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Emergency Rooms Crowded With Psych Patients

Posted on: Friday, 4 July 2008, 13:10 CDT

A study found growing discontent with the way U.S. emergency rooms handle psychiatric care.

In June, hospital staff at Kings County Hospital Center in Brooklyn ignored a middle-aged woman lying face down on the emergency room floor.

The section of the hospital had a reputation for being busy, so staffers said it was a common sight for patients to wait hours and even days for care. They claimed some patients would pass the time by sleeping in chairs, or the corners of the room.

It took a nurse an hour to notice the woman passed out- sprawled on the ground. But it was too late; she had already died.

Security camera footage of the incident drew public outrage when it was released this week. Experts say it is a dramatic symptom of a crisis happening in hospitals nationwide.

Experts claim emergency rooms are routinely bombarded with mentally ill patients. They stay in waiting rooms while health care workers struggle to find someone to care for them.

The American College of Emergency Physicians surveyed hundreds of U.S. hospitals last month and 79 percent routinely "boarded" psychiatric patients in their waiting rooms for at least some period of time due to limited healthcare services.

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

One-third of emergency rooms reported psychiatric patient stays averaged at least eight hours. Six percent said they had average waits of more than 24 hours waiting for the next step in a patient's care.

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

Doctors said the delays are easily linked to one factor: a lack of available mental health services.

There are shortages of clinicians and few open beds at psychiatric hospitals, according to doctors. Another factor that causes problems is insurance companies who refuse to approve treatment. Patients must then wait while doctors appeal the decision. Doctors said, many patients aren't sick enough to need hospital care, but would be lost if discharged to the street. Therefore, many times patients can only 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.

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

For one whole hour, no one noticed the 49 -year-old sprawled across the floor. Security camera tapes show no one bothered to check her condition, including the emergency room's psychiatrist and two security guards.

Doctors are still investigating the cause of her death.

In the days following Green's death, 6 hospital employees were fired. The city also agreed to cut patient overcrowding and trim the time patients spend in the unit. Hospital administrators said they would strive to improve the unit's condition, which had been deplored in a recent lawsuit.

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

One patient said someone stole her bed one night when she got up late to use the restroom.  Another patient said someone stole his wallet after he fell asleep in a busy hallway.

A 54-year-old man said only days after he had open-heart surgery, he was forced to curl up on the floor of a reception area. He was kept awake by arguments between patients and security guards.

"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, others claim emergency room waits can be routine.

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

Hospital officials in Austin, Texas, have complained a county decision to reduce the number of patients sent to a state psychiatric hospital has bombarded their emergency rooms with mentally ill people who have no alternate place to stay.

Massachusetts parents have complained about days-long waits in the emergency room for children who need help from a pediatric psychiatric service.

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, says not every long emergency room wait is pointless.

She said doctors need time to monitor patient reaction to medications. Other patients arrive intoxicated, and need to sober up before they can be properly evaluated.

In other cases, there is worry the need is not severe enough to send patients to a mental hospital.

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

She said every hospital emergency room in the city feels the burden of being used as a dumping site for the 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 Cohen.

Source: redOrbit staff and wire reports

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