Imagine this: You're an overworked waitress. You have your first night off in three weeks. You down a few drinks, end up a little tipsy, and next thing you know, you're on the psych ward at county general hospital for 26 hours. An inmate threatens to kill you, a nurse questions your sanity, and you sleep maybe two hours as your truly disturbed roomie screams all night.
Finally, to top it all off, you get a bill for more than $20,000.
All this happened to Sarah Macdonald, a slim, pretty, dark-haired 24-year-old, thanks to Florida's Baker Act, an ugly piece of legislation that is being increasingly and perhaps improperly used on hordes of South Floridians each month. In Broward County alone, it was invoked almost 9,000 times in 2002.
Macdonald's story began when she moved to Fort Lauderdale from Phoenix three months ago. Sure, she'd had her share of problems. She'd filed for divorce and left her husband behind. Two companies had sued her for $19,000 in debts. But she had settled with 32-year-old boyfriend Sean Dolan in an apartment near the beach and found a job at McSorley's Irish Pub, a friendly joint with a close-knit staff. She planned to earn enough to pay off her debts and start fresh in America's Venice.
Her first problem arose in early May, the opening of South Florida's mosquito season. An allergic reaction to bites caused her "to blow up like a balloon," she says. So she bought a pack of Benadryl. She noted the warning not to drink alcohol when taking the medicine but didn't pay it much mind.
On May 19, she took four doses of Benadryl and then, around 7 p.m., sat down at the McSorley's bar with a couple of friends. Generally a social drinker (she's never been arrested for DUI, disorderly conduct, or any other crime in Arizona or South Florida, according to public records), MacDonald began downing exotic concoctions: two Irish Car Bombs (which include Bailey's Irish Cream, Guinness Stout, and whiskey), a couple of pineapple drinks, and a pair of shots of something called Surfer on Acid (you don't want to know). Six or seven drinks in all.
When Dolan, a pizza delivery guy, arrived at the bar around 11 p.m., Macdonald "had a pretty good buzz, but she wasn't crazy or anything," he reports. On the way home, she was wobbly and soon started falling against parking meters. By the time they had walked the several blocks to Vista Mar Resorts, where they were living, she was shivering severely. He called 911. Paramedics delivered her to Broward General Medical Center.
Then it got weird.
After Macdonald was called for an examination, she reacted violently, according to Sara Howley, a spokeswoman for the North Broward Hospital District, which runs the hospital. The doctor, whose name Howley wouldn't disclose, had Macdonald's hands and feet tied to a gurney. Then he ordered sedatives, which, according to Dolan, included at least ten milligrams of Haldol, a drug used for "chronic psychosis, including schizophrenia and manic states" as well as "management of aggressive and agitated behavior in patients with chronic brain syndrome and mental retardation," according to the Internet site mentalhealth.com.
(Dolan and Macdonald contend that the drug was unnecessary. Howley says it is "commonly used on emergency room patients who are uncontrollable.")
When emergency room personnel tried to put in a catheter, Macdonald ripped the catheter out -- and the IV came with it. "They said she had gotten violent," Dolan recalls. "They said that was probably a result of the Benadryl and the alcohol."
At that point, the doctor decided to invoke the Baker Act, Florida's involuntary-commitment law, Howley says. It allows a hospital to hold a patient for 72 hours after he or she has been declared medically fit if law enforcement or doctors suspect psychological problems.
The next afternoon, Macdonald's mother, Suanne DeClue, flew to Fort Lauderdale from Phoenix. She and Dolan waited in the intensive care unit while Macdonald lay unconscious. On Friday about 6 p.m., almost two days after arrival, Macdonald woke up and was moved out of the ICU to a private room. "I was dizzy, barely conscious; I couldn't eat," she says. "I think it was the drugs they were giving me."
That night, doctors assigned a woman to sit with her, presumably to make sure she didn't harm herself. (Howley explains that patients receive sitters, free of charge, if doctors are concerned about their safety.)
Later that night, a nurse showed up and said she was going to administer Librium, a drug used for alcohol withdrawal. "I told her, 'No, I'm not taking that. I am not having any trouble sleeping,'" Macdonald recalls.
"She said, 'I'll just write it down as refusing to take your medication.' I guess refusing to take medication didn't look good."
That was two strikes against Macdonald. She'd been violent upon arrival and then declined medication. The third strike came Saturday morning, after Dolan and DeClue had gone home for some shuteye. A psychiatrist entered her room about 6:30 a.m. "He said, 'May I ask you a couple of questions... I said, 'No, I want to wait for my mom. She'll be here in about 15 minutes.' He said, 'If you won't answer my questions, then I have to send you up to the psych floor. '"
When DeClue arrived a few minutes later, she learned that Macdonald had been committed under the Baker Act and might be held for as long as three days. It was the first the family knew of the emergency room doctor's decision to commit Macdonald. Both mother and daughter protested, but it was too late.
At 9 a.m., a female security guard escorted her to the psych ward, on Broward General's sixth floor. Only then was Macdonald given a form describing her rights under the Baker Act. In a stupor, she signed it. "I didn't know what I was signing," she says. "I was afraid, and I thought if I don't sign, I will be considered uncooperative."
Then she was told to take off her clothes. She was searched and ordered to remove the laces from her shoes. She was shown to a room, where a woman -- "280 pounds and on her way to the state hospital" -- was lying on a bed, Macdonald says. "She began screaming, 'Get the hell out of here; I'm going to kill you. '" The woman called an Asian woman on the ward "nigger" three times, Macdonald recalls.
"I left the room and told an orderly, 'That lady is gone, in la-la land,'" she says.
Patients in the ward were talking to themselves, singing out loud, and yelling. Twice, the group was called to a large table for group therapy and asked their goals for the day. "Everybody just said, 'To get out of here,'" Macdonald reports. She called Dolan three times before the 10 p.m. cutoff seeking solace and help. There was nothing he could do.
That night, she slept for only about two hours. Her roommate screamed the entire time.
Finally, early the next morning, the psychiatrist walked into the room and told Macdonald she could leave. "I felt like I had just spent 24 hours somewhere because the hospital wanted money," she comments. "Nobody ever asked me how I was feeling. They had no reason to think I was suicidal and never asked me. No one ever referred to my rights as a human being, because to them, I had none."
Indeed, Macdonald's case apparently represents widespread misuse of the Baker Act. The statistics are frightening. In Broward County, the law was invoked 8,700 times in 2002, the last year for which numbers are available. There's been a 15 percent increase since 1999. And the number of people held because doctors or cops fear they will do harm to themselves -- as was the case with Sarah Macdonald -- has grown twice as fast, by 30 percent, to more than 6,000. In 2002, almost 1,000 people were held under the Baker Act four times or more.
In February, the Sun-Sentinel called the law "a foolish system that wastes money, helps few, and stimulates recidivism." John DeGroot, a policy analyst for the Broward Sheriff's Office, recently termed poor evaluation of patients in the county "a shuttle of shame."
Macdonald's bill for the treatment still hasn't been totaled, but she was told last week that the preliminary charges come to more than $20,000, which she doesn't have. Hospital spokeswoman Howley recommends she sit down with a financial counselor to work out a payment plan.
That's not good enough. Rules for commitment in Florida need to be reconsidered. Forcing someone to suffer such indignities, then pay such a hefty sum -- just because doctors were overcautious -- is unjust. Not only does the state legislature need to take action but hospitals, doctors, and others should heed these words from Dolan: "We have never met with such ignorance in our lives. Something has to change."
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