Patient shot at hospital....

[cornflkgrl]

So you would have been totally okay with the guy who clocked me because I told him he had to go back into his 6 week old child's room and put on some clothes.

He did not like the fact that I tried to stop him from walking into another child's room (as he was servicing himself totally naked).

Bizarre behavior indeed. And yes the police had to be involved to get him under control and into jail.

Are you relaying.additional details of this case that were not in the article?

 

[indygirl99]

Are you relaying.additional details of this case that were not in the article?

Read what I posted.

 

[cornflkgrl]

Read what I posted.

Read what i posted. Also read the article which says nothing about Pean going into patient rooms naked. The man who was shot -- the man in the article -- he was dancing naked IN HIS ROOM according to the article and.the police were called after he was coaxed into a gown but did not want it fastened. We aren't discussingbsomeone clocking you unless you are the nurse who cared for Pean.

 

[indygirl99]

Read what i posted. Also read the article which says nothing about Pean going into patient rooms naked. The man who was shot -- the man in the article -- he was dancing naked IN HIS ROOM according to the article and.the police were called after he was coaxed into a gown but did not want it fastened. We aren't discussingbsomeone clocking you unless you are the nurse who cared for Pean.

It is interesting to hear how other places are handling this. We have moved several times. I have a family member that worked in mental health and it seemed most places were moving away from restraint and seclusion. But some states just can't seem to let go.

Bizarre? That's a medical term used in their report?

I wouldn't care a bit if there was a naked guy in the hall.

You say he was "naked and escalating"...does restraint or police presence usually have a calming effect on patients?

I am sure you would care quite a bit if the person who clocked me was walking into your child's room naked and escalating while servicing himself.

You asked how other places handle this and I told you how a place I worked "handled this".

I can guarantee there are many more healthcare professionals injured by violent patients and their families than there are patients injured in taking them down from this violent behavior.

 

[Pea-n-Me]

No. I have a background in being a patient ...and a family member of a patient.

But, carry on...there was no way around shooting the "mentally ill" guy. Once he got naked, of couse, the police had to be involved. They did the right thing. We can all rest easier now that they got this bad naked guy before some poor old lady saw his bizzare nakedness.

It seems like you want an argument here and I'm not going to give you one. You are putting words into my mouth and don't seem to want to see anything any way but your own.

I think the subject of armed police officers in hospitals is a good one.

 

[Pea-n-Me]

Read what i posted. Also read the article which says nothing about Pean going into patient rooms naked. The man who was shot -- the man in the article -- he was dancing naked IN HIS ROOM according to the article and.the police were called after he was coaxed into a gown but did not want it fastened. We aren't discussingbsomeone clocking you unless you are the nurse who cared for Pean.

You have at least three very experienced nurses here telling you that that is what happens - people whose behavior is bizarre and escalating will often go into other patients' rooms. Those patients deserve protection, too.

 

[FlightlessDuck]

What else could have been done to avoid this?

Not provide guns to their security?

 

[cornflkgrl]

I am sure you would care quite a bit if the person who clocked me was walking into your child's room naked and escalating while servicing himself.

You asked how other places handle this and I told you how a place I worked "handled this".

I can guarantee there are many more healthcare professionals injured by violent patients and their families than there are patients injured in taking them down from this violent behavior.

I never asked how other places handle this. I simply responded to what someone else said. Someone asked if I'd care if there was a naked person in the hall. No, I would not. And especially in THIS CASE where this man was shot, the patient wasn't in other rooms. He was briefly in the hallway. Then they got a gown on him and he didn't want it fastened.
You keep returning to other scenarios to defend what happened to this patient.
The doctors and nurses had a duty to treat this patient too.

 

[kamik86]

I think the main issue with medical problems is our laws have a hard time dealing with them.

To protect every patient and their wishes their are laws that no medical care can be given without consent of the patient for example. However how do you handle when the patient isn't in their right mind? Its not like there is a clear cut answer to if someone is in their right mind and allowed to refuse care for example.

Then you have the problem of when a patient is clearly not in their right mind how do you handle their behavior? Just because they are not in their right mind does not give them the right to do something illegal. As in this case a grown man can't be allowed to walk around naked. Also who knows what the other nearby patients were there for? If you say that you should allow him to do anything that isnt' hurting others... What if the woman 3 doors down was there because of being attacked and raped. The man just being naked would hurt her mental health. So who do you protect?

So they call security to deal with a patient that maybe does need some type of restraints, maybe the facility isn't set up with a door where they can just lock him in the room after all (I'm fairly certain it wouldn't be in most places that is illegal due to fire concerns). So what should have been done?

I don't know the answer to that and I don't think society does either. When you have someone that isn't choosing to break laws but at the same time need to protect others from what they are doing how do you proceed?


As for not having security carry guns well yes that is fine for the mental health patients but then how do you handle the two rival gang memebers that ended up seeing each other in the same emergency room after they had a shootout? Not every reason for security is going to be a mental health issue.


As for this patient specifically who knows what happen when security was called. Maybe all they did was have a conversation with him about needing to get dressed and he for some reason, something about these individuals, their uniforms, their mannerisms triggered a larger issue and he did try to attack them. Maybe he just refused to do what he was told and a power hungry cop chose to point a taser at him whichthen caused the other behaior. We don't know.

 

[Magpie]

So you would have been totally okay with the guy who clocked me because I told him he had to go back into his 6 week old child's room and put on some clothes.

He did not like the fact that I tried to stop him from walking into another child's room (as he was servicing himself totally naked).

Bizarre behavior indeed. And yes the police had to be involved to get him under control and into jail.

A question for you... is there some protocol in place at the jail for getting him the medical attention he clearly needs? As in, is jail merely a place to hold him until he can be sent to the proper medical facility? Or was this obviously mentally ill man simply charged and processed as a criminal offender?

 

[pryncess527]

I am sure you would care quite a bit if the person who clocked me was walking into your child's room naked and escalating while servicing himself.

You asked how other places handle this and I told you how a place I worked "handled this".

I can guarantee there are many more healthcare professionals injured by violent patients and their families than there are patients injured in taking them down from this violent behavior.

FWIW, I care that you got clocked just trying to do your job.

But, is it also safe from me to gather from your posts that you have not worked in a hospital with security that carries guns, and see the use of guns (not force/restraint/straightjacket, but taser and guns) as excessive in a hospital setting?
I can see how, for family members of these patients how even the use of restraint can seem excessive and antagonizing, but setting that aside for the moment, I'm curious how you feel about the use of weapons by security in this situation, or if you would have welcomed security with tasers/guns in the situation where you were hit.

 

[MariMama]

No. I have a background in being a patient ...and a family member of a patient.

But, carry on...there was no way around shooting the "mentally ill" guy. Once he got naked, of couse, the police had to be involved. They did the right thing. We can all rest easier now that they got this bad naked guy before some poor old lady saw his bizzare nakedness.

There was way more to his behavior than just wanting to be naked. I don't know why you refuse to acknowledge that. He was a threat to himself and others around him (including the medical staff).

 

[kamik86]

I actually think what concerns me even more in this story is how the medical professionals at the hospital handled this patient before things got out of hand. I don't know what happened in that room but the article has records from the doctor on what they wrote on his chart.

I know there is a problem with security and police not being trained in how to handle the mentally ill and with our laws having trouble defining at what point the person becomes such a safety risk that no matter what the cause the patient does need to be stopped.

That they gave him a medication known to exacerbate a medical issue he had stated he had. Even if this man did attack security there is a good chance he only did so because of this medication that was making his condition worse.

I think the best solution possible solution in this situation would have been this man being treated well before he got to the point that he was trying to walk around naked so no security would have been called. To give families the resorces to help people before the emergency room is needed more often.

There would still be emergency cases, and maybe they would end badly... because unfortunatly there does have to be a point where the motivies for a person trying to hurt someone else no longer matter and all that matters is protecting that person. However I hope that it would at least make those cases much fewer and further between.

 

[cornflkgrl]

There was way more to his behavior than just wanting to be naked. I don't know why you refuse to acknowledge that. He was a threat to himself and others around him (including the medical staff).

From the times article:


"He sang and danced naked in his room, occasionally drifting into the hall. When two nurses coaxed him into a gown, he refused to have it fastened. Following protocol, a nurse summoned security, even though he was not aggressive or threatening."

"After an emergency investigation, the Medicare agency faulted St. Joseph for the shooting, saying it had created “immediate jeopardy to the health and safety of its patients.”

 

[Monykalyn]

@roseaster
beautiful job explaining what happens when mentally ill patients come into ED and the prolonged process of trying to find appropriate placement!!! I don't think most people know the requirements of documenting the need for restraints-chemical OR physical. I know some RN's very grateful for the ability to use physical restraints when needed (bath salts anyone??)


My hospital actually has a dedicated psych hospital (on another campus-have a detox unit on main campus). Depending on which ED the patient goes to whether the staff will recognize the patient as someone who has diagnosed mental illness and off meds vs one who is high/stoned/intoxicated (in sW MO so obviously high/intoxication is HUGE issue). So observing initially while blood work comes back is actually reasonable.

We do have armed security guards on both campuses. They have both handguns and tasers. REquired to go through same training as police officers with refreshers and physical fitness. Also extensive training in de-escalating situations. In 10 years at my hospital I can recall one incident of patient being tasered as last resort. They do a good job. I actually think the hospital has less incidents of violence as these guards are well trained-and the regular patients know them too.

The bigger issue is overall lack of patient beds and follow up care-many many readmits could be prevented with better followup and supervised out of hospital treatment - like assisted living but with more psych focused treatment/help with meds.

 

[Monykalyn]

Also remember it is JULY-the month all the hospitals have the new residents starting...always see spike in admits...

 

[roseaster]

I think the main issue with medical problems is our laws have a hard time dealing with them.

To protect every patient and their wishes their are laws that no medical care can be given without consent of the patient for example. However how do you handle when the patient isn't in their right mind? Its not like there is a clear cut answer to if someone is in their right mind and allowed to refuse care for example.

Then you have the problem of when a patient is clearly not in their right mind how do you handle their behavior? Just because they are not in their right mind does not give them the right to do something illegal. As in this case a grown man can't be allowed to walk around naked. Also who knows what the other nearby patients were there for? If you say that you should allow him to do anything that isnt' hurting others... What if the woman 3 doors down was there because of being attacked and raped. The man just being naked would hurt her mental health. So who do you protect?

So they call security to deal with a patient that maybe does need some type of restraints, maybe the facility isn't set up with a door where they can just lock him in the room after all (I'm fairly certain it wouldn't be in most places that is illegal due to fire concerns). So what should have been done?

I don't know the answer to that and I don't think society does either. When you have someone that isn't choosing to break laws but at the same time need to protect others from what they are doing how do you proceed?


As for not having security carry guns well yes that is fine for the mental health patients but then how do you handle the two rival gang memebers that ended up seeing each other in the same emergency room after they had a shootout? Not every reason for security is going to be a mental health issue.


As for this patient specifically who knows what happen when security was called. Maybe all they did was have a conversation with him about needing to get dressed and he for some reason, something about these individuals, their uniforms, their mannerisms triggered a larger issue and he did try to attack them. Maybe he just refused to do what he was told and a power hungry cop chose to point a taser at him whichthen caused the other behaior. We don't know.

Actually, there are many systems in place to safeguard patients in just these situations.

First I want to say that whatever happened with the patient in the article it was clearly handled improperly. He was shot, that never should have happened, and I have never worked in a hospital psych or medical that allowed armed security. I am, absolutely, against that.

Unfortunately, physical restraint is sometimes needed. There is absolutely training that goes into how and when to apply physical restraint, and if you work in psych it training that you have to recertify yearly. You also get a lot of training on how to de-escalate situations without the use of restraint. FTR, medications, such as tranquilizers are also considered a form of restraint. They are classified as chemical restraints.

No to the treatment and safety issues.

The "consent" issue varies greatly. The patient does not, necessarily, have to consent, and there are systems in place for that. If a patient arrives in the ER and they are unconscious, then "emergency consent" is applied and the patient is treated. Also, if a patient is under the influence of substances, it is, also, automatically assumed they lack the capacity to consent and they will be treated. In the case of people with developmental disabilities they usually have a legal guardian who determines their treatment. In the case of people who may have other conditions such as brain injuries, or dementia, or any type of organic illness that may affect their ability to make decisions, they often have a medical and/or legal power of attorney to make decisions for them. If they do not they are given appropriate medical treatment as deemed by the physician.

Now in psych it becomes dodgy. If you are a voluntary patient you cannot receive any treatment against your will. If you are involuntarily committed and you are deemed to be a danger to yourself or other and that condition will not improve without the use of medication, then you will be examined by 2 psychiatrists and if deemed appropriate, a certification is signed stating that you can be medicated against your will for 72 hours. After the 72 hour period is up, you are re-evaluated, if you are still refusing medication and you are still a danger a 2nd 72 hour period is initiated. After the 2nd 72 hour period is up if you are still refusing and still a danger then involuntary medication is ordered for 30 days. Incidentally, in NJ involuntary commitments are also reviewed by a judge every 30 days. This is only with adults. I have never worked with children, I do not know the rules regarding children.

As for hospital security and gang members. There is absolutely a protocol in place for this. My husband worked in an inner city with a lot of gang activity. First all patients and visitors who "walk in" (not ambulance) go through a metal detector. However, if there is a gang related shooting the hospital goes on lockdown which means that all the door are locked and that the only entrance permitted is through the ER, and then only for patients requesting to be seen. Everyone entering through the ER goes through a metal detector.

Secondly any patient that comes in for a gunshot, or stabbing, or any type of assault or violent crime is undressed down to a hospital gown and "wanded" with a metal detector by security. Any firearms or weapons are removed by the police. Actual on duty city police, not security. The police are notified of every gunshot wound and stabbing.

The police in these areas are aware of gang activity, and when something occurs they are heavy present in and around the hospital.

It is a difficult situation for nurses, especially when dealing with psychiatric patients who are in crisis on a medical unit. Nurses have to protect all their patients and the way the workload is a nurse cannot leave 5 patients to deal with one. If a nurse is in the middle of a complex treatment with Mrs. Smith in room 300 she can't leave her and go deal with Mr. Jones in room 301 who is naked in the hallway. Mr. Jones can't be naked in the hallway. Maybe Mrs. Green is having her physical therapy walking with her walker in the hall, or maybe her 6 year old granddaughter is visiting.

An important part of psychiatric nursing is reorienting psychotic patients to reality. Reality is that it isn't appropriate to be naked in public, so it was appropriate to insist this man be dressed.

Do I think it was mishandled? Yes. Very likely whatever was done after security was called escalated the patient's behavior. This is, likely, due to lack of training. I don't fault the nurse for calling security. That is, generally, the policy if patients or visitors are uncooperative. The nurse was, also, likely, uncomfortable or intimidated. Often, just the presence of security, changes the patient's behavior. People, not just psych patients, seem to find men in a uniform more authoritative than a woman.

 

[indygirl99]

A question for you... is there some protocol in place at the jail for getting him the medical attention he clearly needs? As in, is jail merely a place to hold him until he can be sent to the proper medical facility? Or was this obviously mentally ill man simply charged and processed as a criminal offender?[/QUO

Yes there was protocol for him getting the help he needed in the jail. This was an east coast hospital and the jail actually had a locked psych ward.

This hospital had armed police officers on duty 24/7 and when they arrived to take him down he asked the officer if that was enough to get him arrested because he wanted his 3 meals and a cot to sleep on.

Yes I pressed charges. No he did not go to the psych ward.

 

[indygirl99]

FWIW, I care that you got clocked just trying to do your job.

But, is it also safe from me to gather from your posts that you have not worked in a hospital with security that carries guns, and see the use of guns (not force/restraint/straightjacket, but taser and guns) as excessive in a hospital setting?
I can see how, for family members of these patients how even the use of restraint can seem excessive and antagonizing, but setting that aside for the moment, I'm curious how you feel about the use of weapons by security in this situation, or if you would have welcomed security with tasers/guns in the situation where you were hit.

I have worked in several hospitals (I was a travel nurse) with security/police officers that carry either/both tazers/guns and do NOT see it as excessive. In the incident I posted the police did carry both.

I have had many an occasion that I have had to call security to come to a patients room to remove a loaded gun from a parent (working pediatrics)and lock it up until there child was discharged.

I also have had many occasions when just having security make routine walking rounds on the unit has helped de-escalate situations with parents.

 

[Magpie]

Yes there was protocol for him getting the help he needed in the jail. This was an east coast hospital and the jail actually had a locked psych ward.

This hospital had armed police officers on duty 24/7 and when they arrived to take him down he asked the officer if that was enough to get him arrested because he wanted his 3 meals and a cot to sleep on.

Yes I pressed charges. No he did not go to the psych ward.

Ah, the reason I asked was because of this recent news story: https://www.readfrontier.com/invest...liott-williams-jail-cell-became-burial-crypt/

Tl/dr (if you'd rather not follow the link): The gentleman had a bipolar mental break and cause a disturbance at a hotel. While in custody, he broke his neck. The police, unaware that he was paralyzed from the neck down, and believing he was faking it in order to be "waited on" left him lying on the floor unable to reach food or water for five days until he died.

That, one hopes, is an extreme case. But it does underline the fact that only a professional can determine whether someone is "faking" a need for medical help, whether of the mental or physical variety. And police officers are not equipped to make that diagnosis.

You described someone who stripped naked and ran around in a pediatric ward masturbating. That is not sane behaviour, not even from someone who may have been desperate to find food and a place to sleep. I'm sorry he punched you and you had every right to press charges, but I'm also sorry that he never got to the psych ward.