Frustration grows as lawmakers try to expand involuntary treatment authorization

The 7 Investigators have been exposing problems in the psychiatric hospitalization process.

Now some lawmakers are trying to make changes to who’s allowed to fill out some crucial court forms that can hold patients against their will.

A clinical certificate is a key part of the process when someone is hospitalized against their will.

They look like harmless pieces of paper, but clinical certificates are powerful documents in Michigan’s mental health system.

“I’ve never been treated so poorly, like I wasn’t a human being,” said Bri Jackson.

VIDEO: Michigan doc pre-signed blank forms that can rob you of your freedom:

Michigan doc pre-signed blank forms that can rob you of your freedom

Jackson says she was held against her will inside the Ascension Providence ER back in 2022 for depression. One of the documents used to hold her was a clinical certificate. A doctor wrote on the form that Jackson had psychosis — a diagnosis she’s never been given before.

And that’s not all. According to Jackson, the doctor who signed the certificate never examined her, and his name appears nowhere in her medical records.

“And I’m like — I didn’t see this doctor. I don’t have psychosis — what is this,” said Jackson.

The 7 Investigators also obtained copies of clinical certificates from inside two local psychiatric hospitals that were pre-signed by psychiatrist Dr. Nagy Kheir long before patients were ever examined.

In the past when the 7 Investigators asked Dr. Kheir about why he pre-signed the blank clinical certificates, he admitted that he signed them in advance.

VIDEO: Dr. Kheir speaks with 7 Investigator Heather Catallo:

Dr. Kheir speaks with 7 Investigator Heather Catallo

“Before patients are examined,” asked Catallo.

“Yes,” said Dr. Kheir.

“Doesn’t that violate their rights,” asked Catallo.

“Not uh, we examine them but I sign it to be ready for the time factor,” said Kheir.

“That is not allowed. That is not regular practice. And that is not how the majority of psychiatrists practice,” said Dr. Theadia Carey.

Dr. Carey is the President of the Michigan Psychiatric Society.

Alleged abuses of those forms are one of many reasons why the MPS is opposing a proposed change to the law that would allow more people to be able to sign clinical certificates.

“I'm concerned that we would have a greater number of patients being evaluated, being involuntarily hospitalized inappropriately,” said Dr. Carey.

House Bill 5114 would add Physician Assistants or Associates (PAs), Certified Nurse Practitioners, and Clinical Nurse Specialists as mental health professionals under Michigan law.

Rep. Carrie Rheingans (D-Ann Arbor) says she sponsored this bill in part to add mental health workers to underserved areas of the state.

“Adding these professionals will allow for expanded access to care in those other kinds of settings,” said Rep. Rheingans.

But the bill would also allow PAs and certain nurses to fill out clinical certificates to hospitalize someone involuntarily for mental health treatment.

For a court-ordered hospitalization, you need two clinical certificates: one completed by a psychiatrist and the other can be filled out by a psychologist, a physician, or another psychiatrist.

The proposed changes would still require a psychiatrist to fill out at least one of the clinical certificates. But Dr. Carey says she’s concerned about adding more professionals with less training to fill out the other certificate.

“Psychiatrists in general are not a fan of expanding the scope of individuals with 1 or 2 years of training, to act as a physician in that situation because we're concerned about the quality of the care,” said Dr. Carey.

“For something as serious as taking your civil rights away and hospitalizing you against your will, what can we do to make sure that all the rules are really being followed,” Catallo asked Rep. Rheingans.

“In the process of working on my bill, I have had some groups express concerns about different pieces of the bill. So I thought, well, there's got to be stuff that I just don't know. So I convened a working group that included folks from the payer community, different providing institutions, the different provider types and disability advocates and autism advocates. And we've sat down and talked,” said Rep. Rheingans. “I think the intent to expand mental health access, the intent to protect patients — we do all agree on those things, but we want to make sure that we're not doing damage if we can avoid it.”

The bill would also add PAs and certain nurses to the small list of people allowed to physically or chemically restrain patients.

“I've heard this claim that the bill allows more people to release people from restraints. That doesn't appear anywhere in the bill,” said Brian Calley.

The former Lt. Governor is a mental health advocate and board member of Disability Rights Michigan. Calley is also Board Chairman of the Autism Alliance of Michigan. He says both groups strongly oppose the bill.

"It sounded like it was it was meant to expand mental health, mental health care and mental health particularly in rural areas. So it sounded like a good thing. When I really dug in, when I read the language in the bill, all it really does is expand the use of restraint and seclusion and expands the number of people that can authorize involuntary treatment,” said Calley.

“This actually, for people with disabilities and mental illnesses, it puts them in a situation they have less rights than a person in prison,” he said. “This was a vast and I think very substantial expansion in the use of restraint and seclusion practices that are inhumane and barbaric and should only be used in emergency situations. It expands them in a way that I find just shocking and disappointing. That's even being contemplated.”

Representative Rheingans says they are still working on some changes and says some additional bills may need to be introduced that will address some of the concerns about restraints.

She maintains her goal is to increase the number of mental health providers in the state, because Michigan desperately needs more people in this field.

Opponents say these changes as written in the bill are just too risky.

If you have a story for Heather, please email her at hcatallo@wxyz.com