Hospital violence

[Van Canna]

Hospitals are also vulnerable targets — in the past 10 years, violence in health care settings has increased — and they present critical challenges to the law enforcement community in terms of strategic response.

Violent incidents have come to medical facilities, too. In Long Beach, California, a pharmacy technician shot the pharmacy’s executive director and a supervisor and killed himself; the shooter apparently feared he was going to lose his job.

In Baltimore, Maryland, on learning of an unfavorable prognosis for his mother, a distraught man shot his mother’s surgeon in the hallway of the hospital. In Rockdale, Texas, a 77-year-old man went to the room of his bedridden wife, who suffered from dementia. He shot her in the head and killed himself.

Most shootings that occur in hospitals are due to domestic violence. In addition, it is not uncommon for human resource and financial personnel to be primary targets, as well as professionals in the patient relations department who are tasked with resolving patient complaints.

[Bill Glasheen]

People are not at their best when ill.

My dad was a passionate Irishman, but the product of a parochial school education and engineering school discipline. I was the medical power of attorney in his final years, and got to witness what he became when cancer and the ravages of old age slowly took over. Studies of people with amnesia have shown this. As the cognitive functions wane, the emotional brain usually remains and is often amplified in its highs and lows. It makes you understand how rational thought works in dynamic tension with our feelings, and what happens when the former no longer governs the latter.

Whenever my dad needed to spend time in the hospital, he was OK for about 3 days. Then it started to get bad. What came out of his mouth frankly wasn't him, so I didn't take it personally. Being objective about it all (and not minding the occasional right cross to my jaw from my beloved dad), I could have fun with it. The words that spewed from his mouth reminded me of a Warren Zefon song.

I'm hiding in Honduras
I'm a desperate man
Send lawyers, guns and money
The sh1t has hit the fan

Indeed... He was going to call his lawyer on me and/or sue the hospital... he was going to get his gun and (use your imagination)... and of course I was out of his will. Alrighty then!

One day when a nurse wouldn't answer the call button, he got his cell phone and called 911. I kid you not.

All my martial arts students who were nurses or doctors had fun stories for me. They appreciated everything I taught them - especially techniques which shut someone down without causing harm.

- Bill

P.S. Love you, dad!

[Van Canna]

Sad

[Bill Glasheen]

I remember the good, Van. And with 8 kids, there must have been a reason he chose me to be medical power of attorney (and my brother the financial part). We were able to execute during chaos, and we didn't take anything personally. We got to shield the rest of the family from the bad parts. The good memories are preserved.

My reason for bringing all this up is to show how even the best can be at their worst when sick. It's incumbent on the healthy and sane to be aware and to be caring.

The biggest and strongest can be the biggest babies and PIAs when ill or when seeing a loved one suffer. You just need to be on guard.

- Bill

[Van Canna]

Good post bill...still sad..though

[Bill Glasheen]

Bittersweet, my friend, like unsweetened chocolate. But only the finest.




- Bill

[Jason Rees]

As Safety monitor for our ER, I had to do a survey of all staff and their perceptions of what was most likely to cause them injury. Patient violence was the one thing on everyone's mind. We've all had non-violent intervention training, but I've spent a great deal of time considering what I would do if 'x' happened, 'x' being the worst-possible-scenario. Rory's book, 'Helping them through it,' is a big help, and of course the prime directive: don't take it personally.

[Van Canna]

http://www.npr.org/blogs/parallels/2013 ... e-patients

[fivedragons]

I have a brother who is mentally ill, and I have spent the last several months basically mourning his loss. He is sort of okay when on medication, but his illness dictates that he will go off his meds at some point. Then he becomes a strong man in the prime of his life who doesn't understand what personal boundaries are, or how to communicate and relate to people. He becomes a monster. The only people that can help him, become the enemy in his mind, and it is hard to believe that he has survived this long. Oh well.

[fivedragons]

May God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

[Bill Glasheen]

and of course the prime directive: don't take it personally.

Thank you.

Health care workers must understand the mind-body connection, and the fact that they must treat the whole patient. If you can't handle the bad moods, then your place is the ICU (where patients are drugged and intubated) or in pathology.

Good doctors and nurses are special people.

- Bill

[Van Canna]

http://www.kevinmd.com/blog/2011/03/und ... rkers.html

[Van Canna]

I had a fair share of cases involving liability exposure of nursing homes and hospitals when violence was perpetrated by an inpatient upon another inpatient…very often a 'roommate'_Example:

You may find yourself admitted to a hospital for whatever ailment, surgery etc, that places you in conditions not able to defend yourself, in a room with some nut case that should not be there to begin with.

In one case, the plaintiff had been in the hospital for three days, confined to bed with a 24 hour a day for continuous antibiotic therapy. He was unable to move/get up because of his being attached to intravenous device.

Next to him was the worst of society's human dregs…that was not only mentally unstable, but had all kinds of physical problems. He was very combative with the attending doctors and nurses and refused to take his medications.

He was a real pig: smelly, unclean…the restroom was a catastrophe…unflushed…crap all over the seat…etc.,
The pig kept the TV on very loud all day and all night long, so the roommate could not get any rest.

The roommate complained to the staff, asking to be moved …but no action was taken. Shortage of rooms.

One night the roommate plaintiff was beaten badly, unable to move, after having politely asked the pig to turn down the TV at night.

Imagine yourself in that situation…what would you do?

[Van Canna]

Basic precautions

As common sense would indicate, keeping patients with aggressive tendencies and psychological disorders away from other frail patients would be an important first step towards minimizing the risk of injury. However, in situations when patients have ongoing problems, it is incumbent that facilities provide ongoing monitoring of the patients and seek to have the patient removed from the facility to ensure the well being of all.

While certainly a consistently disturbing picture, injuries resulting from the violence of other patients may indeed open the door to liability against the facility. While pursuing a claim against a facility may be a distant afterthought following a violent episode following an injury, reporting the incident to police authorities, both provides the best opportunity to conduct a complete examination for purposes of both civil liability as well as ensuring other patients remain safe from similar behaviors.

[Bill Glasheen]

As common sense would indicate, keeping patients with aggressive tendencies and psychological disorders away from other frail patients would be an important first step towards minimizing the risk of injury. However, in situations when patients have ongoing problems, it is incumbent that facilities provide ongoing monitoring of the patients and seek to have the patient removed from the facility to ensure the well being of all.

This is common sense in theory, and difficult in practice.

Hospital ERs are the front lines of acute care medicine. There's a reason why hospitals have security and "orderlies" to handle difficult situations. Good triage certainly helps, but understand that anything and everything comes in that front door. And hospitals also make it very clear that patients themselves have rights, so there are limits to what personnel can do to manage a situation. If you want to know all the deep, dark, dirty secrets of a town, work a few years in a hospital ER.

In addition to being aware and taking advantage of the mantle of authority (e.g. wearing those white coats, taking charge, keeping scrupulous records, doing what is necessary), a sense of humor helps. Sometimes that's all a doctor or nurse has between them and burnout.

- Bill