When the Hospital Fires the Bullet

[Not_A_Hat_Person, RN]

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.”

[Hoosier_RN, MSN]

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.

wow...if he had been dangerous, 1 thing, but he apparently wasn't. Reason why I wouldn't have a gun in my workplace at this time. Too many knee jerk reactions that are dangerous!

[PaulBaxter]

I hadn't seen anything here about this story, so I figured maybe people weren't aware of it yet. The short version is that a delusional patient was shot by two off duty police officers working as security in a Houston hospital. The whole thing is pretty horrifying.

The story was worked on jointly by the New York Times and the This American Life radio show. If you prefer reading it:

http://www.nytimes.com/2016/02/14/us/hospital-guns-mental-health.html

If you'd rather listen, which is how I found it, you can follow this link or just pull it up via your favorite podcast player:

My Damn Mind | This American Life

[TriciaJ, RN]

This is a multi-faceted problem. There are some who will try to distill it down to whether there should be firearms in hospitals. This is not only simplistic; it misses the point entirely.

A hospital should be able to treat psychiatric illnesses appropriately. That means psychiatrists need to be available, just like surgeons are. All staff should have at least some training in how to communicate with people who are experiencing psychosis. There should also be experienced behavioural health staff available to appropriately handle these situations. If security staff are to carry firearms and function as police officers, they need the requisite training.

The bean-counters responsible for this mess are the same people who have brought us the customer service model and parroted scripting. They put money into things that look pretty, but they won't hire or train the appropriate staff. That's why nurses have heavy work loads, and security is provided by armed bunglers who are winging it. Then when something bad enough happens that the media get involved, the front line staff get thrown under the bus.

A Russian proverb says "A fish begins to stink from the head." Accountability needs to start from the top.

[Asystole RN]

This is how the article read to me.

Patient was admitted just hours prior.Two POLICE OFFICERS who happened to be working as security shot the patient as he fought the POLICE OFFICERS. There is a surprising lack of detail of the fight but we do know one of the police officers was wounded.

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.

[LadyFree28, BSN, LPN, RN]

This is a complex problem; healthcare assaults are a huge problem, so is the mental health crisis-people's mental illness doesn't check out when they enter a hospital.

What happened seems to be an inevitable ish-storm that happens more often than is revealed; unfortunately is it lack of training, lack of resources, or both? That come into play when healthcare is indeed a business, but the ones at the top have no idea of healthcare or their own preconceived notions of what healthcare should entail, which looks like they're pretty inept at keeping not only their staff safe, but their patients safe.

[Purple_roses]

My take away from this is that both hospitals and the police force need reform.

[NOADLS]

This is where taz0r h4x would have worked perfectly.

[TriciaJ, RN]

This is how the article read to me.

Patient was admitted just hours prior.Two POLICE OFFICERS who happened to be working as security shot the patient as he fought the POLICE OFFICERS. There is a surprising lack of detail of the fight but we do know one of the police officers was wounded.

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.

But it happened in a hospital. Where a patient was brought for care and ended up being shot. And the news story, while lengthy, contained a paucity of helpful information. The media loves to demonize the police. Even if these two officers didn't handle the situation appropriately (and there is nothing at this point to say they didn't) I'm not letting hospital leadership off the hook.

[klone, MSN, RN]

Even if these two officers didn't handle the situation appropriately (and there is nothing at this point to say they didn't) I'm not letting hospital leadership off the hook.

Why? I'm unclear why this is a hospital leadership issue.

[nutella, MSN, RN]

This is a very sad story all around - i listened to it on NPR the other day.

Basically, the patient really needed a psych consult, it was even documented that the patient had said to be "manic" and the father asked for a psych eval - that did not happen. Instead of picking up on the clues and behavioral problems, the patient ended up shot. And the officers went into the room and closed the door so nobody knows what was going on in there.

It is a very sad example of dangerous it can be for people to be mentally ill. I am not saying that violence or inappropriate behavior from people who act out of illness is ok - but there are other interventions that need to be used.

[calivianya, BSN, RN]

Why? I'm unclear why this is a hospital leadership issue.

I would have to agree that there is a hospital leadership problem here. The biggest failure that I see after carefully reviewing the article is patient placement. Mr. Pean came in for a psychiatric emergency and got put on a surgical floor, which is unacceptable.

The hospital leadership should be ensuring that patients who come in with a psychiatric crisis end up receiving psychiatric treatment and have psych nurses taking care of them. Med/surg and ICU nurses are just not trained to handle potentially violent psychotic patients. I don't know about this hospital, but the only crisis intervention training I have ever had was in nursing school before I did my psych rotation, and that was a long time ago at this point. I would be willing to bet there are more non-psych nurses like me who have not had a crisis intervention class recently than there are ones who have. I have had active shooter training, of course, which is ridiculous because an active shooter is less likely to happen than a patient getting violent, but that's administration for you.

I doubt security would have even been called if the patient's escalation had happened on a psych floor, and really, I doubt he would have escalated in the first place if he had received appropriate psychiatric evaluation and treatments on arrival to the hospital.

The problem started long before security walked in the patient's room.