Media and Medical Bias

Media and Medical Bias

Comments by hospital PR flacks suggest that persons accused of psychiatric
illness are the cause of ERs being overwhelmed. (Liz Kowalczyk, "Psychiatric
patients feel strain," Boston Globe, July 15, 2007) More importantly this report
lacks any reference to the Rehabilitation Act of 1973, the Americans with
Disabilities Act of 1990, and Mass General Law Chapter 151 B (the state anti
discrimination statute). Many cities also have anti discrimination laws.
Do these medical professionals, and the editors at the Boston Globe believe
that persons accused of psychiatric illness are excluded from enjoying the
rights enumerated in the US and MA Constitutions? Janice Sullivan a Quincy PR
flack said safety overrules Constitutional Rights. Huh?
Kowalczyk notes, "the challenge of caring for sometimes-aggressive
psychiatric patients." Why are persons accused of psychiatric illness treated
differently? Are all "normal" patients passive? It appears that the Boston
Globe, the DPH, the DMH, and hospitals believe that a person accused of
psychiatric illness is violent and dangerous. Police and prosecutors share this
misguided belief. It is institutionalized in MA state courts.
Why are the training plans for ER employees not meant for all of their
patients? That in itself is discriminatory and unlawful. What is the legal
rationale for allowing "some psychiatric patients to keep on their clothes and
instead be frisked and scanned with a hand-held metal detector?" Why is this
proposed policy only applied to persons accused of psychiatric illness? That is
an unlawful proposal.
In Cambridge until I complained for three years the Cambridge Health
Alliance boasted that they delivered mental health care coordinated with the
Cambridge police. That is an outrageous admission. The comments in this report
suggest it is not just a Cambridge problem. A new perspective is needed. The DMH
and taxpayer funded attorneys whose mission is protect persons with disabilities
and their rights failed by intentionally negligently allowing institutions to
express their unlawful bias and abuse a class of vulnerable persons.
Few psychiatrists know the laws regarding persons with disabilities. They
believe that their feelings and personal opinions trump law. That needs to stop
immediately.

Roy Bercaw, Editor ENOUGH ROOM

Constance Surette, a Plymouth resident who has bipolar disorder, (left) and
Jill Judson participate in a discussion about patients' rights during an M-Power
meeting. (Globe Staff Photo / Evan richman)
The Boston Globe
Psychiatric patients feel strain
State investigates complaints at ERs

By Liz Kowalczyk,
Boston Globe Staff
July 15, 2007

The state investigated at least 21 complaints over the last 18 months that
emergency departments mistreated psychiatric patients, and officials cited
hospitals in half those cases for problems that included wrongly forcing
patients to undress, punching or hitting patients, and restraining others for
hours without proper monitoring.

One patient died while in restraints, and a patient's arm was broken as a nurse
forcibly removed his pants.

These cases are a sign of the growing strain on the state's overcrowded
emergency rooms, doctors, nurses, patients and state officials said, and also
reflect a shortage of services for the mentally ill, the challenge of caring for
sometimes-aggressive psychiatric patients, and inconsistent training of harried
ER staff.

Emergency rooms can be battlegrounds. They often are the last resort for
psychiatric patients in crisis -- some patients are so out of control and
aggressive that mental health facilities will not take them -- and ERs have
responded by creating "safe rooms" to handle such patients and on occasion
calling in police for help, according to inter views with 20 doctors, nurses,
patients, and hospital administrators.

ER staff give psychiatric medications but are not trained to provide
comprehensive psychiatric care, they said. And many of these patients stay in
ERs for days without proper treatment because of backlogs in psychiatric
facilities, creating potentially volatile situations for those patients, staff,
and other patients. Hospital officials said nurses, too, have been injured in
confrontations, and patients contend that they are humiliated by policies like
the one requiring them to undress.

Patients "will be in the ER from hours to days and they get absolutely no care,"
said Linda Condon, an emergency room nurse who has worked at four hospitals in
Southeastern Massachusetts. "You put a person with psychiatric problems in a
room with four walls and nothing to do, and there are going to be problems."

Documents from the Department of Public Health -- which conducts investigations
when patients or relatives complain or hospitals themselves report problems --
show that investigators cited 11 hospitals for a range of problems. Those cases
include:

A blind, disabled patient who went to Lawrence General Hospital in April because
he was suicidal. Hospital policy then required psychiatric patients to undress
so that staff could look for hidden drugs or weapons, but the patient wanted to
keep on his jeans. A male nurse "used excessive force" to remove them, the
health department found, breaking the patient's arm. The patient required
surgery and a three-week hospital stay.

In April 2006, a 49-year-old former nurse who arrived in the emergency room at
Melrose-Wakefield Hospital at 10:30 p.m., intoxicated and uncooperative. Staff
strapped down his arms and legs, gave him sedatives, and assigned a security
guard to watch him. After a nurse called the security guard away to help with
another violent patient, the first patient had a fatal cardiac arrest. The
hospital's internal investigation determined that the patient was not properly
monitored. Staff told state investigators that the ER was "very, very busy."

In June 2006, a male teen in the Merrimack Valley Hospital ER in Haverhill began
pulling medical equipment out of a wall, kicking furniture, and biting staff.
While he was biting a nurse, a staff member repeatedly punched him in the face.
State investigators said the hospital did not properly train staff on how to
restrain patients. Hospital staff said punching was a last resort because the
patient was severely injuring the nurse.

State documents released to the Globe omitted the names of patients and staff
for privacy reasons. When health officials find problems during investigations,
hospitals must implement plans to correct them.

The state public health and mental health departments have been so concerned
about the pattern of complaints that they sent a memo to hospital executives in
September, detailing 21 steps they should take to improve care of psychiatric
patients in ERs, including reducing waiting times, using trained mediators, and
further training staff in techniques to calm patients.

But patients and advocates for people with mental illness say problems remain
rampant. They are pushing legislators to increase the mental health department's
role in regulating ER care and to require the public health department to
develop "best practices" for treating psychiatric patients.

"When we get upset and don't want to take our clothes off, they think we're
going to flip out," said Constance Surette, 57, of Plymouth, who has bipolar
disorder and works with a group pushing for legislation. "But the way they treat
us, of course they're going to get that reaction. The ERs should use peer
mediators to talk to [psychiatric patients] because they are frightened of the
authority figures."

Surette filed a complaint with the health department last month, alleging that
city police officers at Quincy Medical Center sprayed one psychiatric patient
with mace and handcuffed another to a bench while she was in the ER. Hospital
spokeswoman Janice Sullivan said that she could not confirm Surette's account
but that the actions taken were appropriate "for the safety of everyone
involved."

Doctors and nurses say they have made improvements but are doing the best they
can in an impossible situation. They said the number of complaints statewide is
small considering the thousands of psychiatric patients who seek care in
Massachusetts ERs each year.

In 2005, ERs reported 168,000 visits by psychiatric patients, 10 percent more
than in 2003, according to the Massachusetts Health Data Consortium. And they
usually have to wait longer for care. The average ER stay for patients who are
eventually sent home or to another hospital is nearly three hours; it's nearly
six hours for psychiatric patients. And many of these patients wait two to three
days in the ER for an inpatient bed in a psychiatric facility to open.

"The emergency departments are overwhelmed," said Dr. Paul Bulat, medical
director of the emergency room at St. Luke's Hospital in New Bedford. "We are
seeing more violent patients and out-of-control patients. We're seeing mental
health problems much worse than we should be."

ER directors are reluctant to acknowledge that overcrowding hurts patient care.
But staff told the state health department that busyness was a factor in several
of the cases investigated, especially those that involved inadequate monitoring
of patients.

In the case of the former nurse who died at Melrose-Wakefield Hospital, not only
did the security guard leave the patient alone for about 20 minutes, but the
patient's condition was not checked every 15 minutes while he was restrained, as
required by hospital policy. Monitoring is especially crucial for intoxicated
patients who receive sedatives.

Hospital spokesman Richard Pozniak said he could not comment on the case because
of regulations requiring patient information to be kept confidential. State
investigators said in their report that 13 patients were in the ER when the man
arrived, and 20 other patients arrived before he died 4 1/2 hours later.

Public health investigators also found that lack of training is an issue,
including in cases where staff used excessive force. Better training in
techniques to calm patients is especially important as frustrated psychiatric
patients with no where else to go spend hours in the ER .

In the case of the patient whose arm was broken at Lawrence General Hospital,
investigators found a range of problems, including that the hospital's internal
investigation of the complaint did not include interviewing the patient.
Investigators also found no evidence that staff and security had been trained in
patient's rights. And they said the nurse should have explored the patient's
reasons for wanting to keep on his jeans before resorting to force.

Hospital spokeswoman Ellen Murphy Meehan said the hospital "expressed deep
regret to the patient" for what it considers an accident. She said Lawrence
General has since changed its policy to allow some psychiatric patients to keep
on their clothes and instead be frisked and scanned with a hand-held metal
detector.

Paul Dreyer, director of the state Division of Health Care Quality, said "a
culture change" is needed; he is organizing an educational summit for ER staff
in the fall, hoping hospitals will improve on their own, making legislation
unnecessary. Legislators expect to hold hearings this summer or in the fall.

We want "people to realize they don't have to call in security the first time
someone looks at them cross-eyed," Dreyer said. "The ERs are in a production
mode. Their aim is to process the patients as quickly as possible to get on to
the next patient. These patients may not take well to being treated that way.
They may act out."

A number of hospitals said they have improved care after serious encounters.
UMass Memorial Medical Center -- where campus police beat a psychiatric patient
with a baton in 2004, injuring him, and, several months later, threw a patient
against a wall and called her a "bitch," according to state reports -- said it
has made significant changes. These include creating a secured, quiet area for
psychiatric patients and training police to use calming techniques. Dr. Patrick
Smallwood, medical director for emergency mental health services, also joined
the hiring panel for campus police officers last year.

Dr. Bruce Auerbach, chief for emergency and ambulatory services at Sturdy
Memorial Hospital in Attleboro, said hospitals need more resources, not more
regulation. "When a patient who is having a behavioral health crisis is in my ER
for four days not getting the intervention he needs -- it's a travesty in our
healthcare system," he said.

Liz Kowalczyk can be reached at kowalczyk@globe.com.