News in my neck of the woods

[vintagemother, BSN, CNA, LVN, RN]

California prisons alter 'use of force' policies for mentally ill inmates - Crime - Sacto 911 - The Sacramento Bee

I finally got around to reading this article. As a nurse in psych, I can see both sides. The article states the medical professionals asked the guards to let the inmate out after pepper spraying him. I think he was on a trach. But the guards refused saying he's too dangerous. He died.

Apparently a judge has now ruled no force can be used unless a superior approves it. I know from experience that sometimes there's no time to wait for a supervisor when a situation has already escalated.

However, sometimes people are over zealous with the use of force.

I'd love to hear more experienced nurses opinions on the use of force on dangerous mentally ill persons.

[Meriwhen, ASN, BSN, MSN, RN]

Apparently a judge has now ruled no force can be used unless a superior approves it. I know from experience that sometimes there's no time to wait for a supervisor when a situation has already escalated.

This would be my concern too. I'll admit that I don't work in the prisons so I can't speak to experiences in there. But coming from someone who does work Psych ER, should the lives of staff and other patients be jeopardized by a violent patient while someone goes to find a supervisor to get an OK to take action? What if it's at 0300? What if there aren't the minutes to wait? You'd be surprised how much damage a violent patient can do in so little time.

I also agree with your statement that some staff are also overzealous to resort to force, emergency meds, seclusion and restraint...even if the situation is nowhere near calling for that level of response. Sad but true.

If this patient was determined to be in medical distress, then they should have let him out of care, or gone in to take care of him. Leaving him in a cell for 7 hours without assistance is inexcusable.

[vintagemother, BSN, CNA, LVN, RN]

Meriwhen, I don't work in a prison setting either, but in an acute psych unit.

It seems to me that in this case, a knee jerk reaction was made by the judge in order to protect mentally ill persons. It peeves me when laws/policies are made as a "reaction" rather than after looking at all the factors.

[MrChicagoRN, RN]

It doesn't seem like they can't take any action to quell situations, rather:

"The new policy states that if there is disagreement between custody staff and mental health staffers over whether to use force, the issue must be elevated to higher-level officials on duty at a prison."

Guards are responsible for controlling security, MH staff for management/treatment. Which is ultimately responsible?

Watching the video is a must see. Their approach is so very much different than how we deliver care in hospitals.

[imapsychrn]

Maybe that judge should spend a day with the violent mentally ill patient and attempt to get a hold of the supervisor before he can do anything about it. I agree there should be strict laws, but that is ridiculous! People get hurt!

[cjcsoon2bnp, MSN, RN, NP]

I think one of the important things in this case was that this patient/inmate died because the guards refused to allow him out of the cell when the medical personnel on duty asked for him to be taken out in order to be decontaminated. I think that is a huge piece that should be taken into account.

I agree that guards are trained to maintain the safety of the prison including the other prisoners and employees but they do not know how to recognize subtle changes in someone's mental or physical condition and when the medical personnel (physician, LIP or nurse etc.) have said that something is happening that puts this person's life at risk the ultimate authority should defer to the medical personnel, in my opinion.

I can't help but think of the video I was watching of Eric Garner who was put into a chokehold by NYPD and died in the middle of the street. I understand that prison guards and police officers are trained to maintain safety but there are times when the use of excessive force has cost people their lives and there needs to be a systems of checks and balances in order to keep people honest and avoid unnecessary deaths/life threatening injury.

!Chris

[Stephalump]

I don't see that it says you cannot use force without a supervisor's approval. If prison staff and mental health staff disagree whether or not to use force, it needs to be handled by a supervisor, instead of what happened here - prison staff just pulled "rank" and pepper sprayed the guy and refused to move him out of the cell afterward.