On the last day of February, Tahani Nelson needed help, and she thought she knew how to get it.
She and her husband had moved back to Billings from Malta last summer and she had not yet found a primary care provider, but all she needed was a new prescription for Zoloft, to deal with the depression she had been diagnosed with at 18.
A little after 2 in the afternoon on Monday, Feb. 29, she went to Billings Clinic and set up an appointment with a primary care physician. The appointment was a month away, however, so she figured somebody at the hospital could write a prescription for enough Zoloft to tide her over.
The same thing had happened in Malta, shortly after she moved there three years ago. She had gone into the Phillips County Hospital looking for help and left there an hour later with a prescription for her Zoloft.
That wasn’t the way it played out at Billings Clinic. There, she said, she sat for six hours, five of them in a small room wearing nothing but “psych ward scrubs.” She was finally allowed to leave, but without a prescription and feeling considerably more depressed than when she went in.
Worse yet, a few days later she received a bill for $1,411.
“I could have gone out and purchased a gun for less time and money than this,” she said, holding up her bill during a recent interview. “And that’s frightening.”
Fortunately for her, Nelson did not passively accept what had happened. She detailed her humiliating experience on her personal blog, Mortal Asphalt, and she was aided by a co-worker who helped her get into RiverStone Health, where she was seen by a doctor who got her back on Zoloft by Thursday, March 3.
Nelson, 27, also managed to arrange a meeting this past Tuesday with six medical and administrative representatives of Billings Clinic, who listened to her complaints and talked about some of the problems facing the hospital. And on Wednesday, Nelson was told by Chad Miller, vice president of clinic operations, that her entire $1,411 bill had been forgiven.
That much was gratifying, but Nelson is still upset, and more than ever convinced that telling her story in public will encourage other people with mental illnesses to stand up for their rights and to demand dignified treatment.
Nelson said she went to Same Day Care at Billings Clinic at 2:15 p.m. on Feb. 29, scheduled an appointment with a primary care physician and then spoke to a nurse about getting her prescription refilled. The nurse said that Same Day Care couldn’t prescribe anything, but she could escort her to the Emergency Department where, she was told, someone could help her.
After a 45-minute wait in the Emergency Department, Nelson said, a woman took her to a small room and asked her to start taking off her clothes, including her bra. She was asked several times whether she had anything she could hurt herself with.
Nelson said she assured the woman that she was fine, that she only wanted to get a prescription filled. She was told she’d have to wait and speak to a psychiatrist, and then was given what Nelson called “psych ward scrubs.”
And there, in a small room with a security guard out front, dressed in scrubs, she broke down.
“I cried so hard,” she wrote on her blog. “I’d come here looking for help. I already knew I was depressed. I already knew ‘there was something wrong with me.’ But I knew what I needed to get better, and so far no one was listening to me. Instead, I was being treated like … like a crazy person. I thought I’d worked past thinking of myself and others like me as ‘crazy.’ But here we are.”
She said she was soon put in a different room, without a guard, and this room had a TV and a remote. “Apparently I was stable enough to have a TV remote, now,” she wrote. “So that was nice to know.”
Nelson said she spent nearly five hours in the second room. Her blood pressure was taken twice during that time, and toward the end of her ordeal a woman came in and spent about 15 minutes asking her questions that Nelson described as “pretty typical.”
She said she answered everything honestly: yes, she had shown signs of depression. Yes, she had had suicidal thoughts in the past. No, she wasn’t feeling suicidal at the moment. And so on.
She asked again about getting antidepressants but was told she’d have to talk to the psychiatrist about that. She never did see a psychiatrist, however. After she’d been at Billings Clinic a little more than six hours, the woman who conducted the oral evaluation came back and said she was free to go.
Nelson said the woman told her the psychiatrist—apparently based on the evaluation—didn’t think she was a danger to herself or others. Nelson, exasperated, told her she knew all along that she was not a danger to anyone and that all she had come in for many hours earlier was a prescription refill.
That’s when she was told for the first time that nobody in the ED could prescribe her anything.
“By this point I was crying again,” Nelson wrote. “I was tired. I was hungry. I was still wearing the humiliating psych ward scrubs without a bra on. And for the first time in a long time, I was ashamed of my depression.” She called it “one of the worst experiences of my life,” adding that she “wouldn’t wish the feelings I carried with me out those doors on my worst enemy.”
She ended her blog entry with some advice: “Stop making people fear getting help. And if a mental care provider near you is treating patients without respect, DO something about it. Because no one listens to the ‘crazy’ ones. And they won’t until we, as a society, stop labeling those with mental health issues as anything other than ‘human.’”
Nelson finally got help the next day, when she went to her job at Young Families Early Head Start, where she works with toddlers. The help came from her co-worker Penny Struckman, who has worked with the Billings chapter of NAMI, the National Alliance on Mental Illness.
It was Struckman who helped set up an appointment at RiverStone Health, where Nelson was able to get her prescription filled.
“It was cruel to do that,” Struckman said of Nelson’s experience at Billings Clinic, “and really cruel to send her on her way without any assistance at all. And if it happened to her, it happens to others.”
Struckman accompanied Nelson to the meeting at the clinic on Tuesday, as did Nelson’s father, Bob Dalrymple. At the hour-long meeting, the clinic representatives mostly listened as Nelson talked about her experience. They also answered questions and talked about some of the challenges they face.
Rikki Rumph, clinical coordinator of the Emergency Department, said that the nurse in Same Day Care must have believed that Nelson was suicidal, and if she had told Nelson exactly why she was being taken to the ED, she might not have gone. That would also explain the inspection and the change into scrubs, Rumph said.
Carol Christensen, manager of the clinic’s Psychiatric Center, said it would have been highly unusual if Nelson had had her prescription filled by somebody in the ED.
“The part that’s missing is that nobody told you,” she said.
Christensen and Rumph said the clinic also failed Nelson by neglecting to give her any information on other community resources, including RiverStone Health. Christensen said Nelson should have left the clinic with at least three sheets of information and referral advice. Nelson said she was given nothing.
Dr. Bob Merchant, the clinic’s chief medical officer, said the staff members’ “first and foremost job” would have been keeping Nelson safe. If she had been suicidal, he said, even sending her home with a prescription for more Zoloft, without doing a full evaluation, could have ended badly.
Jim Duncan, president of the Billings Clinic Foundation, said clinic officials are aware of problems with psychiatric care and psychiatric intake. For that reason, he said, all proceeds from this year’s Billings Clinic Classic, its annual fundraiser, are already earmarked for expanding the psych center and opening a “crisis stabilization center.” With such a center, he said, people who come to the Emergency Department with mental problems would receive separate, specialized help rather than being seen with everyone else using the ED.
He said the clinic is also committed to establishing a psychiatric residency program, and Merchant acknowledged the need for more primary care doctors—the lack of which resulted in Nelson’s first appointment being a month away.
“This is a huge problem for this clinic, for this region,” he said.
Christensen told Nelson she wasn’t surprised that the Phillips County Hospital was able to help her more quickly than Billings Clinic. Smaller rural hospitals by necessity try to help everyone who comes in the door, she said, while big hospitals like Billings Clinic tend to become compartmentalized, making people wary of providing services that are the province of another division of the clinic.
Nelson’s father, Bob Dalrymple, agreed with part of Christensen’s diagnosis.
“You’re getting too big,” he said. “You’re forgetting your people. Right now you’re failing.”
Nelson said she was told late Wednesday by Miller, the VP of clinic operations, that her case became the focus of a regular weekly meeting of clinic leaders earlier Wednesday. In addition to talking about ways to prevent what happened to Nelson from happening again, Miller told her, it was decided that her bill would be forgiven.
As painful as the ordeal was, Nelson said, and as difficult as it was to talk about her depression in public, “I’m glad I did something.”
As she said in an earlier interview, “I don’t want this to happen to anyone else. Things don’t change if people don’t talk about them.”