; medications were verified. The Tourist’s father agreed to pay airfare for the patient and an escort. All we had to do was contact the German Counsel.
The German Counsel in Denver consists of a lone man with a briefcase. He referred us to the embassy in Los Angeles. Our contact there, in his first week of employment, now had his first big case. He was enthusiastic and hopeful, traits not often seen in those of us who work with homeless psychotic guys in jail.
I jokingly suggested I’d be happy to escort him home. For future reference, German embassy officials have no sense of humor. Fine. Can you be ready this Friday? Not one to turn down a free transatlantic flight, I quickly agreed. The hospital, however, said something to the effect of No Way On Earth, citing details like liability, time off work, etc. The sergeant was willing to go but the Sheriff’s Department had the same reaction. Word got out, leading to interesting voice mails: Dr. O’Brien, this is Joel on 9th floor. I speak some Polish, and I can get this weekend off. Let me know if you need me.
One of the Important Staff Physicians recommended the Complex Discharge Committee as a resource. An appropriate multitude of calls were made to get him on their agenda, ahead of the other homeless psychotic guys found at county hospitals. Five days later, they met, deliberated and delivered with pride the enthusiastic recommendation that I contact the Germany embassy.
Then the Important Staff Physician commented, You don’t want to spend 12 hours next to some psychotic guy on a plane, showing how little he knows about my life. This patient is almost mute. I live with a 15-year-old daughter who speaks English well and constantly. Her life is a psychodrama. Twelve hours with the Accidental Tourist sounded like a vacation. No matter, I was not to go. The sergeant and I sadly informed the embassy that neither of us could travel. The Tourist’s father was too frail to come alone, and he had no other family. The embassy official began the task of finding an employee who wanted a really quick trip back to Germany.
Fortunately, Denver has an innovative court-to-community program, and in stepped our Angel Advocate. She could arrange his release from custody on the day of his flight to Germany. All we needed was someone to get him from jail to the airport while not letting him know that technically he wasn’t in custody anymore.
In the meantime, the Tourist went to court. He was clearly incompetent, but if released he’d be out the door and lost some where in the United States again. The judge agreed not to address the competence issue at this time.
Multiple e-mails flew from hospital to court services to jail to the sergeant’s house to the German embassy, the German police and the German psychiatrist.
The patient improved enough to return to jail. Medications were continued, e-mails were continued, and court was continued while we stalled until we heard back from the embassy. The sergeant kept up his persistent phone calls, the embassy official kept scouring viable employee travel options, and the Angel Advocate kept standing by, unsigned release form in hand. The Important Staff Physician and the Complex Discharge Committee kept meeting, though the patient was now at jail and technically out of the hospital; thus their work here was finished.
On Tuesday we heard; the embassy had an escort and two tickets for Thursday. The sergeant e-mailed the hospital, who e-mailed the Advocate, who e-mailed back, and we all e-mailed the embassy and the jail. Then, in an unexpected move, the jail psychiatrist wasn’t sure she could clear him to travel. Fearing violence against the psychiatrist from everyone except maybe the patient, I suggested she reconsider. Lo and behold! He was cleared to fly, but only with a nonmedical German civilian.
Thursday morning, we were sending him out without pills or prescription. The nonmedical German escort couldn’t give him medication anyway, and he couldn’t fill our script in Germany. We settled on giving him his evening dose early and hoped for no weather delays. The Angel Advocate came with the release as promised. The sergeant showed up at jail and drove him to the airport.
Through the day, as the plan appeared to be working, the Accidental Tourist became more open. He stepped out of jail into the warm July air and told of his adventures riding the bus across the country, visiting his (delusional) family in Minnesota, and coming to stay in the Denver parks. The nonmedical German escort came off the L.A. plane to pick up our patient for the next leg of the trip. As the Accidental Tourist boarded, he warmly shook the sergeant’s hand and asked that everyone be thanked for their kindness. Turning back on the tarmac, he shouted with sincerity, Auf Wiedersehen—I’ll be back for Christmas!
Dr. O’Brien is an SCP member and physician with Denver Health and Hospital. Readers may contact her at kelly.obrien@dhha.org.
