VA Loma Linda Accused of Illegal Use of 5150 Holds

In the Golden State of California, a troubling trend is emerging within the walls of esteemed health care facilities receiving State funds to provide mental health care.

At the VA Loma Linda, whistleblowers report that their facility's policies are misusing the 5150 Hold—a legal safeguard designed to protect the civil rights of individuals grappling with mental health issues—leading to isolation and further marginalization of patients who are already marginalized.

Signed into law in 1967 by then-Governor of California, Ronald Reagan, the Lanterman Petris Short Act, the law that governs the 72-hour psychiatric hold, known as the 5150 Hold, was aimed to stop the abuse of, and to end the inappropriate and indefinite hospitalization of, mental health patients.

In addition, this law aimed to ensure that all mental health patients maintained the same civil rights as those receiving voluntary medical treatment, that they had more rights than incarcerated persons, and to provide the least restrictive environment as possible.

Furthermore, Assembly Bill 2983, passed in 2019, clearly specifies that a general acute care hospital or an acute psychiatric hospital cannot require a patient voluntarily seeking mental health treatment to be placed on a 5150 involuntary hold as a prerequisite for admission.

In El Dorado County, California, patients and administrators have reported that patients admitted on -- or later placed on -- a 5150 Hold, are having all of their civil rights revoked at some of the facilities in the area. These rights outlined under the LPS Act are being revoked as a condition of admission to these particular facilities. This is a direct violation of WIC 5235 and WIC 5235.1 of the Lanterman Petris Short Act.

Patients report that rights being revoked are things such as: Using a telephone to make or receive calls, be involved in their own health care decisions, the right to refuse psychiatric medications, allowing loved ones or family members advocate for them if they are incapacitated, receive care for an existing medical condition, amongst other things.

This alarming abuse of power not only undermines the very essence of the law but also inflicts devastating consequences on a vulnerable population.

But the ramifications extend far beyond the psychiatric realm.

Medical patients, whose symptoms may be mistakenly attributed to psychiatric disorders, find themselves ensnared in this web of misapplication. As a result, critical delays in treatment occur, exacerbating their original medical conditions and leaving them in a state of suffering that could have been avoided.

The ripple effects of this misuse are profound, highlighting a pressing need for reform and a renewed commitment to compassion and care in the healthcare system, with regard to how it treats those perceived to be suffering from mental health issues.

The VA Loma Linda has instituted a controversial--and unlawful--policy that restricts patient transportation to the hospital, stipulating that such transport will only occur if patients are placed on a 5150 Hold.

"Using a 5150 to physically restrain a patient who doesn’t require that kind of crisis intervention...is based on an amorphous idea that people with mental health disabilities are violent. (This) is an ableist concept, and unconscionable."

This unethical directive was confirmed by VA Loma Linda's Associate Chief of Staff, Michael J. Potoczniak, in an email dated August 28, 2022, which was subsequently acquired and reported by the Southern California News Group.

Potoczniak proposed that this questionable protocol be mandatory for veterans seeking voluntary hospitalization at the Ambulatory Care Center. Potoczniak's protocol is for staff to place these individuals under an involuntary 5150 hold, a measure designed to guarantee their safe transportation by ambulance to the Jerry L. Pettis Memorial Veterans Hospital Emergency Department, located just over 2 miles away.

However, while the intention may be to ensure safety, this policy is a violation of patient civil rights, and it is not legal.

This policy has shocked VA Loma Linda staff, who are concerned about not just the ethical implications, but also the legal ramifications, of placing 5150 holds on individuals seeking treatment voluntarily.

“People are dismayed and shocked that the 5150 is being misused in such a manner. A 5150 can’t be (legally) used as a transportation voucher.” said a VA Loma Linda mental health provider who asked not to be identified because they are not authorized to discuss the issue.

"It’s illegal to use a 5150 for anything other than evaluation, assessment and crisis intervention for people deemed a danger to others or themselves or who are unable to provide for basic needs such as food, clothing and shelter, and unwilling or unable to accept voluntary treatment, said Rebecca Basson, lead patients' rights attorney for the Law Foundation of Silicon Valley.

Basson noted that “using a 5150 to physically restrain a patient who doesn’t require that kind of crisis intervention, but might in the future, is based on an amorphous idea that people with mental health disabilities are violent, is an ableist concept, and unconscionable.”

“I would also argue it is not ethical to knowingly misuse a legal tool to impose additional ‘safeguards’ on clients who do not meet the criteria for them,” she added.

The House Committee on Veterans Affairs is currently investigating widespread complaints from VA Loma Linda whistleblowers.