Some psych patients wait days in hospital ERs

Some psych patients wait days in hospital ERs


Some psych patients wait days in hospital ERs
July 03, 2008


In this still photo taken from video provided by the New York Civil
Liberties Union, Esmin Green lies face down on the floor in the
psychiatric ward of the Kings County Hospital in Brooklyn, N.Y.,
Thursday, June 19, 2008. Green, 49, had been waiting in the emergency
room for nearly 24 hours when she toppled from her chair at 5:32 a.m.
and lay writhing, face down on the floor. Security guards and a member
of the hospital\'s staff appeared to notice her prone body, but made
no visible attempt to see if she needed help. Within an hour she was
dead. (AP Photo/New York Civil Liberties Union)


(AP) -- When staffers at a Brooklyn hospital spotted a middle-aged
woman lying face-down on a waiting room floor last month, it hardly
seemed like cause for alarm.


The sight, after all, was common in the psychiatric emergency room at
Kings County Hospital Center. The unit is so routinely backed up with
people waiting hours, or even days, for services that patients often
spend the night nodding in chairs or sprawled in a corner.

It took an hour before a nurse realized the prone woman was in
trouble. By then, she was dead.

Security camera footage of the woman drew outrage when it became
public this week. Experts say it is also an extreme symptom of a
crisis occurring in hospitals nationwide.

Emergency rooms, they say, have become all-purpose dumping grounds for
the mentally ill, with patients routinely marooned a day or more while
health care workers try to find someone to care for them.

A survey of hundreds of U.S. hospitals released last month by the
American College of Emergency Physicians found that 79 percent
reported that they routinely "boarded" psychiatric patients in their
waiting rooms for at least some period of time because of the
unavailability of immediate services.

One-third reported that those stays averaged at least eight hours, and
6 percent said they had average waits of more than 24 hours for the
next step in a patient's care.

"We try to find a place to put them," said Dr. David Mendelson, an
emergency physician in Dallas who wrote the ACEP report. Ideally, he
said, that place would be a quiet spot with one-on-one nursing care,
but that doesn't always happen.

"Unfortunately, sometimes the only thing we can do is restrain them,
or medicate them," he said.

There are many reasons for the delays, which vary from city to city,
but doctors said they usually boil down to one thing: a lack of
available mental health services.

In some communities, there are shortages of clinicians and few open
beds at psychiatric hospitals. Sometimes, insurance companies refuse
to approve treatment and patients must wait while doctors appeal.
Other times, patients aren't sick enough to need inpatient care, but
would be lost if discharged to the street. Finding a program to look
after them can take days, doctors said.

In the meantime, the patients sit - and wait.

"There's no place to put them in the community, so we literally hold
onto them," said Dr. Michael Cohen, director of the emergency
psychiatric unit at Stony Brook University Medical Center on Long
Island.

Esmin Green, a poor immigrant from Jamaica, had been in the waiting
room at King's County Hospital Center for almost 24 hours when she
toppled from her chair the morning of June 19.

Security camera tapes show that, for an hour, no one who saw the 49-
year-old sprawled on the floor bothered to check her condition,
including the unit's attending psychiatrist and two security guards.

Doctors are still trying to determine a cause of death.

Six hospital employees were fired in the days after she died, and the
city agreed to reduce overcrowding and trim the time patients spend in
the unit. Hospital administrators also promised to improve conditions
in the unit, which had been deplored in a recent lawsuit.

The suit, which is still pending, claimed the long waits for care at
King's County could be cruel. Patients had limited access to linens,
gowns or soap. The showers were filthy and there were few places to
sleep.

One patient lucky enough to get a bed complained that someone stole
her spot when she got up in the night to use the bathroom. Another
patient said he was robbed of his wallet after falling asleep in a
busy hallway.

A 54-year-old man only days removed from an open heart surgery said he
had to curl up on the floor of a reception area, where he was kept
awake by fighting between patients and security guards.

Emergency physicians at other hospitals describe conditions far less
grim, but they uniformly agreed that a hospital waiting room is rarely
a comfortable place for someone in a psychological crisis.

"Optimally, you don't want a patient sitting in the emergency room for
any length of time," said Dr. Bruce Schwartz, the director of clinical
psychiatry at Montefiore Medical Center, in the Bronx.

Still, those types of waits can be routine.

In Austin, Texas, hospital officials have complained that a county
decision to reduce the number of patients sent to a state psychiatric
hospital has clogged their emergency rooms with mentally ill people
with no place else to go.

In Massachusetts, some parents have complained about days-long waits
in the emergency room for children who need placement in a pediatric
psychiatric service.

California health officials have struggled for years with complaints
about overcrowding in psychiatric emergency rooms.

Not every long emergency room wait is pointless, said Joyce Wale,
senior assistant vice president of behavioral health at the New York
City Health and Hospitals Corporation, which runs the city's public
hospitals.

Doctors need time to see how patients react to medications. Patients
arrive intoxicated, and need to sober up before they can be properly
evaluated.

There is also reluctance, in many cases, to simply commit patients to
a mental hospital, when their illness may not be that severe.

"Everybody really tries very hard not to admit someone into a
psychiatric inpatient unit unless it really needs to happen," Wale
said.

And every hospital emergency room in the city, she said, feels the
pressure of being used as a dumping for the city's mentally ill.

"It's the police. It's the schools. It's health clinics, all sending
people to the emergency room, when these people don't really need to
be there," agreed Stony Brook's Cohen.

© 2008 The Associated Press. All rights reserved.
This news is brought to you by PhysOrg,com
URL: http :// www .physorg,com /printnews.php?newsid=134323775