When the Hospital Fires the Bullet

[Not_A_Hat_Person]

The NY Times ran an article about armed guards in hospitals. The patient profiled went to the hospital during a manic episode, seeking treatment for suspected bipolar disorder. He ended up shot in the chest.

When doctors and nurses arrived at Room 834 just after 11 a.m., a college student admitted to the hospital hours earlier lay motionless on the floor, breathing shallowly, a sheet draped over his body. A Houston police officer with a cut on his head was being helped onto a stretcher, while another hovered over the student.

Blood smeared the floor and walls. What happened?” asked Dr. Daniel Arango, a surgical resident at the hospital, St. Joseph Medical Center.

The student, 26-year-old Alan Pean (PAY-an), had come to the hospital for treatment of possible bipolar disorder, accidentally striking several cars while pulling into the parking lot. Kept overnight for monitoring of minor injuries, he never saw a psychiatrist and became increasingly delusional. He sang and danced naked in his room, occasionally drifting into the hall. When two nurses coaxed him into a gown, he refused to have it fastened. Following protocol, a nurse summoned security, even though he was not aggressive or threatening.

Soon, from inside the room, there was shouting, sounds of a scuffle and a loud pop. During an altercation, two off-duty Houston police officers, moonlighting as security guards, had shocked Mr. Pean with a Taser, fired a bullet into his chest, then handcuffed him.

I thought of the hospital as a beacon, a safe haven,” said Mr. Pean, who survived the wound just millimeters from his heart last Aug. 27. I can't quite believe that I ended up shot.”

[TriciaJ, RN]

Reality is that not all patient who have behavioral /psych problems can be admitted to a psych facility or psych floor (for a variety of reasons from medically not cleared to no bed, financial..).

I worked on med/surg floors that took pat with MH problems and I worked on neuro floors, which seemed to be the designated place for "all things weird and crazy". Staff can be trained and need to know how to access resources. In one of the hospitals they had psych CNS nurses who were just a call away to come and help as well as a code for psych emergencies. The security officers did not carry weapons and were all trained in de-escalation. I worked on a non psych floor that had daily psych emergency codes and things did not get out of control because staff was trained and reacted early to get appropriate help. We needed security often but they were totally de-escalating and helpful! Once in a while somebody would end up in four point restraints (violent behavior) or seclusion (for spitting at staff) but this was last resort, carefully monitored and an intervention with the goal to get the pat out of restraints/seclusion as soon as safe.

And the reason these things all worked so well was because there was appropriate leadership. Someone had to have the right programs in place, hire the right staff members and provide the right training.

If it happens in a hospital, the buck stops with hospital leadership. Why else are they there?

[heron, ASN, RN]

Laws have made the use of restraints so difficult that many times when they are indicated the staff is unable to get them due to policy, etc. I'm sure this patient would have rather have been restrained for a bit, than shot. I understand that restraints are a last resort, but they should be used prior to shooting a patient.[/quote']

A bit OT, but there's no legislation regarding restraints, as far as I know. It's all local/state regulators. And we have only ourselves to blame for those. Regulations tend to be a reaction to widespread abuses. I'm old enough to remember some of them.

End of OT ... Carry on ...

[CryssyD]

Correctamundo. It is indeed a police problem. The problem is that policemen were armed inside a hospital and responded to a perceived security threat AS POLICEMEN. In other words, they acted to protect themselves first, and the patient/"aggressor"(because I have not one shred of doubt that that is how they defined him in their reports) second. As we all know, people are often in hospitals when they are mentally at their very worst--they are stressed, scared, angry, injured, in crisis, or impaired. Maybe all of the above. Policemen are NOT adequately trained to deal with people in these situations. I know they should be, but I'm a realist; they are not.

I don't want to start a debate about whether the vast majority of police are good and decent people. Of course they are. But lethal force should not be an option within the confines of a hospital. And no one would consider it necessary if this country weren't armed to the teeth. But armed security guards are not the answer.

QUOTE from Asystole RN: I am not sure what this has to do with "bean counters" but this does have to do with POLICE OFFICERS defending themselves with lethal force. Whether or not they were justified in that defense the article did not even try to comment on. The article does not expand upon this particular situation and whether or not the patient received reasonable and prudent care up to the fight. Considering he was just admitted hours earlier, I doubt there was enough time to conduct a full psych eval...let alone completely rule out any other medical causes.

This is a police issue, not a nurse, doctor, or hospital issue IMHO.

[CryssyD]

I think nurses should have access to Xanax/Haldol coated blow darts for the out-of-control patients.......

Perhaps they should also have them for out-of-control security guards, too.