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Man with drink
Noah has been admitted to hospitals in Madison 34 times in the past year due to alcoholism. Each time he arrived at the emergency room in severe pain, attempting to detox himself, experiencing withdrawal symptoms, and suffering from pancreatitis. Despite Noah’s family’s desperate attempts to get him help, they have been halted each time due to Dane County’s refusal to abide by the law.
Noah is my brother. I am not using his real name. He is 44 years old and has been sick with alcoholism for the past 10 years. His alcoholism is so significant that he has not held a job in nearly a decade, is unable to provide for or have any relationship with his children, and would be homeless if it were not for his twin brother allowing Noah to stay at his residence. Noah has tried to stop drinking on his own but hasn’t been successful for more than a short period of time. During a conversation Noah had with a doctor at Stoughton Hospital four years ago, he told the doctor, “I can’t stop. I’ve tried. This isn’t about getting drunk and having fun — that ended years ago. If I stop drinking, I’m sick and in pain, so I drink to stop the pain.”
Noah’s primary care doctor at Dean Medical Group has completed and signed forms deeming him “disabled” due to alcoholism. I’ve reviewed these medical documents — they list the multitude of health problems Noah has acquired due to excessive drinking, including cirrhosis of the liver, chronic pancreatitis, and diabetes. Due to the severity of Noah’s disease, his entire life has been destroyed: Noah used to work a full-time management position, own his own home, and support his family. Noah does none of that now — instead, he stays inside his brother’s apartment and drinks all day every day.
Often it is asked of individuals who are suffering from addiction, “Do they want to help themselves?” The answer to that question is not as simple as yes or no. Individuals who are suffering from alcohol- or drug-related problems often struggle with seeking treatment — it is the nature of the disease and its effect on the individual's mind and body. The more severe the addiction, the fewer moments of clarity the individual has to make a healthy choice. Then too, there are other barriers to seeking treatment itself: a lack of health care coverage, or long waiting periods to be seen by a treatment provider. Frequently, an intervention is needed when an individual is too far down the path of addiction to choose to help themselves.
I spoke to another young man a few weeks ago in the hospital who was suffering from alcoholism and mental health issues. After experiencing hallucinations and seizures from withdrawal, he began to stabilize and we talked about alcohol treatment. Before his two-week stay in the hospital, he did not have the clarity needed to decide to seek treatment on his own. While in the hospital, he told me, “A person really needs some time in, to get off the stuff and think straight.”
Our family has intervened and attempted to convince Noah to seek treatment many times over the years, but Noah always believed he could stop drinking on his own. The deeper into alcoholism he has gone, the more health-impaired he has become, and the less clarity he has to decide to seek help.
While sitting with Noah in the critical care unit at St. Mary’s Hospital recently, two gastrointestinal surgeons came in to discuss whether they would need to cut out parts of Noah’s pancreas that have died off. “If you continue to drink, you are not likely to live another year,” one surgeon told him. As our family became more desperate to save Noah, we sought assistance to get Noah into treatment involuntarily.
To pursue involuntary treatment for a loved one, you must seek help through Dane County Human Services, the agency that oversees the legal proceedings under Chapter 51 of the state statutes. That chapter “provides legal procedures for voluntary and involuntary admission, treatment, and rehabilitation of individuals (adults and minor children) with mental illness, developmental disability, drug dependency, and alcoholism.”
I reached out to Dane County Human Services to start the process for involuntary treatment and was put in touch with Derek Blum, community intervention team supervisor. My brother Michael, who is an attorney, and I had multiple conversations with Blum regarding getting Noah help. Derek assessed Noah at St. Mary’s Hospital and informed us that Noah met the criteria for Chapter 51 under the alcohol provision. He advised us of the three ways in which Noah could be placed inpatient involuntarily: law enforcement emergency detention; treatment director emergency detention; or three-party petition for examination emergency detention.
Although law enforcement has regularly been called to Noah’s home for disturbances involving alcohol, he has never been taken into custody under a law enforcement emergency detention.
He has also never been placed under a treatment director emergency detention despite the many times he has been admitted to the hospital over the past year for alcohol-related illnesses; on some of those visits his blood alcohol level exceeded .40, more than four times the legal limit.
Our family, therefore, attempted to get him help through the three-party petition process. This was in early winter.
In the case of Noah, our family members met the criteria for the three signers under Chapter 51 law. We planned to complete the petitions and have Noah transferred to an alcohol and drug inpatient rehabilitation facility as soon as he was medically stable. This effort, however, as well as four additional attempts, has been unsuccessful.
Why? Because Dane County does not follow Chapter 51 law. Dane County has added its own special provision which states that one of the signers must be a doctor. I reached out to four other Wisconsin counties (Milwaukee, Brown, Racine, Waukesha) and none of them require this. They all follow Chapter 51 law. So does Shawano County, where I once worked as the inpatient and crisis services manager handling all Chapter 51 proceedings, including three-party petitions for both mental health and alcohol and drug abuse issues. (According to its website, Marathon County does require that a “medical professional” be one of the three signers on a three-party petition for involuntary commitment for alcohol abuse.)
While Chapter 51 does not require that a doctor sign the commitment petition, it does call for a doctor to become involved as soon as the individual is detained. A court hearing must be held within 72 hours of the individual's detention. The doctor conducts an evaluation and reports her recommendation to the court. If the court does not find probable cause to commit, the individual is released. If probable cause is found, the petition moves forward and treatment is court-ordered.
I’ve asked Dane County officials multiple times why they require that a doctor sign the three-party petition. “That’s just the way we do things in Dane County,” said one. “It comes down to funding,” said another. I have not been able to find any written policy to this effect on the Dane County website or anywhere else.
And here is the problem with Dane County’s added provision: No medical doctor will sign. I have asked several doctors to sign over the years — neither the emergency room doctors, nor the critical care doctors have been willing to sign. They directed me to Noah’s primary care doctor for the needed signature. When my brother Michael and I contacted Noah’s primary care doctor — the same doctor that deemed Noah disabled due to alcoholism — she stated she could not talk to us due to federal privacy regulations under HIPAA. Carlos Pabellon, deputy corporation counsel for Dane County, attempted to contact the doctor to discuss signing the petition. Pabellon informed me via email that though he had left several phone messages with the doctor, she had not returned his calls.
Noah is certainly not the only person who is unable to get the help he needs. When speaking with a nurse recently in the critical care unit at Meriter Hospital, he told me, “Good luck getting him into treatment involuntarily. It is next to impossible in this county.” How many people in Dane County are unable to get the lifesaving care they require because Dane County has decided to work outside of the law? Dane County has added its own interpretation to the law that ultimately renders Chapter 51 null and void in its ability to provide the protection and treatment it was created to provide.
Equally disturbing is the response from Noah’s doctors. What responsibility does a medical doctor have to cooperate with signing a three-party petition when the county has deemed the individual a candidate for treatment but needs the signature of the doctor? If a doctor completes and signs documents stating her patient is disabled due to alcoholism, yet her patient has never received any alcohol treatment, isn’t she ethically bound in some way to help him get the treatment he needs?
My question to Dane County Human Services and the medical community participating in this unlawful practice is: What price tag have you placed on the lives of each of these individuals and are you prepared to live with the consequences?
We will know soon enough. Our family is about to try, once again, to petition to get my brother committed for treatment. He is back in the hospital — his 35th time just this year.
Tammy Rabideau is a writer living in Madison, Wisconsin. She has a bachelor's degree in sociology and a master's of education in professional counseling.
