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Hospital versus rehab: Amanda Bynes and health privacy

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October 2, 2013

Fans of former teen star Amanda Bynes have been distressed by her behavior over the past several months, and new reports indicate that she has left Ronald Reagan UCLA Medical Center for The Canyon. After more than a year of distracted driving, hit-and-run, drunken driving, and marijuana-related legal altercations, Bynes allegedly started a fire in a neighbor's driveway in July 2013 and was placed on a "5150 hold." A 5150 hold is a procedure specified by the Welfare and Institutions Code of California, which states, "When a person, as a result of a mental disorder, is a danger to others, or to himself or herself, [...] a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, or other professional person designated by the county may, upon probable cause, take, or cause to be taken, the person into custody and place him or her in a facility designated by the county and approved by the State Department of Health Care Services as a facility for 72-hour treatment and evaluation."

A judge later extended the 72-hour hold to 14 days; Bynes's mother subsequently sought and received conservatorship over Bynes, including control of her finances and her medical treatment. (The type of conservatorship awarded is a Lanterman-Petris-Short conservatorship, which may be a temporary situation for Bynes.) On October 1, 2013, in response to reports on TMZ.com that Bynes had left Ronald Reagan UCLA Medical Center for celebrity rehab facility The Canyon, Bynes's parents issued a statement indicating that she had, indeed, left UCLA for a private facility in order to receive one-on-one treatment and be away from individuals whose illnesses were more serious than hers.

Observers on TMZ have noted that The Canyon does not have a psychiatric ward, and have questioned Bynes's parents' decision to move her there (if, indeed, they did). However, concerns for Bynes's privacy may have been paramount. In a late August 2013 issue of Addiction Science and Clinical Practice, researchers review the privacy regulations involved in the treatment of substance use disorders (SUDs), and find that clinicians may not honor patients' privacy all the time. The authors note, "When general health care providers assess for and provide a brief intervention in a general health care setting, the documentation of the pertinent substance abuse information does not fall under the SUD confidentiality regulations." Protection of patient confidentiality and coordination of patient care appear to be two conflicting aims in a general health care setting such as UCLA. Given the Bynes family's stated desire for privacy, their treatment decision is understandable.

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