Suicide in Psych Ward

NurseBenz · Sep 25, 2003

Originally posted by psycorn
the other reason we do a seach is for any maks and brusies because a lot of false claims get made once a patient is in our facility and that is our documentation when they arrrived with these bruises, exp when they have been in police custody and have resisted arrest, the handcuffs and shackles can leave some nice bruises.

Ditto...our facility does strip search and photographs all bruises for the protection of staff from false accusation.

Larry77, RN · Sep 27, 2003

I know I'm coming into this conversation late but my question would be about the information disclosed...isn't this some kind of breach of confidentiality? I don't know maybe I'm just paranoid with all these knew HIPPA regulations. I know the name isn't given but if someone knew the parties involved I'm sure they could figure it out...Just a thought.

lucianne · Sep 27, 2003

Good point, but the initial post was 11/2002, well before HIPAA took effect. If it were me, I might not have supplied so many details even back then, but no one will be subject to a fine for doing so. Even though this is an anonymous board and the chances of someone knowing the family involved are slim, it could happen.

luci

PsychNurseDee · Oct 14, 2003

In the facility where I work, our rule of thumb is we search them anyway so we can be accountable for what they do or don't have in their possession before the enter the unit. At our admissions office they also have a metal detector that is used. It is a tragedy, and I hope the facility is providing counseling services to the staff as well as the patients who witnessed the incident. The facility would be wise to review their current search policies in light of this sentinel event. Keep us posted as to the outcome

mother/babyRN, RN · Oct 15, 2003

The poor soul who shot himself is at fault.......So sad for his family and all those involved....

**canoehead, BSN, RN** · Oct 15, 2003

If I knew a hospital did strip searches I would risk death before I would go there. It is such a violation physically, as well as in regards to power, and also puts the whole trust issue in doubt. Why should I trust them if they distrust me so much that they have to strip me naked and go probing?

Just another point, some people become legally blind, or experience nausea and dizziness without glasses. If someone wants to die they are gonna- you need to concentrate on what is best for those that are committed to seeking and using help.

PsychNurseDee · Oct 17, 2003

The "strip search" we do is as respectful and private as it can be. We have two witnesses with the client. Same sex staff only. They must remove their tops first and are given either pajamas or their own shirt back if it is free of contraband and clean. ( Another side...many of patients come from the streets or due to their illness have paid little if any attention to ADLs, so they typically require, and often want, a good hot shower. so you have a perfect opportunity to do the search at that time, and it seems less intrusive) Then they remove the pants/underwear and are shielded by a towel as they sit the clothing on the bench to be searched. I am a big advocate for pt privacy, but not to the detriment of the other clients and staff of the unit. I try to ensure my staff make the event as respectful as possible.

Dedee

EMSParalegal · Oct 22, 2003

RE: Liability is Psych Ward Death

I would like to address the following compound questions, but before I do, I have to give this disclaimer: I am not an attorney, I am a paralegal and as such, I cannot give legal advice, only general legal information. The facts of every situation differ and only an attorney who works in your jurisdiction and is familiar with the facts of your situation can give you advice relevant to your situation:

It may be obvious that the police are obviously liable. However, you do not say what jurisdiction this incident took place in. In some states, there is a rule called "sovereign immunity" This means that the police (or other government agencies, such as the school board, fire & EMS departments, etc.) are generally immune from a lawsuit because they are part of the state, county, or federal government. Generally, you cannot sue any agent of the government unless the government consents, or if the immunity is waived by statutory law. For example, see the contract case below:

Smith v. State, 289 N.C. 303, 320, 222 S.E.2d 412, 423-24 (1976).

However, the North Carolina Supreme Court has held "that whenever the State of North Carolina, through its authorized officers and agencies, enters into a valid contract, the State implicitly consents to be sued for damages on the contract in the event it breaches the contract."

The same thing can apply in negligence matters. Also, the state may have a rule that the negligence must rise to a certain level before the defense of sovereign immunity is automatically waived. The standard, generally, is that the negligence must reach the level of "gross negligence," a much higher hurdle than proving "ordinary negligence." In addition, it may be possible to sue the hospital for negligence in failing to meet the standard of care dictated by the medical community.

There are two standards of care, local and national. It depends on the state which one is followed. If most of the psych facilities in your jurisdiction (or nationally, if applicable) routinely search patients for weapons and/or other contraband when they are brought in, then your facility could be liable for failure to search the patient, as well as the police. This is called "joint and severable" liability and both parties can be held either equally or proportioned liable for the damages caused by the unnecessary death.

It is also possible to sue all the personnel who were working at the time the patient was admitted. The philosophy of lawyers is to "sue everybody and let the judge sort them out." And before you diss the lawyers, remember, it is their job to do everything legally and ethically possible to protect their client's rights. Put the dead guy's shoes (or his family's) shoes on your feet before you whine about "greedy lawyers." They take an oath, just a medical professionals do.

Of course, the cops either did a lousy job of searching the patient prior to transporting him, or they did not really search him at all. Anyway, both cops could have ended up dead. No cop in their right mind would transport a psych patient (or criminal suspect) without thoroughly searching them.

As an former EMS worker, I would not take a psych patient into my ambulance without first having them searched by the police or searching them myself. You shoud see some of the stuff I have confiscated. Kinves, afro picks, scissors, screwdrivers, you name it.

If you work in a psych ward, you must search the patient for contraband and this is usually a strip search. If no weapons are found and the patient is not deemed to be a clear and present risk to themself or others, you can give them back their clothes after searching them. If you fear a weapon, especially after taking a report from the police that says your patient is there for "threatening his wife," insist that the police do, at the very least, a thorough "pat down" search before they leave you with the patient.

I am not familiar with "chaptered," but I am assuming that yo are talking of involuntary commitment. In PA, they call it "302ing" a patient. In DC, involuntary commitment is covered by DC ST 21-542. But whether the patuent is voluntary or involuntary, they should be searched.

If the patient is brought in for threatening other people, they are generally placed on close observation until they are deemed to be no longer a threat. This means they may be physically restrained with Posey wrist restraints to a bed in a single room and a psych tech is stationed at the doorway and must keep notes on their observations of the patient. The patient may also be medicated. All clothing is removed and a hospital gown is supplied. The patient is never left alone. Once the patient is permitted to loin the general population, the clothes are given back, except for things they could hurt themselves of such as lighters, shoelaces, belts, etc.

The main legal key, which is tied in with the standard of care, is what a 'reasonable person would do." but as I said, you have to do the legal research to see what the medical standards of care are for your particular jurisdiction.

EMS Worker

Turned Personal Injury Paralegal

OIFsoldier · Oct 23, 2003

WOW,

I'm glad I do Army Psych! We can be almost as bad as a prison at times. Every change of shift we search every pt.

When they are being admitted, we strip them down and have them "duck walk" [an army exercise where you squat until your butt is on your heals and you walk a couple feet].

Most of the pt.'s hate it and I think it's a real bummer but everyone is still alive end of story!

Barry

erroridiot · Oct 27, 2003

Most units I have worked on do strip search with a skin assessment for tattoos, wounds and scars noted on the admission form.

Several years ago, a patient overdosed on pills hidden inside of sanitary napkins she brought in with her. The mental health worker checked her belongings - but not each pad.

Since then, I have had several nurses make comments to me about checking sanitary pads so carefully when a patient brings them in.

_________________

"The significant problems we face cannot be solved at the same level of thinking we were at when we created them." -- Albert Einstein

laurenkst · Oct 31, 2003

The patient was not on a Psych Unit. If he had been he would have had a contraband search on admission. All belongings that he could have used to harm himself or others would have been confiscated. Did anyone know he was suicidal? Most patients do not realize that they are so depressed until they become suicidal.

And although the availability and potential for suicide by gun usage should be out of the question, if a patient is determined to take his/her life nothing on god's green earth is going to stop them. They will wait for the opportunity they want and take their life. The hope that we have is that we can get them help--medication, therapy and communication-wise--that helps them to realize that there is always another alternative to death.

Please remember that nurses need to take care of themselves too!!! Psychiatry is a high pressure field and it can take a toll on a nurse too!! Please don't take your health for granted when you are giving everything that you have to your patients. Nurses have needs too!!!

OIFsoldier · Nov 1, 2003

Once again,

When we get 'um, we always plan for the worst. That still doesn't make things safe, just safer!

I'll use my friend Jonny as an example...

He was doing a MDD's inventory when she pulls out a box knife from her purse. Jonny jumped her and since she couldn't cut her own wrists, she started to go for him! One of our NCOs just happen to pass by the room at the time and was able to get the box knife away so things turned out for the best; however, any D/O can turn deadly for a staff member at a moments notice.

Spc Barry