The Case Management Process in Action
by Julie Carlyle, RN, BSN, CCM
Mr. G. sustained a catastrophic burn injury. In the accident, three other employees were killed and it was “touch and go” for Mr. G. for several months. A field case manager (FCM) was assigned to this injured worker at the time of his accident, and she has developed an excellent working relationship with not only him but his family, attorney and employer. Beyond the multitude of physical injuries, Mr. G. has been diagnosed with post-traumatic stress disorder and major depression. Fortunately, the FCM has coordinated care with an excellent psychiatrist, Dr. C.
On February 28, 2007, the injured worker’s spouse, Mrs. G., informed the FCM that the injured worker had made comments about getting a gun and killing his employer. She told the FCM that there were guns and ammunition in the home. The FCM immediately advised the wife to remove all weapons from the home. The FCM contacted the psychiatrist, and the injured worker was scheduled an emergency appointment that day. The FCM notified the injured worker and he agreed to attend. Finally, the FCM notified the employer.
The FCM spoke with the wife following the psychiatric appointment. She advised that everything went well and that the injured worker told the doctor that he had no weapons. However, the wife advised that there was still a weapon in the house and the injured worker had access to it and to the ammunition. The FCM contacted the psychiatrist’s office but was not allowed to speak with the doctor and the receptionist would not listen to the FCM’s concerns. The FCM Supervisor contacted the doctor’s office and discussed the situation. The receptionist would not allow her to speak with the doctor ? even after all concerns were discussed. The receptionist stated that they “believe the patient ? not the FCM.” This was at the close of business. At 5:05 p.m., the FCM Supervisor had the doctor paged urgently to the GENEX office. While this was occurring, the FCM branch manager and the FCM were on a phone conference with the employer to determine the best safety approach. Additionally, Baker Acting ? involuntary commitment ? of the injured worker was discussed. It was determined that the police chief of the city needed to be involved. The FCM branch manager contacted the police chief and alternatives were discussed. It was determined that Mrs. G. had to allow the police to come into the home. If she wouldn’t, then there was nothing that could be done. The FCM branch manager and FCM conferenced with Mrs. G. She advised that all weapons and ammunition were removed from the home and the injured worker had no further access to weapons. She stated that the injured worker told her that if he didn’t feel better by morning, he would commit himself. We urged her to contact the police chief regarding her decision. Also, we advised her that if she felt unsafe at any time, to call 911. After our conversation, we notified the police chief and the employer.
While we were speaking with the police and the employer, the psychiatrist returned the FCM Supervisor’s page and they discussed all concerns. The doctor realized that he had received a different story from the injured worker than what everyone else had heard. He agreed to see the injured worker every day until the crisis was resolved. He stated he would commit the injured worker if necessary.
The next morning, the injured worker and his wife reported to the doctor’s office and the injured worker agreed to voluntary commitment for treatment. However, when he arrived at the hospital for admission, he changed his mind. At that time, the doctor had him involuntarily committed ? for 48 hour observation. Even though the injured worker returned home after the 48 hours, he had a definite psychiatric treatment plan, his provider was aware of the issues, all weapons were removed from the home and no one was injured or killed.
