Yesterday the New York Times reported on the longstanding problem of patient assaults on medical personnel, particularly in psychiatric care: citing Bureau of Labor Statistics numbers, it said “half of all nonfatal injuries resulting from workplace assaults occur in health care and social service settings”. (David Tuller, “Nurses Step Up Efforts to Protect Against Attacks”, Jul. 8). So it’s worth noting what happened to Northfield City Hospital in Northfield, Minnesota when a man showed up at the emergency room at 2 a.m., ranting and yelling in an increasingly agitated manner. Hospital staff finally called the police, who arrived on the scene at 7 a.m., assessed the situation and tasered the man. (He was uninjured otherwise and was subdued without losing consciousness.) “Now federal and state health officials have cited the Northfield hospital for violating the patient’s rights,” a development that has outraged hospital officials in the state. The state health department says it believes that staff at the facility, a small one with fewer than 100 beds, “needs more training in deescalation techniques”. The hospital has hired two security guards and is negotiating other steps with the state (Maura Lerner, “Hospital calls cops and feels the sting”, Minneapolis Star-Tribune, Jun. 15). A commenter at KevinMD asserts:
A few years ago, Medicare tried to prohibit physicians from discharging a patient for any reason, up to and including physical attacks on physicians and staff.
Just as the doctors were required to hire translators at the doctor’s expense, they would be required to hire security at the doctor’s expense.
They backed off then, when they physicians called them on it. Not surprised they would try again.
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What is the address of these state and federal officials? I am coming over with a couple of psychotic patients off meds, and intoxicated.
Don’t you have a “Damned if you do…Damned if you don’t” tag?
It may well be a good idea for hospital staff to be trained in deescalation. Budget willing, most staff would probably appreciate the training, as their main interest is usually in helping patients. But police are typically trained in deescalation; if they couldn’t resolve this particular problem peacefully, it’s unlikely hospital staff could.
… and I assume the “damned if you don’t” is the lawsuit by hospital staff injured by angry patients, claiming that a policy of not calling the police created the danger.
There have been quite a few incidents recently in which the police used tasers inappropriately. They seem to think that tasers are safer than they really are and to use them in cases where no physical restraint or lesser forms of physical restraint are called for. Without knowing more details of this case it is hard to tell, but it is possible that the police overdid it. What I can’t see is how the hospital could have any liability. A patient behaving that way is certainly a potential danger and the hospital staff are entitled to call security or the police.
Yes, I fully agree with Bill…isn’t there some kind of duty of care or duty to provide a safe place to work, imposed on the employer? In hostile situations, second-guessing whether or not to engage trained professionals to deal with people who pose an immediate threat could cost someone his or her life. This is silly and typifies government thinking. Would patient-rights laws not be trumped by employment law?
Todd: This is settled law. The employees have assumed the risk upon accepting the position. Second, they have workmen’s comp, and have waived the ability to sue the employer for this ultimate of hostile work environment. Nor are they allowed to sue the patient, however wealthy the patient.
What the unions or professional societies should do instead is get an injunction against all regulatory bodies, and try to sue the government officials. These regulations and enforcement violate the half dozen Supreme Court rulings giving presumptive validity to clinical judgment. If an injury can be traced to these oppressive and nonsensical rules, then the employee victim should sue the regulatory oppressors on a Section 1983 claim of deprivation of civil rights, under color of state law. The union and professional societies never will because they are run by gutless punkasses who stopped caring about clinical care long ago.
This case is ridiculous, obviously. How about this rule in a state hospital forensic unit? This is the treatment place for prisoners expelled from Supermax.
No restraint is allowed.
Patient goes on a rampage? Remove the other patients and empty the TV lounge for the 3 hours it takes for this person to calm down. OK. What if the patient is choking another, and the other is turning blue? Well, then you pull the choking patient off, but everyone lies about doing so on the report.
Thank you for the free consulting. Working at a CPA firm doesn’t present me with the same risks one might encounter in say, an ER. We just don’t get uppity people in these parts who might need to be subdued. In our case, I imagine the cases and statutes are a little more generous to employee rights as opposed to privacy.I do have to offer props for the colloquialism, punkasses.
Now, the Supermax – a dear friend of mine did her PhD clinicals in one of these human-landfills. She would regularly meet us at the bars after work; complete with feces and other “fluids” on her clothes/hair. Expulsion from a Supermax should be analogous to “taken out back to dig (and fill) a hole.” That’s for another day.
Before the lawyer got control of these places by ruinous litigation, and by the thinnest of excuse lawyer gotcha, there were holes out back. Today, a guard can be fired for the verbally abusive remark, “Stop acting like a fool.”
About 200 guards, over three shifts, controlled 2000 forensic prisoners. Now, about 200 guards control about 200 people. Cost have been driven up 10 fold.
It was an earned privilege to work, until full minimum wages was demanded and closed an operation, providing the vegetables and beef to an entire state prison system. Prisoners loved it, stayed busy, and felt the gratification of good achievement.
It was also well known, the assaultive, uncontrollable, fluid flinging prisoner had this tendency to slip down slippery metal staircases, but head first, and to land in those holes dug up behind the forensic hospital. So with 200 guards guarding 2000 prisoners, it was much quieter, more productive, and safer, including for the other prisoners.