Magazine article Clinical Psychiatry News

Physicians Were Distressed to Learn of the Psychiatric Patient Who Died While Waiting to Be Seen in a Brooklyn Hospital. How Can Such Tragedies Be Prevented?

Magazine article Clinical Psychiatry News

Physicians Were Distressed to Learn of the Psychiatric Patient Who Died While Waiting to Be Seen in a Brooklyn Hospital. How Can Such Tragedies Be Prevented?

Article excerpt

Several weeks ago, JAMA published a commentary, "Physicians Behaving Badly," detailing some of the inhumane ways in which doctors (and, I might add, hospital staff and office personnel) treat patients (JAMA 2008;300:21-2).

The recent incident, ending in the death of a patient at Kings County Hospital Center in New York, ranks as an egregious example of patient treatment. New outlets across the country ran numerous stories and pictures of a woman who had waited for almost 24 hours in the hospital's psychiatric emergency department for help. Eventually, the patient fell out of her chair and reportedly stayed on the floor for almost one hour before hospital personnel made efforts to revive her.

Staff members reportedly came into the waiting area on several occasions, looked at her, and walked out. The patient died face down on the floor. She was 49.

Now that she's dead, six staff members have been fired or suspended, the family is suing for $25 million, and everybody in New York City is investigating the incident. One thing we do know is that the staff entered information in the record that was contradicted by the surveillance video that captured the woman during her ordeal.

What can we make of this? We all know that many patients, every day, are treated rudely and thoughtlessly. This lack of respect happens at the hands of doctors and staff who either give the wrong medicines or provide the wrong treatment.

Medical errors are well documented, and thousands of patients die annually because of them. We have instituted quality assurance and a variety of other bureaucratic efforts to stop these events. Kings County Hospital officials vow to implement several reforms to its psychiatric emergency program, such as 15-minute checks and "expanded crisis prevention training for staff, including managing of agitated patients." Too often, however, such reforms are to no avail. Falsification of records or enormous hospital-wide efforts starting 2 weeks before the inspection are common activities. In some hospitals, every record is read and adjusted to demonstrate the "excellent" care that people are getting in the particular institution.

But every doctor knows that these errors are human. These nasty, inexorable events involve ordinary human beings such as the staff members who saw the woman lying on the floor and did nothing. Why does it happen every day in almost every hospital in America?

In response to the incident, Dr. Nada Stotland, president of the American Psychiatric Association, released a statement saying, "Incidents like this reflect a complete breakdown of the mental health system." She went on to say that the time to intervene is "long before a person finds herself in the position of needing emergency help from a hospital that is ill-equipped to care for her."

I agree with Dr. Stotland, but it seems to me that problems that this case illuminated go beyond the mental health system. People don't seem to care or are too occupied with paperwork, or need a cup of coffee, or it's lunchtime so patients are neglected or they feel as though they are neglected. They push the nurse button endlessly with no response, and the staff in the nurse's station see who's ringing and decide, "Oh, she's such a pain," or "She's always complaining," and the result is neglect.

The assumption by the staff that they know what to do and will do it in their own time is the first thing that needs to be corrected. And if the patient wants to see or talk to his doctor, the staff protects the doctor by lying to the patient about when he'll arrive.

One disturbing case involves a Denver woman, Esso Leete. Several years ago, Ms. Leete had gone to the same hospital several times with symptoms of schizophrenia, became very depressed, and returned to the hospital for an examination and medication. She was sitting quietly despondent on a gurney in the ER, when suddenly four large techs held her down and strapped her to the gurney. …

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