What's Actually Going On In Baltimore?

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This topic contains 97 replies, has 71 voices, and was last updated by  D3513 2 days, 12 hours ago.

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  • #6256

    ZDoggMD
    Keymaster

    Anybody have the inside scoop on the patient dumping story at University of Maryland? I’d like to have more info before I talk about it on the show.

  • #6257

    RedBrocket
    Participant

    Shouldn’t the title of this thread read, “What the Actual Fuck is Going On in Baltimore?”

  • #6258

    Kikirn
    Participant

    I’ve been a nurse for 20+ years, security does not “discharge” you or walk you out of the building unless there is a problem and they have been called to escort you from the building for some reason. That alone tells me there is more to the story

    • #6261

      Rnmom2girls
      Participant

      Kikirn, I’ve been saying the exact same thing! The moment I saw 3 security guards taking the patient out it was a dead giveaway that there was more to the story. Maybe in some of the smaller rural hospitals security will assist with taking d/c’d patients out but not at somewhere as large as UMMC and certainly not 3 of them!

    • #6324

      Nursecenary
      Participant

      As an er nurse and former security contractor I get called to do both in my er (60beds level1 etc) “mental health” has become a catch all for every pt in the er that doesn’t have a physiologic disorder. The true mental health have had all the resources swallowed up by the unreasonable patient. I’m sick of dealing with it

    • #6299

      Nursewine
      Participant

      From what I have read, per her mother, this woman has bipolar schizoaffective disorder and asberger’s. She had been in a group home but was kicked out for refusing her meds. Her mother has been trying to get guardianship but has not been able to.
      https://www.cbsnews.com/news/university-of-maryland-medical-center-patient-dumping-mother-speaks-out-viral-video/

  • #6259

    Elas
    Participant

    Regarding UMM midtown – I worked there as an RN last year in the MICU. I talked to my colleagues who are still there. It was a discharge from the ED. Not sure what the CC was on admission but it sounds like they discharged her against her wishes. She refused DC, refused to put her clothes back on, so she was simply taken to the bus stop per security. It sounds like she was not oriented. Not sure of her psych history. The staff at Midtown don’t have a lot of information themselves. CMS is there investigating right now.

    • #6260

      ZDoggMD
      Keymaster

      Thanks for this info!

    • #6289

      AndieeRN
      Participant

      This is EXACTLY what it looks like if you have any psych experience. Sad but we aren’t human keepers. We can only help to a certain degree in a hospital. This guy conveniently says the right things making the patient (this is my theory) realize it’s a good chance to take advantage and manipulate the situation to making herself look like a victim. It’s harsh but it happens ALL the time. Psych patients go from acutly psychotic to completely stable in the blink of an eye depending on the situation or opportunity to manipulate to their advantage. (Also of course not all people but a shit ton of them).

  • #6262

    Risgrig
    Participant

    I worked UMMS downtown (Greene street) for a number of years, some of which were in the ER. This was several years ago. I cannot speak of this individual case however sadly seeing a disoriented person in a hospital gown wandering the streets was not an uncommon sight. This isn’t to say that nobody cared. They certainly did. Many patients had mental issues, but not to the point where the hospital could legally keep them without a court order. Additionally, many patients are not compliant with instructions (for discharge, for dressing, for waiting for a cab…whatever) and security must be involved. It’s a sad state but security is often so jaded because there is So much dangerous activity that happens just outside the door (and sometimes inside) that they are not the ones to be “care givers”. Once a man laid down in the middle on Lombard, hoping to be run over. I came down to find our security guard simply watching and making offhand comments about him. I called an ambulance to shuttle him to the er. This is only one example, but there is definitely a challenge of becoming jaded and cynical when you work in such an environment. I can say this, we don’t know the CC was, nor the instructions for discharge, nor what happened to cause her to be “chucked out” in such a manner by security. No matter what, this is a very sad and unfortunate case, and I hope that this woman receives the care and compassion that she needs. Truly I was saddened by the sight, but at the same time I was not entirely shocked. Having worked there, having seen so many things “in the trenches”, and knowing the doctors that work there, I also reserve judgment against the facility until I know more details. Clearly, no one is a winner here.

  • #6263

    Emandeen
    Participant

    My one thought was in the video she is not speaking and per the person video taping she started to become more and more unstable. I am wondering how much of this was an act by the patient. I have seen a few times ether as an EMT or a Nurse a patient will start acting up as soon as they think it will get them more attention. Ether way the hospital should of left her with warmer clothes. Interested in hearing the rest of the story.

    • This reply was modified 1 week ago by  Emandeen.
  • #6265

    PatientA
    Participant

    Uh nah. Nope… this should have never happened. This is neglect. They have social workers at that hospital and at local social service agencies. There are resources in that city. There are telephones at that hospital. They have shelters and shelter staff that a medical staffer could call. Nope, FUCK THIS failure of human decency, and that hospital. This shit should have never happened. Call a family member to come get her, or an agency to pick her up. To put her out like that, is absolutely disgusting.

    • This reply was modified 1 week ago by  PatientA.
    • This reply was modified 1 week ago by  PatientA.
    • #6287

      AndieeRN
      Participant

      I’m sorry but you actually have no idea what your talking about. How do you force someone to do anything your saying? All the social programs or shelters in the world won’t help a person who doesn’t want to go there or be involved with case management. What if the woman refused to give a phone number or any information? Do you have even a days worth of medical experience? Let alone any knowledge of psychiatric patients. Calm compliant people don’t get escorted out by four grown men in a hospital gown. It’s actually against the law to keep a patient in the hospital against their will when there is noting wrong with them. ESPECIALLY psych patients. They have a shut ton of rights that make is sometimes impossible to get them or give them the care they actually need to live even semi normal lives. The woman is so obviously a psych patient. Without any knowledge you shouldn’t put your two cents in where a majority of medical professionals are participating. It looks bad if you don’t know a thing about it. Especially only seeing thirty seconds worth of a probably days long Situation. If the case is that foul play was done I would agree with you completely. But it’s very clear what happened here if you’ve seen it before countless times.

    • #6310

      OldCrone
      Participant

      Okay – what is your address and phone number? Or you bank account number? My social work team is all out of magical powers to manifest services and shelters to take 2 homeless people today? Perhaps you would like to offer your couch – as all the shelters were full by the time it was established to look for one? Pay for nursing home or private psychiatric facility (all our local/state ones are full and have a waiting list)? Maybe you can come and sit with the homeless fellow that was cursing and threatening our staff and tell him not to frighten the children and parents in our over crowded waiting room? Good luck not getting the flu while you are sitting out there. Or maybe we could leave them in the stalls and we could just do our best with the gun shot, car accident and heart attack that came in this afternoon out in the parking garage? Or should we kick out the SOB/possible blood clot? Or the anaphylatic kid? The TWO ODs who are still not coherent? I vote for letting them hang out in the CEO’s office – but that was a no go…

    • #6357

      OphthoDocDO
      Participant

      What if she was putting the staff and other patients health and safety at risk. You have no idea what her competency was in the ER. She could have been completely lucid. This is an emergency room. If the ER doctor deems the case to be non-emergent, they are to be discharged. There are real emergencies that get delayed treatment because people are using the ER as a hotel and walk-in clinic. My grandpa died from a ruptured AAA because the ER staff was dealing with an angry and belligerent patient because they wouldn’t give him dilaudid while my grandpa was bleeding out internally. By the time they got to his gurney IN THE HALLWAY, he started to code. The sheer fact that there were three security guards tells you something. If she chose to not put on her clothes, that is her choice. To forcibly dress the person against their will is assault. I guarantee there were multiple patients that suffered, possibly mortally, because of this ladies behavior in the ER.

    • #6406

      JJmarie
      Participant

      Yes you are right. Medical Social Worker/LCSW here from Fresno. It is wrong on its face. You don’t need to be a doctor, therapist or have worked in an ER or ED one day to see this.

  • #6270

    PSRN
    Participant

    Having been a CC for 18 years with 4 years I the ER I am sure I will have plenty of folks disagree with me. So here goes. I used to try and fix everyone until my boss told me that the patient came in from this situation and likely would leave to the same situation. The hospital is a dumping ground for people that no one wants to deal with. Almost all of our homeless patients get disability checks and food stamps. If they live somewhere they have to spend their money on life things. Not drugs, alcohol, or cigarettes. We continue to buy meds, get cabs or medical transport many times daily. The police bring the drunks to the ER to sober taking up needed space for ill patients. Once I had a TBI in rehab from another state who wrecked a motorcycle without a helmet. We had him for about a month and his family would not come and get him until I basically threatened to put him on a bus (I wouldn’t have) but miraculously his family showed up the next day. I have story after story but wish people would not blame the hospitals. We are acute care; not babysitters.

  • #6271

    LydiaS
    Participant

    I’m not in Baltimore, but I encountered hell recently when I stopped the unsafe discharge of a patient who was homeless and (at the time) unable to walk independently and did not have a safe DC plan. For background: this patient had a recent and active history of IVDU and was septic with MRSA bacteremia which would require a PICC. I was told she would have to opt to receive the 6 weeks of abx treatment at an inpatient rehab center, which she was refusing. Now, she wasn’t refusing treatment, she just didn’t want to go to the inpatient rehab center. But apparently we wouldn’t treat her at the hospital as inpatient, which she agreed to do, even with a strict behavioral plan that I was planning to write and discuss with legal. So CM/SW gave her a bus pass, filled a script for PO Bactrim, and- as the discharge resource nurse for the unit- I provided her with DC instructions and, because I was already feeling uneasy about this, wheeled her downstairs myself to pick up the meds and take her to the bus stop. Now, this certainly wasn’t a pleasant patient, she was kind of a nightmare, but as I helped get her dressed the girl could hardly stand up independently without falling, and couldn’t walk safely. I questioned it, and was told she walked fine the day before and that I should take her downstairs. So I did. She was crying out in pain, shaking, and had a thin jacket that I found left on the unit because it was in the 40’s outside and even then she was not equipped to safely withstand the cold. I asked her which bus she would take, and she said she’d never taken the bus before and didn’t know where to go, didn’t know anyone, and didn’t know how to use the bus system. I wheeled her as far as the front door before I couldn’t take it anymore, and imagined how easily she could legitimately die if I just left her there on the street- which was basically what I’d been told to do! She didn’t even have the strength to climb into a bus, and I was supposed to wheel her to a nearby bus stop on the side of the road, in the cold, and just walk away!? So I brought her back to her room, called the doctor and my manager who both trust me and said they’d cancel the Dc and figure it out tomorrow (it was around 6pm by this time). The next day, case management had apparently called an interdisciplinary meeting about what happened that took place in my boss’s office, without asking me to join (which I did anyway because the doctor unwittingly invited me to come) to discuss their plan of discharging the PT again- the exact same way they did the day before. The only reason this didn’t happen was because the PT finally agreed to the inpatient rehab place after talking with myself and the doctor again. After all this, I met with SW and CM independently to discuss what had happened, my rationale, and mend any burnt bridges since these are people I work with. I was told that there is actual POLICY saying that we can discharge patients to the street when they refuse certain things, because we can’t continue to waste resources. I was given the example of a homeless man who was on another unit who has had a stroke and needs a walker to ambulated safely. I was told that because we’ve already provided him with several walkers in the past, we would now discharge him without one because he always loses them, even though it will be unsafe for him. I suppose what I don’t understand is how there is a law that prohibits the ED from dumping patients, yet we were essentially making hospital policies that state it’s okay to do so from the floor. I’ve been a charge nurse and a resource nurse at a very busy university teaching hospital for over six years, and have dealt with unfortunate situations, but this still seems so wrong to me. I felt I did the right thing when I prevented the discharge that day, and I had to fight for justification, and was still ostracized by CMs. Is there something I’m missing here??

    • #6430

      CodeSurge
      Participant

      LydiaS, First off, what an awesome doc and manager for supporting you. It’s great when someone in management will go to bat for you.

      I wish there as an easy answer, but frankly, I don’t think there is. I know that there seems to be a rising trend in hospitals looking for wasted resources (which leads them to hire more people to look for waste which adds to operating costs so they have to find more waste, lol). I’m guessing the meeting you attended had about 2 or 3 people who actually do work, and the rest of the room was full of pencil whippers.

      Then again, maybe they have a point. Sadly, we are not able to look at every individual’s needs in a bubble, in this day and age. I say ‘needs’, but I’ve been seeing a lot of ‘wants’ walking through my doors lately. The patient who ‘needs’ to be treated but doesn’t ‘want’ to cooperate with the treatment plan, should not steal all of your attention from the patient in the next room who ‘needs’ the treatment and will do their best to cooperate with the treatment plan. Be careful that the septic patient who is not cooperative doesn’t over-ride the time you should be spending with the septic patient who is cooperative (that’s not black-and-white, sometimes people can be so sick they can’t make rational decisions for themselves, and if that is your concern, then you should definitely hit the pause button). Maybe there was no conflict, as there was no one in that moment who needed intervention more than her. In the broad scope of things though, the hospital is going to look at how much they are wasting on ‘trouble’ patients (like the stroke patient who keeps pawning off his walkers), which lessens their ability to treat others who are also in great need. At the end of the day, they came to us because they ‘needed’ help. They didn’t ‘want’ what we suggested was the best course of action. That’s quicksand, right there. I guarantee you’ll be stuck negotiating with that patient while the needs of others get neglected. You gotta learn to shout, “Next!”

      If only we all had a bag like Mary Poppins where we could just unpack endless resources to give out to patients while the children look on in disbelief, but then, who would really appreciate what they do receive? I think that is a large part of healthcare these days. Patients only think about themselves. Nurses are trained to think about every patient. And patients never consider the needs of other patients. It’s why people can be downright heartless when they throw an undignified tantrum in the ER over their baby sick with a runny nose, even while they hear “code blue” come over the intercom. And it’s getting worse. I’m becoming a bit jaded when I allow myself to think about the fact that this is the caliber of patients we are dealing with more and more. I can’t say I get a lot of satisfaction caring for patients who are so callous and ungrateful.

      • This reply was modified 4 days, 9 hours ago by  CodeSurge.
      • This reply was modified 4 days, 9 hours ago by  CodeSurge.
      • This reply was modified 4 days, 9 hours ago by  CodeSurge.
      • This reply was modified 4 days, 9 hours ago by  CodeSurge.
      • This reply was modified 4 days, 8 hours ago by  CodeSurge.
  • #6272

    jlangdale
    Participant

    What I found very strange about this is how the video starts so early, along with the behavior of the guy recording the video. It seemed obvious was likely deaf, at least to me. But he seems to specifically ignore this on purpose. To then look up the guy who recorded the video and find that he’s a BLM healthcare activist makes the initial conditions of the video very dubious.

    Did he stage a deaf woman to purposely go into the ER to cause a problem & refuse discharge just so he could “happen to stumble” across her while already having his video recording long before he even comes across the scene?

    VERY dubious! A hoax that was made real to test the ER response & trigger a negative response to a deaf African-American woman?

    • This reply was modified 1 week ago by  jlangdale.
    • This reply was modified 1 week ago by  jlangdale.
  • #6275

    Nursenessa1
    Participant

    She had a spit mask on. Had all her clothes with her. My guess is she came in pychotic and spitting and restrained and they gave her anti pychotic drugs. She went to sleep they medically cleared her with labs and then tried to wake her up for dispo and forgot the half life of whatever drugs they gave her. Asssumed she was faking sleep or whatever. Gave her multiple attempts to dress, she refused or fell back asleep and they called security who came in was told to throw her out, did so and will now take the fall. Outside in the cold she is alert but altered from the psych drugs. Can’t dispo unless aox4 and past peak effect if the drug.

    • #6284

      Nursej81
      Participant

      As an ER nurse things like this happens all the time. I do not work at this hospital, but have seen this happen before. I’m sure there is a back story to this while situation. Was she disruptive, combative, non cooperative? To me it looked like she may have been assaulted? Looked like she had an abrasion to her cheek, and I thought it looked like she had an ice pack hanging around her neck. Obviously there were some serious psych issues here, and the whole situation could have been handled better.

    • #6288

      AndieeRN
      Participant

      You seem to have psych knowledge. You know how quickly a patient can go from acutely psychotic to completely normal depending on the situation and what they can gain from it. It’s the honest truth. No nurse in their right mind would discharge a psych patient like that AND the doctor needs to discharge the patient!!

  • #6276

    groovygrrlg
    Participant

    Working in the ER is different than working in any other area of the hospital. We do not have unlimited resources. As a charge nurse, I have taken lots of heat from administration for letting homeless patients sleep in my lobby until morning. As long as they are not disruptive or abusive to staff or other patients I don’t mind, and I’ll
    continue to let them stay. However, if you act like a damn fool when I’m trying to help you, you might get escorted out by security, which is what it looks like is happening here. I’m sure it looks “heartless” and there are questions about were all options exhausted before this happened. All I’m saying is that you’d have to do something pretty bad to be booted from my ER.

  • #6277

    Lynne
    Participant

    Omg I’m outraged!!!! Wtf…. we are providers, caregivers, advocates, protectors of the vulnerable….. and we did THIS to this lady??!!! Barely dressed, unable to speak, no where to go In freezing temps. She would’ve died of hypothermia in no time.. as apparently the hospital and security guards turned a blind eye to this woman’s vulnerability and risk of exposure and death. I am appalled. Someone needs to advocate for this woman now and make sure that she is forever housed in her own home/ apt by this hospital for their negligence… had this psychotherapist not passed by this woman and events that lead up to this, this person could have very well wandered off and died from exposure… assholes. And those security guards, rent a cops that think their tough.. what a bunch of pu**** for not speaking up or defending this pt, turning their backs and walking away. Regardless of this pt, psych or medical conditions… they turned their backs knowingly, and walked away, possibly aiding in this pts death by exposure… shame on you. What if this was your mother, sister, cousin, aunt, daughter…..

  • #6280

    psychARNPinthePNW
    Participant

    I feel like I have to weigh in here. Used to work in a midwest, busy busy busy ED. It was definitely a “safety net” hospital, and has come close to closing due to lack of finances by minutes, several times.

    Yes, we participated in patient dumping.

    We had about, 4 to 6 almost DAILY patients who would come through the ED, *usually* intoxicated, sometimes not. Yes, uninsured (and this was before the marketplace for healthcare). Their families would call 9-1-1, refuse to speak with medics, and the medics would bring the patient in, no history or CC. Rarely, family would drop them off themselves. Hand to God, “whats going on with X?” Family – “I’m going out of town and I can’t be home with her. She’s gonna have to be out of the house for a few days.” – WALKS OUT.

    Automatic IV, alcohol level, Utox, cardiac monitoring. They stopped the banana bags and went to PO vitamins because the bags were $1,000 to mix.

    Once we got results back to see how drunk they were, THEN we could put them in the hallway (no cardiac monitoring) and wait the hours until their levels came down to the legal limit.

    The ED was abused by these patients, taking up precious beds, using precious funding when we honestly had so little to spare. Many times, they don’t have a CC. They just show up. We HAVE had social services connect them to substance abuse treatment facilities, outpatient, inpatient, housing, shelters, single room occupancies, assisted living – they all had left, and we’d see them back 2-3 weeks later.

    The resources are there for those who want it. But the ED is NOT a drunk tank, it is NOT a baby (or adult) sitter.

    Depending on who the patient was – as some get very nasty while intoxicated – and depending who was in triage, we would sometimes let them hang in the waiting room for hours, give them sandwiches, let them sober up, and NOT put them in the system. While I was there, a few times we did guide them to the nearest bus stop. Nothing we were doing was going to help them, and its a matter of being able to keep the doors open or not. Thats the true face of healthcare sometimes. I’m with the hospital on this one. And the public gets to see what it can be like, but only from one side of the story.

  • #6285

    Smileyshel
    Participant

    While I understand how people are upset by this, it’s not fair to only blame the hospital. There are so many flaws with so many systems across the US.
    I work for a medium private hospital and we are the only trauma center for our county. We see so many patients who will never have a fabulous DC plan and sometimes we just do our best and hope for the best. Many of the patients have learned to work the system to take advantage of everything. At some point we have to say enough is enough!

  • #6286

    AndieeRN
    Participant

    For those saying “nope” this was intentionally an act against human dignity aren’t medical professionals. If you have any experience in psych you see this picture for what it is immediately. By all means if it isn’t than I think it’s horrible. But there is just too many things that coincide with a psych patient who is non compliant and trouble. We can’t force patients to do things this isn’t the 1960’s. There are all the social services available but do you really think we can force a patient to do anything at all let alone something that involves personal change and dedication and even a hint of stability? When have you ever seen four security guards escort a calm compliant patient to a bus stop?!? Exactly. I wish we could reply to other people #6065 really has no clue.

    • #6296

      Risgrig
      Participant

      I agree entirely Andie. There are services, and I can attest to seeing this particular hospital use them, and not in a picky-choosy sort of way. There were so many non compliant patients that I cannot even begin to count. They were often handed everything necessary; clothing, food, vouchers for bus/cab. Referrals to all sorts of resources before they even left the hospital. Nevertheless they would throw those things on the floor and wander out how they wished. You can not restrain a person. You cannot follow them around. There are limitations for what hospitals can do, especially if they’ve handed the patient everything they need. If a patient has been handed clothing/food/transportation/other referrals and wanders out half naked nevertheless, What employee is supposed to follow them around baltimore city? I recommend anyone who disagrees volunteer to stand outside the er and assist these people with the items they e been given. Let us know how it goes.

      • This reply was modified 1 week ago by  Risgrig.
      • This reply was modified 1 week ago by  Risgrig.
    • #6322

      OldCrone
      Participant

      PREACH!!!!!!!! People really do not get we can not make a pt do anything – they can refuse any treatment/intervention and any time for any reason. This is not the 1960s = so true. I once used the term with an MD that the pt was “Chronic self neglecter” (CSN) and the term stuck. Not all pts, but many ( many of whom are not even homeless) actively choose to not take care of themselves, follow education, or take help when offered. We can not make them take it. We are not talking about those who have financial issues. It may be due to being overwhelmed with all the bureaucracy involved, mental illness, distrust, disbelief (oh, the Big Pharm and anti- science comments or the “this Tx makes me pee too much”…etc…) = stuff that is not going to be solved in an ER much less a 3 day hospital stay (cause you know we just have empty beds up in med/surg and stuff right?). It is very difficult for non healthcare or healthcare that are in practices where they do not work with this population on a regular basis to get – maybe because it is so alien? And not thinking about the logistics behind the “solutions” they offer. Who, where, how and who will pay for it. Labor and medical equipment does not just fall out of the sky… Folks if it was really that easy… One has to wonder what tune they would be singing if it was them or a loved one who was out in the lobby for 13 hours truly ill and can not get a bed because we are having a person who is actively refusing Tx and we are trying to get them help the will accept.

      • This reply was modified 1 week ago by  OldCrone.
  • #6301

    98 nurse
    Participant

    Just making a remark don’t shoot the messenger. Homeless is a problem. For those that say the homeless receive food stamps insurance Medicaid or SsI with out a residence this is not possible if you are living on the street you are disqualified for benefits if you have no ID and have a address you cannot get benefits without ID . I know this because I run into this all the time. Yes our system is great but needs s lot of repairs. The amount of people living on the streets every where’s in America needs to be addressed for this se that say they choose this life we’ll have you ever lived in a shelter not saying they are all bad but most tell me they feel safer in prison. So I believe America has s huge problem facing our own homeless adults woman and children and yes there are hundreds of children living on the streets

    What’s the answer? I wish I new ,but the night in question was below freezing in DC
    Where were her personal belongings? Why three security officers for a woman who appeared compliant to the camera . This is just one of billions question how do we help the problemm

  • #6303

    Jana
    Participant

    I have to say I’m terribly disappointed in some of the comments here. Yes noncompliance is a major problem as is mental illness. However that woman did not walk out the of hospital on her own. She was escorted out into freezing weather with nothing on but hospital gowns and left at a bus stop! When did we start doing that? And saying it’s ok???

  • #6305

    TraumaTasha
    Participant

    I have worked in an east-coast inner-city level one trauma center. It’s tough, this situation is tough. Unfortunately we will never hear the other side of the story. We do not know what lead up to this lady’s discharge. Could this have been a ruthless discharge? Possibly, but I doubt it. For those who truly believe this is the case, please spend a day in an inner city er and help the nurses solve the worlds problems. It is harder than you think. Some patients have burned all their bridges with family, have been kicked out of every shelter or even more likely – the shelter has no room. What is an er to do when their 90 beds are full, plus 20 patients on carts in the hallways – which by the way we really don’t have staff for, but they are sick and need a bed. Add on the 40 in the lobby with 14 hour wait times. Sometimes patients cannot stay until morning just because it is cold. Tell me how they should have let her stay in the lobby – for all we know they did and she abused the opportunity. Tell me how they should have gotten her dressed first – for all we know they tried and she became abusive or started accusing them of assaulting her. Tell me how there are always resources for these situations – I promise you, there are not.

    I have spent entire nights calling every psychiatric facility in the state, handed the patient off to day shift and came back the next night to find out we still cannot find placement. Why? Because this was his “normal” crazy- apparently you have to be “abnormally” crazy to get a bed. Some people, in their most functional state, are worse than you would ever wish to be. It took this patient for me to truly understand how broken our mental health system is. It’s a cycle – become so mentally ill you are no longer safe, go to er, get admitted to psych. Spend a couple weeks inpatient, stabilize medications levels, discharge home/street/shelter. Slowly fall off meds, make multiple trips to the er only to be discharged because you still have enough capacity. Eventually, you are bad enough to begin the cycle all over again. But in the meantime, the er is stuck in a tough spot. It is not an homeless shelter, the doctors are not trained to managed psychiatric patients outside of crisis mode. So you set the patient up with the resources you can, sometimes they throw the resources back at you, call you a bitch and storm out the door. Sometimes they refuse to leave and they get escorted out by security. Sometimes that is in gown because despite my best efforts the patient becomes violent, refuses help, doesn’t like the color of the sweatpants I found.

    I know I wouldn’t want to be the nurse who discharged this specific patient, I also know similar scenarios play out every single day. For those who are disgusted by this video – take action, lobby, vote – help your communities obtain the resources needed to manage this challenging population in a more effective manner.

  • #6307

    PatientA
    Participant
  • #6308

    Zdogg i am so normally on your side 1000% but today i have to respectfully disagree. I used to do carecoord for the fresenius health plan and we tracked dialysis patients in several states . When i knew one of my patients was discharging i did everything in my power to work with e.r.s to help with either dialysis or actual housing or whatever so they could continue to have beds and the patients didnt suffer . NOW I WISH EVERYONE HAD THIS SERVICE ! But i deqlt with dementia patients and other patients disabled and not. As a dialysis tech i had my fair share of none compliant patients and patients who swang at me or all the jazz you just mentioned and i always worked towards solutions even in a time crunch. Nothing justifies what happened even the hospital put out a statement saying it was wrong. I feel in the health care profession we are so quick to get rid of mentally ill patients and i have not only experienced this professionally but just as myself as a patient. I have borderline personality disorder and hell some psych doctors dont even want to go near me with a 20 foot pole and it has been so disheartening. No human busy or not should be treated in that manner . There is always something that can be done. I have pulled miracle out my ass time and tikme again for patients and my self . I think the real problem is this why we need universal health care and better understanding of psychiatric needs across the board. Still have mad love for you but the empathy was not misguided and this should be a cry for justice and for better screening of mental illness during e.r. visits . Better procedures for mentally ill patients . We also need universal healthcare and more social workers and therapist in hospitals. We also need more care coord and communication between police hospitals and mental health departments in the states . This a call for change ik my opinion .

  • #6311

    essarge
    Participant

    http://baltimore.cbslocal.com/2018/01/12/woman-left-outside-baltimore-hospital/ This is what the hospital is saying and several agencies.

  • #6312

    Strelok
    Participant

    I’ve been in this hypothetical situation ZDogg describes (maybe not fundamentally, but in circumstances that weren’t life threatening, yes). More than once. And he’s not wrong. It’s sad to see this happen but the truth is this is also a byproduct of the society we live in.

    The hospitals and emergency rooms are over taxed by the excess of people who are homeless or have dual diagnosis i.e mental health and substance abuse disorders. People that have severe issues like this tend to lack stability in several areas in their life including relationships and resources. So when it’s -20° like it is here in Minnesota and you have nowhere to go because shelters are overflowing and you have no social contacts that can help you could find yourself having to choose between feigning suicidal ideation or breaking the law to get arrested, anything that means not freezing to death.

    More than once when I was ready to check out I had found myself having to walk around in the cold overnight, looking for places to warm up hoping I would make it until the local library opened up at 10 AM. Sometimes I was thinking about suicide just because I was already in a bad state of mind and didn’t want to risk an agonizing death freezing in the cold over a few hours as opposed to just a few minutes of suffering. Granted, my own decisions and lack of judgement definitely influenced my state of mind there as well, but there is a lack of adequate community resources too. It’s not okay to burden the healthcare system like this but also people need to realize this is a social problem and that mentally ill people tend to be marginalized when they aren’t suffering from acute mental health crises…when the resources aren’t available to help people maintain themselves, the mentally ill get way worse.

    tl;dr yes, it’s time to remind politicians that mentally ill and homeless people exist and that they need to direct funding and resources towards alleviating these problems, because they won’t fix themselves. Mental illness is not self-limiting or self-correcting. It’s chronic and it gets worse over time without proper care.

  • #6313

    ZDoggMD
    Keymaster

    Your comments deeply informed my show tonight, thank you everyone!

     

     

    • This reply was modified 1 week ago by  ZDoggMD.
    • This reply was modified 6 days, 10 hours ago by  ZDoggMD.
  • #6316

    Amysanthem
    Participant

    You really hit that nail on the head Z! It’s shameful and we must be the beginning of the turn around… you are correct that we have a huge voice if we would just come together and unite against the dumshit! Keep on Z & I will keep on sharing and liking and talking to my peers about the issues we face every single day in healthcare.

  • #6317

    Francesca Diamante
    Participant

    This could happen in any emergency department. Patients who don’t meet admission criteria can’t be housed in a hospital. We in our ER have gone to extreme lengths to assure the safety of discharged patients. We board and feed them in the ED. I have literally given patients my own clothes. (I keep extra in my locker.) We have arranged and paid for transportation out of our own pockets. We contact THE shelter. Have even transported people in our own vehicles because we are located in the middle of a soy bean field, and the nearest cab company is 30 miles away.
    This is generous of us but is a threat to our safety.
    A young woman was once refused by the shelter because she had brought her (abusive) boyfriend in to the shelter to have sex with him. Lack of shelter is often related much more than a lack of resources,kindness, or generosity.

  • #6321

    Sogross144
    Participant

    I have been out of hospital nursing (which did include inpatient psych) for a long time but I am still involved in healthcare and I can’t help wonder what happened to compassion and safety. How can this be a safe discharge??

  • #6326

    SCyankee
    Participant

    As a healthcare professional I always try and look at the agenda of the person or organization that try’s to advance their political goal or agenda when I comes to “news”.
    Everyone is a journalist when they have a cellphone in their hands but let’s pretend for one minute we are not an activist and trying to advance our agenda. Let’s assume that the average individual with no gain came across an individual whom we felt was scared and COLD. I would like to believe that the first act of kindness and compassion when called to action with compassion wouldn’t be to whip out a cell phone but to offer this cold, shivering woman YOUR JACKET!
    As a man, father and husband I couldn’t imagine seeing a situation where I felt injustices were obvious and my first response being to reach in my pocket to pull out my phone. We all know the system is flawed. Not once does he offer to help her find a warm place to stay, help her get dressed, help her find food and shelter.
    Instead do what all armchair social media commenters do; blame a system we already know is failing in so many ways without offering an idea or solution to ensure this does not happen again.

    Put the phone down and Man Up: at least offer a freezing woman your jacket!

  • #6327

    jlangdale
    Participant

    My father was a Vietnam veteran who had some psychological problems, or perhaps he had a homeless problem that amplified what are normal psychological issues for people. Instead trying to go to the ER repeatedly to sleep on a cold night, his “solution” was to go rob a Federal bank then stroll across the street and order beer while waiting to be arrested.

    I know this because I can easily recall many times him advising me to do precisely this if I ever fell on hard times and became homeless, after having served my country in the United States military, which I did do.

    I’ve not yet had to rob any Federal banks yet. He died of pancreatic cancer while waiting for arraignment, after he immediately robed another Federal bank, after being released from prison for the first robbery.

  • #6329

    MTECH
    Participant

    Honestly I believe that this goes on in every hospital nationwide. Yes we have DC planners and social services but in most part this is done as a requirement by the state you live in and the beloved joint commission. The homeless and psych patients are beginning to outnumber the other patients. It’s a vicious cycle that is only going to get worse…do you see it getting any better? Hospitals have to do what ever it takes to empty a bed and that includes bus stops. My facility has paid many cab companies to take patients away and I cringe at times when I know what is really going on. People are not well informed about their own healthcare and what it does and does not pay for. How many times have you heard “I thought Medicare paid for that?”

  • #6330

    Vgsgrl
    Participant

    I have worked in 4 inner city level one trauma centers in my 22 years as an ER RN . 3 if which were east coast And one here in LV . We see these patients on a daily bases esp at the end of the month and esp in extreme weather conditions .
    The resources are limited and the patients know the magic words to accommodate their needs . They also know their “ rights “ and will like a small child push their limits as far as possible .
    What’s the answer in keeping our staff , our patients and our patients families safe ? I believe like you said we need big brother to pull their head out of the sand and realize what is really happening to our society . What funding funding really needs addressed . Not just HCAPs And surveys. When they pulled the funding and closed the mental facilities is when those patients had no where else to turn .
    We need that funding back some how some way , I’m sure their is enough tax money available. Perhaps using the money certain elected officials use to commute across country on a weekly bases , perhaps using the funds allotted for public officials to fly on private chartered planes as opposed to flying southwest Section B like the rest of us fly .

    The money is their the priority is NOT !

  • #6331

    NurseVA
    Participant

    I’ve worked in inner city hospital like MCV in Richmond and moved to a smaller more community hospital and nothing has changed just the faces. As a case manager/dc planner I deal with this same issue every single time I work, every single time-Your ” hypothetical” theory is right on point!! Having searched for weeks for mental health beds(there are none), there are also no MH clinics or MH follow-up clinics. Having patients remain in acute care, when MH is needed, with a care partner sitting at the door because the patient isn’t safe. Calling the city MH services review board who is supposed to perform screening is a joke. Turn around is often more than 48hours, and their evaluation is sup par but we have to call them because they are the ones with the beds for under or non insured patients. WE offer referrals, free pcp follow up in the clinic that the hospital runs, assistance programs for shelter, transportation and free medications. Then there is the anger because we don’t provide d/c narcotics. Between that and the non existent services for heroin users . It’s disheartening and frustrating-not why I attended nursing school. But I keep marching forward sometimes slowly 🙁

  • #6332

    ShyahSmiles
    Participant

    I worked in this ER for 4 years. Granted, I don’t work there now, but I can tell you that in the years I was there, we NEVER discharged to street if at all possible. We worked our asses off to get placement. People who ended up on the street in a gown gave us no choice. They refuse shelters, they refuse detox and often refuse to get dressed because they are adamant that they don’t have to leave. If they are not a true threat to themselves or others, we cannot place on 72hr hold. They become belligerent and combative insistent that they are staying and we cannot house the entire homeless/psych/addict community in Baltimore.

  • #6333

    lil deb
    Participant

    I’m on both sides of the bed, ICU nurse for Level 1 Trauma with a little moonlighting in the ER. I have a son with autism, mental retardation, and bipolar disorder. It’s not pretty, cute little autistic kids grow into hulking teens, and the empathy and compassion go right out the window. My son has been turned down from every single public institution in my state. Every. Single. One. Because they do not have the resources to deal with an autistic individual who routinely becomes violent. I have been told repeatedly that I will have to give up all rights to get him help, because the state hospitals and institutions are not willing to accept him unless it can be demonstrated that he cannot go anywhere else, that he is in essence abandoned. We have one private institution, they accept no insurance, basic services are $500 a day. That is why the ER and jails have become the frontline providers for mental illness, because they can’t refuse. Everyone else can.

  • #6334

    DrAllison
    Participant

    About the UMMC patient dumping Post- I lived a few blocks from there, at 519 W Pratt street and walked past them daily from my parking garage to my apartment. I saw patients being “dumped” regularly. I also worked in the ER at Johns Hopkins Bayview and patients were routinely “dumped” out too. It went down like this: once the doc signed the DC order, the pt was no longer the RNs responsibility. Due to the high volume of pts, understaffing of nurses, and sheer lack of beds, getting people out as quickly as possible was the priority. The RN would print out the dc instructions, breeze through them with the pt then hand them off to a CNA or transport staff with the instructions of “see them out”. These barely over minimum wage staff often saw worrying about doing anything beyond what the RN said as beyond their pay grade. So out the people went. It’s all the hospitals in Baltimore, not just UMMC. Johns Hopkins main campus is also guilty, Mercy, Bon Secours, GBMC… I could point to a lot of issues with Baltimore in general as the possible root cause of this problem, but I’m not sure you’re interested in that. The point is it’s very common there, and outrage about it from the locals is nonexistent. 😟

  • #6335

    Tx_nurse
    Participant

    Having the background of working both in the ER and psych I can tell you we have never discharged a patient from the ER without clearing psych because of the liability. Unfortunately for some patients with psych history their baseline their normal day-to-day would have any normal person hospitalized. However we’ve done away with the asylums many years ago. People have the right to choose or refuse their treatment or hospitalization. It’s like a diabetic patient that refuses to take their Metformin because it causes their stomach to hurt is noncompliant with their diet because they wouldn’t be able to eat their favorite foods and candies. When their legs are amputated no one is crying out how the medical system has done them wrong even though it is the same thing a person with a diagnosed problem refusing treatment. Just because you have a psych history or a drug problem you do not lack capacity. Many hospitals do not have social workers they do not have a donation bin to give free clothes or if they do everything’s already been given out. Also if she’s been at the hospital they have emergency contacts they have a way of finding family. surprisingly though many families don’t answer when they see the hospital because they know who’s calling and why. Now that the media has picked up the story of course family is stepping in and coming out.

  • #6337

    TraumaTwiggy
    Participant

    There’s recently been a revamping of mental health screenings and “mental hygeines” that deem if a patient is competent to make decisions or eligible for involuntary treatment in WV. It was a state wide change. I’ve worked out here on travel contract. The changes caused such strict guidelines to be followed to actually deem a patient involuntary that people who would clearly appear a threat to themselves or others cannot get committed. In the 6mo I worked here it went from most hygiene being approved to rarely being approved. Our ER physicians have refused the current on call assessment by the hygiene hearing and actually held patients in the ER until the next shift was on for hygienes to get someone else to try and approve it. It is so incredibly difficult to force people to get help. We can only do so much. Let alone if they change their story once they are being interviewed to manipulate the system. That burns bridges instantly with social work, docs, nurses trying to help.

    • #6343

      Dolycha
      Participant

      I’m from WV as well. The situation with my aunt happened in WV, but my daughter’s situation happened in FL. The bottom line is that the schizophrenic population is SEVERELY at risk…because there is no adequate care, they are usually NOT successful in a group home scenerio (they need more intense care than group homes offer) and then the STATE itself hires an attorney so that even when a family steps forward, it can cost thousands of dollars to fight the state to gain guardianship. It’s a total disaster for this particular diagnosis all around.

  • #6339

    Spent a few years as a RN psych Liason in a well know Ca Central Valley ED! I wrote 5150’s for placement. I can honestly tell you in my last year there, I wrote 10 holds at the most! The rest were written by PD and we had a LOT of 1799.1! Some with psych history but about 80% on meth aka Methitis! On any given night these fine folks would need to he escort off the property, because they refused to leave they wanted to eat, drink 7up and sleep! And first thing in the morning they wanted or demanded to be discharged! I have been called every name you can think of, spit at, kicked at and punched at as well! Had to ask security to walk people off many times and be threaten that I was going to get my ass kicked when I got off in morning! My non-nursing husband was more afraid for me then I was for myself because I thought I could really help someone. I quickly found out those ppl really wanting help were far and few between. Mostly of the local psych facilities and stabilization center are just being used like a detox, only to have these people go back on street, get high and be back in ED! What did it for me is being in that ED with 38 so called psych patients and I did not place one of them! And let 20 of them go at 5am! I would ask most if they wanted help and they would decline! That was enough for me! NEXT🤦‍♀️

  • #6341

    BabyFlower
    Participant

    I have been in a hospital gown, to think that someone would push me out in the cold wearing only that… (I’ve had an appendectomy.) However, I know what it’s like to deal with someone who on the outside everyone would think they are like everyone else and are capable of making adult decisions, however, they are not. We need a system in place to make power of attorney easier to get. This person also refuses to get a cognitive test because they know already what the results are going to be. (He doesn’t want to be told he’s stupid, even though his medical care doctors have asked him time and time again to take this test, he refuses.) People see this person as an adult as an honest actor in things when they aren’t. As the adult child of this person, your hands are tied. You can’t force them to get the test that they need to prove their incompetence and honestly, I don’t know what to do. My mom helps a lot and does everything for him, but if something happened to her, I don’t know how I’d survive. Sorry if this is a bit personal, but, it’s hard to know what to do when you feel like you can’t do anything. If I lose my mom, I’m lost… I’m not a doctor but I am a caregiver and sometimes it’s really hard. There should be something that helps us. I don’t know what to do. He can fake it for other people for a time being… But after that, when he’s spending months painting and stripping the same thing over and over again, inhaling all those fumes, no matter how many times you tell him to stop… I’m not big enough to apply the force needed to stop it. So a lot of times I let him huff whatever, because at least for the moment he’s not being an ass to me or my mom. I wish I could say I was a better person and was able to stop him, but I can’t. So in the end what do you do? I don’t have the answer to that, I don’t know. If you know, please tell me, I am lost.

  • #6342

    Dolycha
    Participant

    Getting guardianship is darned near impossible. My daughter is deaf and schizo. When she went off her meds she had a break, and became very irrational. I did my best and of course because she was over 18, they refused to give me info and since she was suffering paranoia, she refused to cooperate and they discharged her. I had no idea where she was and filed a missing persons. I went to an attorney, who told me it would cost $5000 up front to get guardianship because the state would appoint a defense attorney for her. The attorney told me that because the state appoints a defense for them (who will convince them to take meds temporarily) I’d literally have to fight the STATE for guardianship. The STATE defends these people from the very people who want to step forward and help. Back in the 80’s they closed all of the facilities that could help. Schizophrenia runs in my family. I had a great aunt in residential custodial care, who was originally admitted because she tried to kill her husband and herself and was a danger. She was completely non verbal, but she was a violent schizophrenic. They sent her home to live with us when the facilities all closed. No nursing home would take her. Nothing. My own daughter had episodes of violence as well…I had to have police intervention several times from the time she was 16 till she was released to the streets and dissappeared at 18. She was deaf too…so for 6 years, I had no idea where my child was. The system and the government absolutely suck and do not protect these at risk groups. Mental illness is real and sometimes requires long term care, but long term care is non-existent. Group homes (which my kid was tried in) do not work for ALL mental patients. Schizohprenics are known to be uncooperative and can be dangerous due to their delusions….and there is literally NOTHING you can do for them because of how the system works…and the system is a complete failure for them.

  • #6348

    CarolynMCA
    Participant

    I provide voluntary medical care at our local homeless shelter so have another point of view; which is, this was clearly an unsafe discharge.
    If she refused assistance in any way, most likely she lacked mental and/or intellectual capacity to make safe decisions for herself.
    I absolutely agree this is an untenable situation for the ER….I do!
    But, hospitals are mandated to ensure safe discharges.

    I also realize the burn out that comes with interacting with this very challenging group-of-often frequent flyers who because of mental illness do not trust the ER staff and/or do not really want care.
    The ER is not the place for them however, at the moment, as we see ~ there are sometimes, few options.

    No matter what – an unsafe discharge is unsafe and not okay on any level….ever.

    For me, the hope of this story is exactly what you are asking for:
    increased awareness of the true realities of mental illness, substance abuse, poverty, and injustice;
    discussion on a much more honest and complete level;
    involvement, attention, resources and commitment by those with authority and interest in solving this problem.

    I hope this does all that and more…

    • #6352

      BuzzyRN
      Participant

      I so agree with Mentally ill are treated like Pirahas in this country for the most part. the people who advocated to get rid of the residential care facilities for these patients, never came up with alternative

  • #6349

    Sujatha
    Participant

    Guardianship laws must vary from state to state. In California, about ten years ago, I saw many adult chronically mentally ill patients with state-appointed guardians. It was done while they were in the hospital and then continued infinitely, although a doc had to sign off on a form periodically.
    I guess it might be different if a family member is the one working on it, instead of the hospital. Maybe a good topic for Zdogg to cover on a future program?

  • #6350

    BuzzyRN
    Participant

    I have been a nurse 25 years and have worked all areas of the hospital am now currently a case manager, and this video could have been shot in any city in America. There are limited resources for mentally ill patients with insurance and virtually none for people who are homeless, poor, uninsured. most of the mentally ill like this are also addicts ( it’s my belief that they attempt to self medicate a lot of the time due to no access to medications). These patients are almost impossible yo place lots of shelters will not take them because of issues with staff and other residents in dealing with them. most families don’t know how, understand or have time, money or energy to take care of them. This is the real crime in this country…. you can’t MAKE these patients take medication, they often time refuse, nobody wants them so they get picked up by police who don’t know what to do with them and they bring them to ER who they think can help them. someone in ER will try to admit them thinking they are helping, ( 3 hots and a cot) but you can almost never find a good SADE discharge plan for them. We need to find a way to fix this

    • #6353

      BuzzyRN
      Participant

      state appointed guardians have hundreds of people they are “guardians ” for. the ones I have dealt with were always unavailable and uniformed about the people they were supposed to be caring for

    • #6354

      Sujatha
      Participant

      Yes I agree about the state guardians. You end up on the flip side which is over-medicating. But at least there’s a way to get med consents and keep patients from blowing their income and ending up on the street.

  • #6351

    Msconcernednurse
    Participant

    I worked as a contracted nurse at UMMC MIDTOWN Campus in th ER. And I will tell you this, the staff there are wonderful people, they are very caring. They work really well together and they always get the worst of the treatment by some of the patients who come there, especially the ones with mental illness. I watched the nurses and tech on the psych holding side have to deal with the irrational patients on a daily basis. I have worked at a lot of hospitals and I seen things like this all the time. I also know that if security had to escort her out then that was definitely a last resort. We as staff at midtown ER only called security when things got completely out of hand. It hurts me to see that someone tried to exploit the staff and hospital without taking into consideration what goes on there on a daily basis. I’m also happy that you reached out to them to find out what’s going on. That ER is not a trauma hospital but will receive traumas on a daily basis with minimal resources also they receive numerous psych patients and only have a holding which can fit up to 5 patients. The ER only holds 21 beds and is not equipped for the census in which they receive. I can go on and on. But what I will say is this, I was proud to be an ER nurse at UMMC MIDTOWN.

  • #6355

    Lesleyeb
    Participant

    Amen on your video. It said everything I have been fighting for over the past few years. I am the system social worker for a catholic hospital system in one of the nations poorest and reddest states, Alabama. My entire job is to place the most difficult patients in our five urban and rural facilities. When the Cm or sw on the floor cannot solve the discharge barriers, the case comes to me. They live with us most times until we come up with something. The lengths the hospital has to go to are incredible. We have hired PIs to find family to help, bought plane tickets to other countries to send them home, rented apartments, paid for nursing home stays, paid power bills. The list goes on and on. The hospital carries the burden of fixing these patient’s problems all in the name of a safe discharge so we can make room for the acute patients who need to be there. All of this without help from the government. Our state is stingy and cruel towards the poor and vulnerable. The system is so, so broken. So when I hear a story like Rebecca’s, it breaks my heart for everyone involved. For her being one of society’s discarded and forgotten and for the hospital employees who are trying our best with our hands tied behind our backs. You are so right about the media spin. There is always more to the story and the outrage can be misdirected. In Alabama, our governor refuses Medicaid expansion and then wonders why our hospitals close. They defund mental health and wonder why the waiting list for a group home is years long leaving people to wander the streets. Our shelters run on such tiny budgets that they depend on local restaurants to kindly donate food. Undocumented immigrants are no longer eligible for our county hospital program and are barred from purchasing private insurance leaving them to use the ER as their pcp. What are we supposed to do?Doors are shut, resources tapped. Case management is caught between empathy and reality. We are slammed for length of stay and readmissions. I get so tired of looking patients in the eye and telling them I have nothing to give them. Last week a patient’s daughter pleaded with me on what to do and I had to honestly say “move out of Alabama if you can”. Thank you for speaking up for us. Thank you for joining us in this fight.

    • #6369

      Valkyrie
      Participant

      Lealeyeb hit the nail on the head. We’ve done these things, also. I’m a hospital CM in GA. We don’t have psych, but the local mental health will send patients to the ER at the end of their workday for “medical clearance” and placement. If they require crisis intervention then they may be in the ER for days without psych treatment. If someone is homeless and has a mental health diagnosis then they will be in the facility for 14 days waiting for a Level determination. If someone is unfunded then the LTC facilities will not take them. There is not a homeless shelter or warming center in our region. Social workers and case managers are expected to find resources where there are none. In the beginning we’re told to find a plan. Later, as the days and weeks pass without placement, we’re hounded by the nurses and physicians, who are tired of seeing someone without medical needs…unit directors,who are struggling with a staffing shortage…and all of the bean counters watching LOS and the bottom line. So there we are, firmly mired in ethics, justice, stewardship, empathy, and reality. We love what we do, but we’re tired.

  • #6358

    MsDemeanor
    Participant

    I am so glad you said it, Zubin. I’m sick and tired of people contributing to problems by blaming a group of people rather than discuss how we address it. Our jails are full of people like this woman, but at least they arent out in the cold. I’m not as upset about how they are being handled by medicine as much as it disturbs me to know that the basic amount of human decency in our societies has dwindled. Families think nothing of putting their loved ones out on the street and literally do not care where they are. God damn Hipaa wont even let hospitals tell a relative that DOES want to know where their loved one is at, where the hell they are or if they have been there. I hate hipaa for that. Dont they see how they are contributing to this, or is there something I’m missing?

    I think a good start would be to make more shelters, but even that is not going to help unless we have a plan to connect them with social service systems that can train the avg layperson to assist their recovery. Being homeless is no picnic. Its trauma inducing, and causes a need for some type of debriefing in most people, and it needs to be addressed first before we can expect any change in the behavior of the majority of these folks.

    • This reply was modified 6 days, 16 hours ago by  MsDemeanor.
    • This reply was modified 6 days, 15 hours ago by  MsDemeanor.
  • #6360

    Bmoremedic
    Participant

    Doc,
    I am a medic with the Baltimore City Fire Department for 18 years. I can attest to this very broken system as well as the overburdening of the local hospitals ED which has been going on for years now. The volume of EMS responses in the downtown area has drastically increased. Many of our patients, such as this young lady, are repeat users of the medical funnel in Baltimore. We transport certain individuals, sometimes the same person 3-4 times a day, to the local ED. Many of these transports are due to psychological or substance abuse issues. The hospitals in the area have been extremely busy over the last several weeks as evidenced by the Maryland CHATS system. With this said, these individuals are known by EMS, hospital staff and police on a first name basis.
    The vicious cycle begins when when EMS picks up a patient. (Same patient we pick up every day for the same complaint) EMS transports the patient to the hospital. (Sometimes being verbally and/or physically assaulted during transport.) The patient get to the ED, which they have been seen in multiple times over the last several weeks for the same complaint. Tests are performed by hospital and patient is usually informed to stop using alcohol and/or drugs and to call social work in the morning to arrange some type of outpatient treatment. Patient is discharged. Homeless walk out the door and go where they go. Alcholics and drug abusers walk out the door and go to the liquor store or to their dealer. Cycle restarts.
    As for the psychological issues of some patients, most patients do not want to be locked up to recieve treatment. These people know the exact terminology to use with the medics and staff that will get them evaluated by psych services. Just as they know what to say to get them overnight stay for evaluation, they also know what not to say to get them involuntarily committed.
    Most of the psych, ETOH abusers and drug abusers are not nice patients. Assaults on EMS and hospital staff have increased over the years in the area.

    • #6362

      MsDemeanor
      Participant

      Is there enough being done to address it? City meetings? Networking to provide shelter, especially in the winter months…food, clothing?

  • #6363

    Shortyshay
    Participant

    I know the security personnel personally and have been trying to tell everyone that these people the guys in video
    are not like that at all the hospital only have a 28 bed unit with people who return all the time.I give give u countless stories where the worker have been hurt broken arms teeth knocked out can’t say anything fir fear of job loss where are the when you sit all night one one with pts people say then you should get another job then how is that solving the problem if everyone quits who takes care of them them have they ever had their face spit on kicked or punched and stand there and say please calm down while they are constantly being called everything but the child of God where is the compassion empathy for the workers who endure this everyday to keep thier love one safe from harming themselves and the public whos parents drop them off and say I just cant deal with them any more we need answers ???

  • #6365

    Dr. Leto
    Participant

    Z, THANK YOU for giving a compassionate, dispassionate (and still passionate!) voice to the nuance in this all-over shitty situation.

    I am a holistically-oriented (whole-person, not pseudoscience & magical thinking) Family and Community Medicine doc who spent the first decades of her career in the safety net, and who currently moonlights part-time for the state prison system to make ends meet as I launch my own little independent attempt at creating Health 3.0. I’ve worked in these ERs, I’ve done medical humanitarian/volunteer work side-by-side with local healthcare teams on four continents, and at this stage of my life I’ve chosen to settle and practice in a smaller, more affluent, progressive university town where we have more resources and proportionally fewer social problems. And yet, I still deal with variations on this theme every week, if not every day.

    You were spot on when you spoke of root causes, and the vacuum of societal leadership and lack of political will to tackle our challenging-but-not-unsolvable societal problems.

    I propose that the fundamental flaws in how the US – both as a society at large, and specifically our healthcare system – deals with mental illness, poverty, social marginalization and “social failure to thrive” comes from one foundational error in our approach:

    # In most of the rest of the developed world (European model), they tend to socialize their medical problems. In the US, we instead medicalize our social problems.

    – Other developed nations invest far more into the Social Determinants of Health, building physical health, mind/body well-being, and resilience for all members of society at a far lesser investment cost and with a broader reach (than one-on-one medical care). Z speaks well about this. 🙂

    – Building a large structure with dominating physical presence, working utilities (power/heat/cooling/plumbing, food and even drugs!) in the middle of a crisis zone, and sticking a giant neon sign over the door that says “Emergency Care” is an invitation to at least dysfunction, if not disaster. Most emergencies in people’s lives are not medical per se.

    – While a “medical model” of addiction, mental illness and complex social problems is certainly more appropriate and compassionate than criminalizing these folks, it leads to the faulty conclusion that hospitals or prescription pads can “cure” the problem – and even that all problems are curable.

    – Our “take a pill for every ill” culture pretends that complete wellness is always the appropriate immediate goal, and imagines we can achieve that with a magic little prescription that requires no effort on the part of the patient. Then people and payors get mad at us when that’s not actually feasible, and insinuate that we’re lousy clinicians when our patients have challenges that are beyond our scope to repair.

    – Measurement and payment systems that set the goal as “perfect health” will always penalize Crisis-Stabilization and Harm-Reduction work for complex social-behavioral issues. Yes, regular exercise is good for cardiovascular health, but that doesn’t mean that we put people on the stairmaster while they’re infarcting. We take them to the cath lab where we can render Crisis Stabilization care. Then we put them on aspirin and a statin for Harm Reduction. But when someone stumbles in, unreachable and self-destructing from life traumas beyond their current skillset for coping, Health 2.0 penalizes us for not achieving things that really don’t matter to that patient at that moment: their blood pressure, their A1c, complete abstinence from opiates… What does real social Crisis Stabilization and Harm Reduction even look like?

    – Unless/until we can actually remove someone from harm’s way, it’s all battlefield medicine: patch ’em up well enough to throw ’em back out to the front. The reality is that most human beings just don’t have the potential, while they are in the midst of a crisis, to undertake the kind of life transformations involved in becoming socially well: being responsible for oneself, understanding Choice and Consequence, developing the skills and self-reliance to be able to let go of a “crutch” such as an addiction, etc…

    – Another unintended consequence of medicalizing social problems is that it lets the real live people who have perpetrated and perpetuated the social problem(s) off the hook. How is the unwell person who has been damaged incentivized to learn responsibility and self-management skills when their abuser gets to dump them off at the ER triage desk, mutter “She cray-cray” and slink away scot-free without ever being held accountable? Health 2.0 doesn’t have a monopoly on systematized dysfunction: it happens in our families and our communities, too.

    • #6366

      ZDoggMD
      Keymaster

      What Dr. Leto said. That.

    • #6375

      MsDemeanor
      Participant

      Hell yes.

    • #6374

      MsDemeanor
      Participant

      Will you be my primary? Lol.

  • #6370

    Margot
    Participant

    Mental health… all of us want us… few of us spend much time trying to achieve it, as it certainly is not intellect or cunningness. (I know that’s not a word, but should/ could be.) I have been working with incarcerated students and have not found a peer group to speak to on my observations. I have wanted to be a bridge between agencies and have addressed the substance crisis as an issue directly related to trauma and pain relief, all levels. I am defending a PhD in Social Justice this year. I have worked in social justice for three decades, I’m so sorry and devastated to report that this video is just a glimpse of the picture, a scratch on the surface. Can you imagine the mental wellness of our incarcerated. This woman was disregarded as millions are each year. Even calling the police and bringing her to a mental or detention facility would have been more humane, this was attempted murder. Our health system is a form of slavery that perpetuates inequality and illness itself. Has anyone checked the mental health of leaders and followers that continue to have provocative conversation and drink wine while doing nothing? Keep blowing the whistle. Even when you do nothing but be conscious you shake the pirate’s boat. Thanks for creating this forum Dr. Z, soon to be Dr. Margot.

  • #6372

    Kellyrn
    Participant

    Our health system is just a moment away from imploding. This incident is just the tip of the iceberg. Insurance companies are directing what care we receive as doctors and hospitals jump through hoops trying to get reimbursed. And in all the gymnastics the under-insured and uninsured fall victim. Either through no services or not enough services ordered because it won’t get reimbursed, our sick, our elderly, our mental health patients become the victim. The insurance companies are getting rich off of human illness. And they have their hands in our politicians pockets.

    We need to unite- patients, doctors, health care administrators and institutions and say it is not okay for our nation’s health to be decided by the dollar bill.

    Insurance companies are paid to cover illness. Period. They collect from masses who are healthy and young who do not need it. They make money off of them for years before they may need health care. Where is all that money? Now they want to turn around and state they are only paying for this or that because they have decided the patient doesn’t need it?

    We the people have allowed this to go on unchecked for years. Now we need to unite together to make it stop.

  • #6385

    MB
    Participant

    I would like opinions on how the hospital administration has thrown the staff under the bus by stating er did not follow the hospital’s mission?!

  • #6393

    Hometowngirl0325
    Participant

    I have been to this hospital I have seen first hand. Yes the system is broken and again we have no idea the facts that led up to this event. However, from first hand experience and not in the ED department, this hospital drops the ball a lot. I had a family member admitted due to a massive stroke. Couldn’t move could barely talk. They allowed her to urinate on herself multiple times when she would alert the nurse she needed to use the restroom, then they would get mad that they had to change the bed. I myself asked the dr numerous times about getting something on her to prevent drop foot and was told it was too soon to worry about that, well guess what the result was drop foot. My family member has come so far thanks to the rehab center she was sent to. She is up walking and talking and doing great. Sadly she needs a brace due to the time spent at the university of md because of drop foot. The hospital was dirty and staff was rude and dropped the ball on many occasions. Yes the system is broken and I am sure the hospital and staff are frustrated, but they still need to provide adequate, actually better than adequate care to everyone, and especially those that are not frequent flyers.

  • #6394

    Abagayle
    Participant

    Hospital systems have many flaws. I have no experience working or living in Baltimore. Having said that, the news clip shown on the West coast that’s I saw, seemed cruel… . After reading, & learning more about the story, I can understand how this patient population does not need to be in the ED, but rather, some form of a mental facility. Of course, the media doesn’t give all the details. Rather than putting a mentally ill person back on the streets, the USA needs mental health care facilities for this population… it is always a placement issue, & they are back, in less than a month.

  • #6399

    MackTbone
    Participant

    I work on developing appropriate ED systems to manage the behavioral health population. The challenge is standardizing care while individualizimg treatment. Furthermore, each location has unique challenges, sometimes legal , and the differences in authority to treat are, vast, sometimes unknown, and often create an impossible treatment environment.
    Regulatory bodies want nothing to do with this population, and while we create awards for populist areas of medicine, we punish facilities who actually meet their EMTALA obligation to stabilize the mentally ill. It’s costly, dirty, sometimes dangerous, and the public have no clue as to the barriers.
    We NEED to create a universal standard of care framework for this PT population that we can then adjust to fit the local needs, and it needs to be based on parity and equity to traditional emergency medicine. AND, we need to modernize our delivery if care model and our legal basis for treatment.
    Too often these pts are forced out, tied down, forcibly medicated, unconstitutionally transferred, or worse. Our “non-system” is SHATTERED, and it must be fixed.

    I’m hoping to start a full telebehavioral health project in Vegas soon to see how the impact of 24/7 Access to Psychiatry impacts the treatment and decision making in the ED.

    • #6407

      MsDemeanor
      Participant

      Thank you for speaking up.

  • #6402

    Shana
    Participant

    I have spent the majority of my career working in emergency psychiatry in urban hospitals in Washington, DC, Philadelphia, Honolulu, and London providing both direct services to patients and in hospital administration. I led the threats to staff committee in a hospital as well and developed a ‘super user’ program for a very busy urban hospital in Washington, DC to manage services to patients that frequent the emergency department with a myriad of problems including mental health, addiction, poverty, social problems and you name it they came to the ED for it. I consistently worked with the team at our hospital to implement systems and address problems related to all of these issues and to find a way to both provide high quality patient care in an ethical manner but also protect our healthcare staff from aggression and violence. This is a huge problem and a very difficult problem to tackle. I often attempted to coordinate with the District of Columbia Homeless services, whom at the time refused to meet with me to develop a coordinated approach in the winter to ensure proper discharges from our emergency department to homeless shelters. In fact at the time, there was a system in place in the city that if the temp’s fell below a certain point they were mandated to provide shelter and had a number that one could call to transport patients to the shelter. But the issue was, that number would refuse to pick patients up from the hospital ED (they stated it was a liability issue because sometimes the patients were too sick for them to handle so they stopped coordinating with hospitals completely). We had to send out patients across the street from the ED to call the number from a non hospital number to get picked up or otherwise we had to provide the transport ourselves. I could go on and on and on about the struggles coordinating services between the hospital and our city/government run programs for our most vulnerable patients. I became very active working with some amazing advocacy organizations and nonprofit organizations providing services to our behavioral health and homeless patients and we were able to to develop some coordination that enhanced the care provided to our patients. As a result we were able to reduce the number of visits in our ED to ‘super user’ patients by over 50%. But this takes an incredible amount of work, resources, coordination and patience. Many hospitals do not have the resources or support to implement these types of programs. I was supported by a hospital that allowed me to develop a 24/7 emergency department team of social workers (2 social workers on the day shift 7 days a week and 1 social worker on the night shift 7 days a week) to manage social issues and behavioral health patients presenting to the ED. So yes, this situation that occurred is incredibly sad to see and I believe that clearly this was not the best decision, however our emergency departments are not prepared and typically do not have healthcare providers with the training and expertise to manage complex psychiatric and addiction issues. Patients often board in the ED for the ENTIRE course of their treatment due to difficulty with coordinating patient transfers to facilities that are able to meet the patients needs. This video is a symptom of a major problem in our healthcare system that needs to be address. I continue to work on this specific issue to this day through two companies I have developed to address behavioral health boarding and access through technology to decrease psychiatric ED boarding and through a training and consulting company teaching other healthcare providers about the system my colleagues and I developed to manage violence, aggression, disruptive patients and ‘super user’ patients in healthcare organizations. I will say that I am happy this video appeared, however I am in complete agreement that the conversation should not be focused on what assholes this one healthcare organization is but rather the systematic issues that healthcare providers are facing on a daily basis and finding solutions that will allow the healthcare system and providers to provide high quality and effective treatment all patients while keeping healthcare providers as safe as possible while performing their very difficulty job. – Shana ([email protected])

  • #6404

    RubDMC
    Participant

    Thanks to everyone who helped piece together the full(er) story.

  • #6409

    Nurse Rachet
    Participant

    I work in one of those cities where we had a State Hostpital. Almost 30 years later we have a huge problem with homeless mentally ill people. Our one homeless shelter is always filled to capacity. Our 20 bed acute staff hospital is always full, and even if they have a psychiatric hold on the patient, it only lasts about 48 hrs. The one outpatient psychiatric treatment center is always maxed out on funds and has a waiting list. I work in an acute care hospital and have taken care of 100’s of mentally ill patients over the last 26years in healthcare. We board them overnight, but does that solve anything? No, it is a bandaid on a much bigger issue. I also have a son who is homeless and mentally ill. And guess what? I cannot force him to be compliant with medications. I can not force him to be admitted for help. I cannot force him to be compliant with outpatient follow up treatment. I have been trying since the kid was 10 years old. Why as healthcare are we forced to solve the worlds social issues? Do I have empathy? Yes. Do I have sympathy? Yes. As a healthcare worker, we can only be expected to do the best we can, and to speak out when situations like this arrive. Thanks Zdogg for giving us a voice.

  • #6410

    Nurse Rachet
    Participant

    I meant to say in Topeka, Ks we have a 20 bed acute Psychiatric hospital. We also have 500 medical beds between two hospitals.

  • #6412

    essarge
    Participant

    I just found this from the mother on FB: https://www.facebook.com/oldladywho.ashoe/posts/1672715752767407

    • #6429

      MsDemeanor
      Participant

      How does she know that person was her daughter if she wasn’t there, and the face is blurred out?

  • #6413

    fromsquibs
    Participant

    I am sharing the link to your video on this to everyone who is posting the outrage video – politely asking them to watch your video before passing judgement on the hospital staff.

    Stepping down from my soap box. ⚡

  • #6418

    A.mouse.anon
    Participant

    As 911 and interfacility medic for the tristate Maryland area, who has been to every hospital in Baltimore repeatedly, all I can say is this:

    When the headlines said University of Maryland (e.g. Shock Trauma/UMMC), I was surprised by this story

    When I found out it was UMMC-Midtown (same system, different hospital) I stopped being surprised. Do me a favor and don’t let one location drag “Baltimore” medical down. In particular UMMC and Hopkins – their EDs especially – do a great job in difficult places with difficult people.

    Now you can say, in their defense, that they’re in an awful area of the city…but their patient population isn’t THAT different from UMMC, or Hopkins, or Good Sam, or Union, or even (city/county line) Bayview or NW or St. Agnes or Harbor. But again, I would have been surprised if any of those hospitals were in this headline.

    But I’m not surprised it was Midtown.

    You can’t handle a psych, transfer them involuntary to somebody who can. Don’t put them out on the street. Bottom line: They failed this patient.

  • #6420

    miamimama
    Participant

    How do we fix this broken system?

  • #6422

    EMR-Tagger
    Participant

    Grant me the serenity…

    • This reply was modified 4 days, 13 hours ago by  EMR-Tagger.
  • #6424

    MsDemeanor
    Participant

    EMR-Tagger, you were saying ”
    The answer might be to find a way to contribute locally, personally; Smaller scale distributed care, home care, models like what’s happening in Vegas and elsewhere. Some of us must continue, unfortunately, to work within the broken system. But in less time than you might imagine, much of healthcare’s framework that we currently take for granted may no longer exist in its present form. ”

    A civil war against corporate America could help speed it up.

    Just a thought of course.

  • #6447

    rachmaninov3
    Participant

    I am a family medicine physician working as a nocturnist in a small regional medical center in the rockies.

    I propose two solutions, and welcome feedback from everyone:

    1) RE-OPEN MENTAL HOSPITALS. I have only heard of the “horror” of the mental health hospitals that were closed due to inhumane conditions in the 1960s. However, I can’t help but wonder if re-opening them with actual oversight might solve a lot of problems. Before, when there was a place that took away your rights in order to provide a roof over your head, being “crazy” was a bad thing. Now, being “depressed” might actually get your disability benefits. We live in a society where people are too depressed to work, but not too depressed to manage their own finances. Over and over again, we talk about “a place to send THEM” and yet there are no places. I know we already have a healthcare worker shortage, but would having mental institutions be a solution?

    2) LEGISLATE LIMITS TO EMTALA. I know I am cruel and heartless. I know that when it is cold or when there has been increased violence against homeless people, and the shelter won’t take you because you are drunk, the ER is the place to be. Who wouldn’t do that if we were in the same position? It is worth crying wolf and saying you have chest pain to have your maslovian needs satisfied for the night. However, when someone has 365 ER visits per year the system is broken. Again, we need “a place” to send people.

    So please, for those who may have had experience with actually mental institutions, please let me know what holes you see in my ideas. As Zdogg says, we need to fix the problem. As medicine is still based in science and not just pushed by economic interests, question me, question everything, only through frank and honest discussion using logic over feelings can we find a solution.

  • #6459

    MsDemeanor
    Participant

    I agree with reopening mental health facilities. Another thing I have always thought about is making “temporary disability” benefits mandatory in every state, and make it more difficult for people to be placed on permanent disability. A lot of people get diagnosed with mental illnesses that are not grave illnesses, and they get stuck on disability for the rest of their lives. Some even work full time jobs under the table, and continue to collect, when those funds could be used for someone who needs them much more.

    • This reply was modified 3 days, 8 hours ago by  MsDemeanor.
  • #6461

    nymary13
    Participant

  • #6468

    fromsquibs
    Participant

    I’ve kinda seen both sides of the story myself.

    Before working as a CNA I did a stint as a security guard at one of our local hospitals, noc shift. Two nights at the building that housed an urgent care clinic open 24/7 and the place where 72-hour holds were sent and three nights at the main hospital. I saw (and had to put soft restraints on and off) of psych patients being evaluated for potential need for a hold as well as patients who were on hold and were refusing medication.

    – There was one frequent flyer who we wouldn’t touch until she’d been x-ray’d because she had a history of wrapping razor blades in tape and shoving them up her whoo-ha.

    – One man who had been placed on a hold needed to be in restraints for everyone’s safety and the ambulance company had a policy against transporting someone in restraints. He wound up assaulting the EMT, jumping out of the ambulance en-route (the vehicle wasn’t in motion) and eventually had to be brought back to the ER for severe injuries sustained while eluding the police.

    – While at the site where the holds were kept I had a couple pull up in a cab. The lady was insisting that she had been put on a hold and there was a bed waiting for her upstairs. Now procedure was that a hold was transported via ambulance and the security officer on duty was called as the hold patient was leaving the hospital. Needless to say when I told her she wasn’t expected and there wasn’t a bed available (~30 bed facility that rarely had a bed free) she got belligerent and aggressive towards me and the admission RN for the urgent care clinic. Her husband was ineffectively trying to talk her down, but the more he did the more the more she escalated. She had burned the cab companies due to her violent behavior and they refused to come for her. Eventually we had to call the police and they trespassed her from the property as she continued to hurl threats and obscenities at me. As she went out the door I heard her asking the police for a ride home (which they told her the only place she would get a ride to from them was jail). This was a very cold (below freezing) December night and they were about 5 miles from home at about 2 AM.

    Fast forward a couple of years and I have an old friend as a roommate and during the first few months of rooming together we find out that he is bipolar and schizophrenic (they called it schizo-effective disorder). He had been self-medicating with St. John’s Wort and alcohol for years (which is, of course, the worst thing you can do). Over the course of the next year he has several suicide attempts and several holds. Never was I contacted by a social worker to try to set up an effective support program for compliance with medications – nothing. I was literally the only friend he had and he’d been estranged from his (abusive) family for most of his adult life. Eventually he was successful with a suicide in our apartment, leaving me do find his body (he OD’d on his lithium and two gallon bottles of wine).

    I understand how hard it can be for the medical professionals in the hospital setting to deal with mental illness, especially with difficult frequent fliers such as my friend. There must be some way to make our mental health care more robust – to keep up with these people before they go into crisis. I have ideas but I’m not sure they’re the right answers, all I know is we as a country, as a society cannot continue going on as we have been.

    *** BTW – many people ask me if I was concerned for my safety living with someone with schizophrenia – the answer is NO – most people with schizophrenia aren’t dangerous to anyone except themselves. ***

    Stepping down from my soap box.

  • #6469

    MsDemeanor
    Participant

    Hello fromsquibs. I salute you for your courage in attempting to assist your roommate. I agree that it is about time people take a stand and stop thinking they have the only answers that are possible for this population and start looking a little deeper into why we seem to think we have all the answers, but yet none of our answers are preventing deaths and hospitalizations, and in most cases— making the situation much worse. Its time for some unity on this subject so that we can make social services more accessible to these patients. Stay strong. I encourage to watch this video and share it with whomever you can. It is very impactful, and although I disagree that they can be “fixed”, as the song implies, I think it speaks very loudly to bring an awareness to those whose lives in seemingly has not touched, or at least perhaps, a “hopeful acceptance” of what we are lacking that has caused so much pain to others.

    • This reply was modified 3 days ago by  MsDemeanor.
  • #6484

    nymary13
    Participant
  • #6485

    nymary13
    Participant

    Uncivil Liberties. Mental Illness Policy.org
    By Herschel Hardin
    Herschel Hardin is an author and consultant. He was a member of the board of directors of the Civil Liberties Association from 1965 to 1974, and has been involved in the defense of liberty and free speech through his work with Amnesty International. One of his children has schizophrenia.

    The public is growing increasingly confused by how we treat the mentally ill. More and more, the mentally ill are showing up in the streets, badly in need of help. Incidents of illness-driven violence are being reported regularly, incidents which common sense tells us could easily be avoided. And this is just the visible tip of the greater tragedy – of many more sufferers deteriorating in the shadows and often, committing suicide.

    People asked in perplexed astonishment: ” Why don’t we provide the treatment, when the need is so obvious?” Yet every such cry of anguish is met with the rejoinder that unrequested intervention is an infringement of civil liberties. This stops everything.

    Civil Liberties, after all, are a fundamental part of our democratic society. The rhetoric and lobbying results in legislative obstacles to timely and adequate treatment, and the psychiatric community is cowed by the anti-treatment climate produced. Here is the Kafkaesque irony: Far from respecting civil liberties, legal obstacles to treatment limit or destroy the liberty of the person. The best example concerns schizophrenia.

    The most chronic and disabling of the major mental illnesses, schizophrenia involves a chemical imbalance in the brain, alleviated in most cases by medication. Symptoms can include confusion; inability to concentrate, to think abstractly, or to plan; thought disorder to the point of raving babble; delusions and hallucinations; and variations such as paranoia. Untreated, the disease is ravaging. Its victims cannot work or care for themselves. They may think they are other people – usually historical or cultural characters such as Jesus Christ or John Lennon – or otherwise lose their sense of identity. They find it hard or impossible to live with others, and they may become hostile and threatening. They can end up living in the most degraded, shocking circumstances, voiding in their own clothes, living in rooms overrun by rodents – or in the streets. They often deteriorate physically, losing weight and suffering corresponding malnutrition, rotting teeth and skin sores. They become particularly vulnerable to injury and abuse.

    Tormented by voices, or in the grip of paranoia, they may commit suicide or violence upon others. Becoming suddenly threatening, or bearing a weapon because of delusionally perceived need for self-protection, the innocent schizophrenic may be shot down by police. Depression from the illness, without adequate stability — often as the result of premature release — is also a factor in suicides. Such victims are prisoners of their illness. Their personalities are subsumed by their distorted thoughts. They cannot think for themselves and cannot exercise any meaningful liberty. The remedy is treatment — most essentially, medication. In most cases, this means involuntary treatment because people in the throes of their illness have little or no insight into their own condition. If you think you are Jesus Christ or an avenging angel, you are not likely to agree that you need to go to the hospital.

    Anti-treatment advocates insist that involuntary committal should be limited to cases of imminent physical danger — instances where a person is going to do bodily harm to himself or to somebody else. But the establishment of such “dangerousness” usually comes too late — a psychotic break or loss of control, leading to violence, happens suddenly. And all the while, the victim suffers the ravages of the illness itself, the degradation of life, the tragic loss of individual potential.

    The anti-treatment advocates say: “If that’s how people want to live (babbling on a street corner, in rags), or if they wish to take their own lives, they should be allowed to exercise their free will. To interfere — with involuntary commital — is to deny them their civil liberties.” Whether or not anti-treatment advocates actually voice such opinions, they seem content to sacrifice a few lives here and there to uphold an abstract doctrine. Their intent, if noble, has a chilly, Stalinist justification — the odd tragedy along the way is warranted to ensure the greater good. The notion that this doctrine is misapplied escapes them. They merely deny the nature of the illness. Health (Official) Elizabeth Cull appears to have fallen into the trap of this juxtaposition. She has talked about balancing the need for treatment and civil liberties, as if they were opposites. It is with such a misconceptualization that anti-treatment lobbyists promote legislation loaded with administative and judicial obstacles to involuntary committal.

    The result, …will be a certain number of illness-caused suicides every year, just as surely as if those people were lined up annually in front of a firing squad. Add to that the broader ravages of the illness, and keep in mind the manic depressives who also have a high suicide rate. A doubly ironic downstream effect: the inappropriate use of criminal prosectuion against the mentally ill, and the attendant cruelty of commital to jails and prisons rather than hospitals. Corrections officials once estimated that almost one third of adult offenders and close to half of the young offenders in the correction system have a diagnosable mental disorder.

    Clinical evidence has now indicated that allowing schizophrenia to progress to a psychotic break lowers the possible level of future recovery, and subsequent psychotic breaks lower that level further – in other words, the cost of withholding treatment is permanent damage. Meanwhile, bureaucratic road-blocks, such as time consuming judicial hearings, are passed off under the cloak of “due process” – as if the illness were a crime with which one is being charged and hospitalization for treatment is punishment. Such cumbersome restraints ignore the existing adequate safeguards – the requirement for two independent assessments and a review panel to check against over-long stays. How can such degradation and death — so much inhumanity — be justified in the name of civil liberties? It cannot. The opposition to involuntary committal and treatment betrays profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness — free them from the Bastille of their psychosis — and restore their dignity, their free will and the meaningful exercise of their liberties.

  • #6505

    D3513
    Participant

    I watched your video on what we can do about mental health and the state we are in as a society trying to deal with the mentally insane medically when there is minimal support socially. My question is this: these patients have a right to refuse their medications, and often do while preferring to self medicate, so how are you going to force care on them? It’s not as simple as you suggest… just stabalize and find placement, I wish it was that easy. Until it gets easier to declare them mentally incompetent, they are still going to end up on the streets. So many patients burn bridges with the few places available to take them in, and if they are violent – forget getting them placement anywhere. Sometimes I wonder if it would be best to build an area, closed off with shelter, food and water resources, where they can be themselves, unmedicated and safe(ish?). I wonder if that is what they want.

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