The care of the mentally ill - USA style
One of the most dangerous places to get a serious physical illness is in a mental hospital. In the UK you get the CMHT. In the USA, you get this. A horrifying story. There can be no excuses. No mitigation.
Nothing more to be said.
Labels: care of the mentally ill, Neglect, negligence
33 Comments:
"One of the most dangerous places to get a serious physical illness is in a mental hospital."
Ooooh! Harsh!
As you say, it's horrifying, inexcusable and there can be no justification for any element of this lack of care.
Actually, on reflection, my indignation's not justified. You're quite right. Hospital care for in-patients is shoddy.
Much badness.
A 24hr wait in a psychiatric emergency room, eh ?
I hope nobody is daft enough to suggest introducing more humane targets for waiting times.
I'm more appalled at the traffic video. There were people who actually saw the hit and run and one women/man who took a few steps into the road to look and then did nothing!
Crazy!
In LB/RB I learned this phrase and definition - "Plaatsvervangende schaamte". In 'Helloland', Nick Walker defines it as:
"This means a shame in humanity. A shame in being human. You see someone acting foolishly or stupidly and you do not laugh at him, you do not feel Schadenfreude, instead you feel a sense of humiliation that this is how your species can behave."
Do we need a phrase that captures the shame of watching inhumanity?
Yes, a & e nurse, it makes the "four hour" rule seem wonderful.
I thought one of the most extraordinary things was that when they finally DID take action, there was lots of effort to bring trolleys and toys, but none of the simple stuff like airway, recovery position etc etc until the kit arrived.
Deeply depressing
John
I think one can understand the response of the witness to the hit and run. Seeing such an incident would leave a person in deep shock.
Inexcusable and disgraceful is the doctor's behaviour and he has rightly been sacked. Kicking a patient to see if you get a response is abhorrent also.
What deeply shocked me was the ejection of the paralysed man from his wheelchair. An action that depicts mans inhumanity to man at its worst.
Video no longer available?
Video is still show for me, anonymous.
John
"One of the most dangerous places to get a serious physical illness is in a mental hospital"
I'd have thought isolated in the Gobi desert might have taken the top spot?
As Shrink points out on his site tho too (link above) there are also those mentally ill who got to mainstream general hospital and are given suboptimal standards of care.
I'm quite pleased where I am at the moment as our general side nurses have always treated our patients as jo public (with appropriate compensatory communication where required) when they go to med/surg despite the fact they have a constant nurse escort.
Doctors still tend to talk in front of the psych patient as if they're not there then ramble some uttering at the patient as if they've been 3 years in med school - so I guess they treat psych patients no different to other patients either.
As you say there are worse places to fall ill.
However the worst place with ready medical help is a psych ward.
As a medical sctudent i remember helping the medical SHO on call with a peri-arrest patient as non of the staff (psych nurses and a psych staff grade) seemed able to do the basics.
I am still pretty new so i don't want to judge too much but is it really that hard to remember how to do airway control and get IV access when you have been doing psych for a long time? I do it a lot so am pretty good now and hoestly think of it like riding a bike...you never forget.
I was pretty shocked as they don't hold much equipment in the psych hospital either and we had to run back (well i did) to get some basic stuff (bags of fluid etc) while waiting to get helo to transport the patient to he hospital.
It was all a bit surprising to me.
I always find it strange that if a patient at our psychiatric hospital arrests/is seriously ill, they ring 999, to send them to the main acute hospital. While the SHOs will deal with minor medical ailments,anything more serious and they'll be whisked off in an ambulance just as if they'd fallen ill in the local supermarket.
"While the SHOs will deal with minor medical ailments,anything more serious and they'll be whisked off in an ambulance just as if they'd fallen ill in the local supermarket."
It;s not an awful lot different in the private hospital. If you have the dosh and make a good recovery from your hip op you can stay there in your private room reading the Telegraph and being attended to be prettier than average Philipino nurses, but if you show signs of needing anything more than the basics, it's a 999 job down to the local NHS A&E
Dr. Crippen, was that the security camera video of the lady that died in a waiting room at King County Hospital Brooklyn?
A government facility?
Hardly an argument for more government involvement in medicine. We just went through that with King-Drew Hopsital in LA.
Involve government in medicine, you'll get more of that, not less. They'll use their government status to escape liability, and the heavy union involvement will shield those directly responsible from any punishment, and more to the point, any correction of the problem.
..........arf
"Involve government in medicine, you'll get more of that, not less."
When I first saw this, my first thought was to remember the bad days of the NHS some 20 years ago.
I remember the 24 hour waits in A&E waiting room, people on trolleys waiting to be seen etc.
I'd like to think that that it couldn't happen here now.
I don't think that you can balem this on a "government" run system, more on the fact that the person apparently *had* to go this shithole because they had no health insurance...
Absolutely disgusting and I hope criminal charges are brought. I still can't believe that someone can watch things like this happen in front and not step in to help. Humanity is not very humane at times.
Discussing the Psych-Med coverage I think you'll find most psych units cover basic medical/nursing physical health needs but are not specifically orientated to cater for emergency or complex medicine - because it's not that commonplace and there's a good philosophy that doesn't just isolate psych patients away from mainstream health care but encourages inclusion by continuing to access such services.
I worked a UK private facility that relied on weekly visiting GP and on-call service for physical health needs. Consultants were happy to follow up or initiate simple stuff like baseline bloods on admission but mostly it was GP work and access to NHS mainstream services (which of course saved the company a few quid - but nothing the patient wasn't entitled to anyhow).
As for the emergency cover - all psych nurses should be trained in CPR as standard. But how far further this training extends depends on what the facility offers.
Because it once took ambulance 45 minutes to reach us on a 999 call some 15 rural (open road) miles away, our facility offered psych nurses training in bag+mask; guedal airways; O2; Entonox; spinal injury management and AED which is not part of the standard RMN training.
We had no on-site medical cover after 5pm or weekends.
My current psych ward has resus trolley; ECG and AED and the crash team is 3 minutes away... but I leave that kinda stuff to the "proper trained" nurses - cos if they need that kind of support - I need a crash team.
However I have seen a few incidents where the attending psych reg has a much lower threshold for calling the crash team than some nurses do. In fact the medical reg attending was not much better when atteding one case of Epilepticus Malingerus.
(But I acknowledge their accountability when 'on-scene' so don't contest this decision).
To respond specifically to Verity's post, and those who echo her thoughts:
there are frequent calls from the psych wing which makes it clear that nobody there is willing/able to assess chest pain, read (or occasionally do) an ECG or sometimes even interpret unexpected blood results
How many medical units are happy to treat a medically unwell yet mentally ill patient for their co-morbid psychoses (no matter how asymptomatic) without getting psych input?
Often medical staff think psych patients should be kept in the psych unit - but why should they be denied the proper care of a medical team or access to an out-patients service?
If a psych reg or even consultant elects to treat a medical condition - they take responsibility for it. Same for having an ECG machine on the unit - someone needs to know how to use it - and why.
How many medical units are happy to treat a medically unwell yet mentally ill patient for their co-morbid psychoses (no matter how asymptomatic) without getting psych input?
I think it works both ways, sometimes it is quite hard to get a psychogeriatric opinion on patients admitted to a medical ward, when are medically fit for discharge, but there is clearly something wrong psychiatricly.
Mr Ian - the medical reg is correct to have a lower threshold for calling the crash team.
Any ALS provider will tell you that the emphasis has shifted nowadays to earlier involvement of the team so as to maximise the possibility of avoiding a full blown arrest - if a patient is simulating a seizure then the worst that might happen is the crash team shuffle away muttering how inept RMNs are [but surely this better than a patient in status epilepiticus being neglected].
A number of deaths following prolonged restraint in psychiatric settings have been associated with a lack of life support skills amongst RMNs - NICE recommend that any RMN involved in rapid tranquillisation should be trained to ILS level [Immediate Life Support].
http://www.nice.org.uk/nicemedia/pdf/cg025quickrefguide.pdf
Of course it doesn't matter what training has been provided when medically trained staff witness a moribund patient [who has collapsed after sitting on a hard chair for an entire day] then simply turn around and walks away.
Having attended a few cardiac arrests on psych units over the years, I would just be grateful if the staff could learn the following:
How to get hold of a defibrillator and some oxygen
How to connect an oxygen mask to an oxygen cylinder
How to set up an IV fluid bag and line
I would also be grateful if they stopped using the arrest trolley as a handy routine source of cannulae, thus leaving the arrest team with no way of establishing IV access in their patient. We also often can’t intubate as none of the laryngoscopes has a working light. Despite this, the checklist for the trolley will have been signed off daily as complete for at least the last three months. Then the psychs have the nerve to whinge about the poor standard of medical care their patients receive.
I have never resuscitated successfully in a psych unit – and every single episode has been a litany of failure to recognise illness + no CPR instituted + staff unable to supply appropriate equipment (which they do have available and should know how to use)
A&E nurse - it was the psych reg who called crash - but that's fine. No one was put out by it and I agree the quicker unnecessary response is preferential to slower necessary response.
Re the restraint and rapid tranx - I agree if they're going to dibble dabble they need to be prepared to know more than "wibble" (just wanted to use the word wibble, sorry)
Personally tho, I haven't used prolonged restraint (prone or supine) in 8 years since I heard about the postural asphyxia issues. At worst I'll direct staff sit with the pt in a 3-seater sofa with no thoracic pressure.
When initially using restraint (ie if placed to the floor) I want the whole party moved one way or another within two minutes - regardless of rapid tranx.
And no, training makes no different when you're staff behave less attentive than a DWP counter staff.
A&E Doc -
How to set up an IV fluid bag and line
I would also be grateful if they stopped using the arrest trolley as a handy routine source of cannulae
Since the nurses can't set up an IV fluid bag and line - I'd guess the docs took the cannulas?
If you got the cardiologist to review the patients as requested - we wouldn't need a resus trolley at all.
And the laryngoscope doesn't work cos the batteries are in the back of a patient's stereo to drown out the voices telling him to kill himself cos he's on no income and the ward has no funds to keep this essential piece of life saving equipment running cos it all got spent on update training for our psych doctors on how to do all the cardio-respiratory-endocrinology medical stuff as well.
How to set up an IV fluid bag and line
I would also be grateful if they stopped using the arrest trolley as a handy routine source of cannulae
Since the nurses can't set up an IV fluid bag and line - I'd guess the docs took the cannulas?
If you got the cardiologist to review the patients as requested - we wouldn't need a resus trolley at all.
And the laryngoscope doesn't work cos the batteries are in the back of a patient's stereo to drown out the voices telling him to kill himself cos he's on no income and the ward has no funds to keep this essential piece of life saving equipment running cos it all got spent on update training for our psych doctors on how to do all the cardio-respiratory-endocrinology medical stuff as well.
If its anyone's fault, its whoever signed the sheet everyday to say the trolley was appropriately stocked. Shouldn't be signed if it wasn't, no matter who they are.
Insider said..."When I first saw this, my first thought was to remember the bad days of the NHS some 20 years ago....I remember the 24 hour waits in A&E waiting room, people on trolleys waiting to be seen etc.......I'd like to think that that it couldn't happen here now....."
You mean this is a 20-year-old blog? I didn't even know they HAD blogs back then. Dr. Crippen, I would suspect as a physician somewhat of an "insider" himself, describes such things this day.
"......I don't think that you can balem [sic] this on a "government" run system, more on the fact that the person apparently *had* to go this shithole because they had no health insurance...."
King County Brooklyn/Downstate Medical Center was one of the best. In the day Boston City Hospital had competing medical services, between Harvard, Tufts, and Boston University. The medical schools competed to see who did the best work in the same hospital. Similar kinds of things at Cook County Chicago, even King-Drew in the day.
So if in the UK and subject to poor service in a NHS hospital because I don't have private insurance, is that somehow better?
Two-tiered service exists in the USA, the UK, Germany, Canada, everywhere on the planet.
To argue over it's existence is pointless. It's inevitable. Let's make sure the bottom tier is something you'd accept for your mother. Clearly King County failed. I'm not surprised. Government-run hospitals become political footballs. Patronage machines. Jobs for cronies. Power bases. Medical care becomes secondary.
.........arf
Understood, arf.
But none of this explains how a doctor can ignore an elderly lady face down on the floor - I suspect there might even have been a bit of bleeding the way her head clunked against the adjacent chair after she finally collapsed ?
Perhaps every health system has a dark corner that is so de-humanising that some staff forget how to care ?
In the bad old days when NHS A&E departments were completely over run and there were very long waits [10hrs+] such accusations were frequently made against A&E staff.......we were in the firing line so it was all our fault [natch].
Many [? most] bloggers here argue that targets for waiting times are a terrible idea, perhaps because it upsets the doctors - I have always maintained that the 4hr rule [overall] is preferable to the previous chaotic arrangements.
Not because it is a brilliant idea, but because things were so shit before its introduction.
I don't want elderly patients sitting on a hard chair for 24hrs while everybody bleats about how terrible it is.
If enough people really believe it is so bad then it would never have been allowed to happen in the first place.................for this reason platitudes can be very dangerous.
HAving worked in the US in both private and county hospitals, I have seen the very best and worst that the US system has to offer. If you have no insurance you will usually get reasonable ER care but if there is any hint of mental illness then you are generally taken by the paramedic crews to a state psych facility rather than an ER (assuming there is a local one as not all states have separate ER psych facilities).
One worrying trend I have noticed in the UK is that many PCTs are encouraging the psyche departments within local hospitals to become independent fund-holders. We often get phone-calls from our forensic unit for someone to come over to do an ECG/ put in a venflon. I am also part of the ALS training team. One of my jobs is to do follow-ups with ward staff after an arrest (regardless of the outcome so its not just wrist slapping). The few arrests that I have been called to on the psyche unit have never ended well and have been pretty harrowing- trolleys with out of date drugs, empty O2 cylinders, suction that doesn't work. Each time we fill out the IR1 and await the hospital review teams- each time it seems to get filed under "b" for binned.They are not part of our Trust, so its not our problem it seems. We have outreach teams for both medical and surgical patients who will review at anytime of day or night. Early review will often prevent patients arresting/ needing HDU. Unfortunatley as the psyche dept is now an external fundholder, they have openly stated that they cannot call for such assessments as they know they will be charged for it- however they do not get charged for calling the arrest team.
"......how a doctor can ignore an elderly lady face down on the floor......"
I daresay the answer is incompetence and/or character flaws, the same answer if you had an incident like this in your area. Notice there were multiple people who ignored this patient, only one was the doctor, and relatively late in the game.
As the narrator reports, the doctor was FIRED.
The staff members and security guards were SUSPENDED. Maybe they'll be fired, but probably not.
See, the doctor is not unionized. He was summarily fired, which will be pretty close to career-ending. There may be an equally bad prison hospital that might take him.
The staff and security guards, on the other hand, are likely in municipal unions, and will be nearly impossible to fire. They'll get a little vacation from the job, and be back ignoring patients soon enough.
As I said.....government medicine.
........arf
the a&e charge nurse said......"Not because it is a brilliant idea, but because things were so shit before its introduction......."
The California State Prison system is paying nearly a quarter million dollars a year for GP's.
As I've been told, they've had such problems with their prison healthcare, repeated problems, finally the courts intervened and a judge is imposing a remedy. They raise the pay until they find a pay level high enough to attract halfway competent doctors willing to work in some of the nastiest prisons on the planet. See Pelican Bay State Prison for example.
http://en.wikipedia.org/wiki/Pelican_Bay_State_Prison
It's pretty hard to generate much sympathy for some of the nastiest criminals and stone-cold killers on Earth.......but they managed to do it, with absolutely awful healthcare.
I would like to direct you all to a blog posting by "The Last Psychiatrist". He has written a post on the matter which does not excuse the in-action and inhumanity but suggests a how and a why about such events. If you get my drift.
It is entitled; "Esmin Green died only because King's county hospital cared"
http://thelastpsychiatrist.com/2008/07/esmin_green.html
I followed the link above "lastpsych~" - and it made for interesting reading - but it's all been said in psychiatry before.
Szasz, Laing, et al have covered this debate... but in short:
Being the Cinderella service mental health is, we are the default service for "anything else" and every time we say it's not working because we do 'psychiatry' not social welfare and moral inadequacy - we're told "oh ok, well as long as you just keep them all quiet we'll all be happy"
Those who work in general health care tend to do so for the beneficence of the individual patients and to return them to the bosom of society with everyone's gratitude for fixing them.
Those who work in mental health used to do it to conduct the social cleansing of the streets and throw them all in Bedlam or Bridewell.
We've managed somewhat to distinguish those who have treatable (tho not always curable) mental illnesses and may improve or require suitable long term supports that alleviate the outcome of the persons problems; so psychiatry has a more health & quality of life improvement function than before.
However, we still have incurable social ailments that continue to fill the wards with little option for improvement or alleviation of the problems.
Nowadays, thankfully, staff in mental health tend to seek to promote the well being of the individual patient yet the society still expects psychiatry to remove the unpleasant vagrants and inadequates from our streets and only return them when they are less offensive.
"The degree of civilization in a society can be judged by entering its prisons."
--Dostoyevsky
Ghandi, Truman and Churchill are amongst those to adapt this:
Ghandi "You can judge a society by the way it treats its animals"
Churchill " ~ treats its prisoners"
Others followed with:
~ "children"
~ "old people"
~ "vulnerable"
Personalized Results 1 - 10 of about 890 for "judge a society by the way it treats"
However;
Results 1 - 2 of 2 for "judge a society by the way it treats its mentally ill".
You can judge how a society treats its mentally ill by the lack of interest it generates.
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