Ask Dr. Mahato
Ask Dr. Mahato
Questions come up on every rotation — in the ED, on call, on the unit. Residents in enrolled programs can ask Dr. Mahato directly. Selected questions are answered here, for everyone’s benefit.
Ask your question
Sample answers
My patient is involuntary. Can I just medicate over objection?
No. Being held involuntarily is not the same as being medicated involuntarily. Under the Rivers doctrine (from Rivers v. Katz), an involuntary patient retains the right to refuse medication, and medication over objection requires a court order.
Involuntary status answers “can we keep you here” — not “can we medicate you against your will.”
The exact procedure for obtaining a Rivers order (who petitions, what showing is required, emergency exceptions) is beyond Module 1 — confirm with your attending and hospital counsel before acting. Module 1, Lesson 8.
Does involuntary commitment mean the patient lacks capacity?
No — they are two different questions. Commitment (Article 9) asks: can the hospital keep this person here? It is a legal status question. Capacity asks: can this person make this specific decision? It is decision-specific — capacity for one decision is not capacity for all decisions.
They cross in both directions: an involuntarily committed patient may still have capacity to refuse a medication (that is exactly the Rivers point above), and a voluntary patient may lack capacity for a specific medical decision. Never use one as a shortcut for the other.
Police brought the patient under 9.41. Is the patient admitted?
No. When officers bring a patient under MHL §9.41, their authority covers custody and transport — getting the person to the hospital safely. It is not an admission.
Someone on your team must still complete the admission paper (usually §9.39). Thank the officers, take the handoff history, and start your own assessment — the legal clock starts with your paper, not theirs.
When can I order restraint or seclusion?
As a general principle: physical restraint or seclusion requires a physician’s order, is time-limited, and must be documented — indication, less-restrictive measures tried, monitoring, and re-evaluation. It is a safety intervention of last resort, not a behavioral tool.
Exact time limits, who may renew, and face-to-face evaluation rules vary by setting and regulation — confirm your hospital’s policy before you order.
A patient threatened serious harm. Do I have to report it?
At a high level: New York’s SAFE Act (MHL §9.46) requires mental health professionals to report to the DCS (director of community services) when a patient is likely to engage in conduct resulting in serious harm to self or others — the provision aimed at firearm access. Know that the duty exists and that it runs to the DCS.
Who exactly must report, the reporting form and timeline, and how this interacts with confidentiality — confirm before you report.
Want to ask Dr. Mahato a question?
Residents in enrolled programs can ask directly — and selected answers are published here for everyone.
Your question didn’t make it here yet? The library keeps growing — check back.