The woman who died waiting to be admitted

[MikeWaters]

to the psych ward/hospital doesn't surprise me.

http://www.cnn.com/2008/US/07/03/hos...ath/index.html

The staff will be the scapegoats, but it is really the system that is the problem.

Parkland hospital, one of the most famous and respected public hospitals in the USA--the psych facilities in the ER are pitifully small, with patients (and until recently children) sleeping on the floor with sheets over their heads. Periodically the people are woken up by the staff to see if they are ok.

The psych inpatient ward in the Dallas VA was shut down after a spate of suicides, at least one of them actually committed inside the hospital. All of psychiatric services are housed in the old hospital, while all the other services are in the new hospital. It's a complete dump. They already spent 100k trying to "suicide-proof" the hospital. Again, it's a demonstration of how psychiatric services are the last priority.

Just this past week, one of the largest hospitals, if not the largest hospital, shut down it's psych ward. Baylor Hospital. Why? They said that they didn't get enough business. They only had 9 beds, and only 3 were filled on average and were usually transferred out by the hospital to other hospitals within 48 hr (this is all in the Dallas Morning News). That ward had been cut to 9 beds, from many more. I know a doctor who worked there for many years as a consultant psychiatrist. He told me the hospital wanted to shut down the psych ward for many years, but for accreditation/reputation reasons kept it open as a sham. They couldn't get any psychiatrists to cover psych call, so they started having to pay thousands of dollars to a few psychiatrists to cover call. Baylor says it is because of lack of patients--despite a bed shortage overall in Dallas. It was because they didn't want to have a psych ward in the first place, but they are smart enough to not say this publicly.

Indigent patients at yet another psychiatric hospital sit side-by-side in lazy-boy chairs overnight on 24 hour observation. They are triaged, with the fundamental principle being that there are not enough beds to hospitalize all of them. So they are triaged. The sickest ones are then hospitalized, the others are let go.

So does it surprise me that there is a psych hospital with dozens of patients waiting 24 hours to be seen, and one of them falls unnoticed and dies? No doesn't surprise me at all.

While the staff is blamed for not caring, the truth is that American should be blamed for the not carting part.

[TripletDaddy]

This phenomenon was one of the main things that shut down King-Drew in LA.

Every now and then, if you go down 6th street and cut through Skid Row, you will see homeless people on the sidewalk....in hospital gowns. I guess after a day or so, the hospitals discharge them and leave them back in the street.

[ERCougar]

Originally Posted by TripletDaddy

This phenomenon was one of the main things that shut down King-Drew in LA.

Every now and then, if you go down 6th street and cut through Skid Row, you will see homeless people on the sidewalk....in hospital gowns. I guess after a day or so, the hospitals discharge them and leave them back in the street.

I wouldn't call this one of the "main things" that shut down King-Drew, I would call it one of the myriad things. King-Drew was a friggin' mess, legendary throughout the country for its problems. EMTALA violation (after violation after violation...) ultimately shut down King-Drew.

Not that I disagree with your point--it IS a huge problem. I just can't pass up on an opportunity to be difficult.

[ERCougar]

Originally Posted by MikeWaters

to the psych ward/hospital doesn't surprise me.

http://www.cnn.com/2008/US/07/03/hos...ath/index.html

The staff will be the scapegoats, but it is really the system that is the problem.

Parkland hospital, one of the most famous and respected public hospitals in the USA--the psych facilities in the ER are pitifully small, with patients (and until recently children) sleeping on the floor with sheets over their heads. Periodically the people are woken up by the staff to see if they are ok.

The psych inpatient ward in the Dallas VA was shut down after a spate of suicides, at least one of them actually committed inside the hospital. All of psychiatric services are housed in the old hospital, while all the other services are in the new hospital. It's a complete dump. They already spent 100k trying to "suicide-proof" the hospital. Again, it's a demonstration of how psychiatric services are the last priority.

Just this past week, one of the largest hospitals, if not the largest hospital, shut down it's psych ward. Baylor Hospital. Why? They said that they didn't get enough business. They only had 9 beds, and only 3 were filled on average and were usually transferred out by the hospital to other hospitals within 48 hr (this is all in the Dallas Morning News). That ward had been cut to 9 beds, from many more. I know a doctor who worked there for many years as a consultant psychiatrist. He told me the hospital wanted to shut down the psych ward for many years, but for accreditation/reputation reasons kept it open as a sham. They couldn't get any psychiatrists to cover psych call, so they started having to pay thousands of dollars to a few psychiatrists to cover call. Baylor says it is because of lack of patients--despite a bed shortage overall in Dallas. It was because they didn't want to have a psych ward in the first place, but they are smart enough to not say this publicly.

Indigent patients at yet another psychiatric hospital sit side-by-side in lazy-boy chairs overnight on 24 hour observation. They are triaged, with the fundamental principle being that there are not enough beds to hospitalize all of them. So they are triaged. The sickest ones are then hospitalized, the others are let go.

So does it surprise me that there is a psych hospital with dozens of patients waiting 24 hours to be seen, and one of them falls unnoticed and dies? No doesn't surprise me at all.

While the staff is blamed for not caring, the truth is that American should be blamed for the not carting part.

It's not uncommon at all for us to hold psych patients for 48+ hours waiting for inpatient beds, particularly on weekends. Our nurses (and doctors, to be honest) hate checking on them because they're, well, crazy, and usually difficult patients to work with. None of us went into emergency medicine to babysit psych patients (nor are we trained to help them). So typically what happens is they got locked in an empty room (for their own protection) with no windows or noises, with little attention other than food and the occasional vital sign check by a nurse. The doctor will check on them once a shift unless they "act up", and I know there are doctors who don't check on them at all. It's really no better than jail, probably worse. I also think there is sort of an underlying negative reinforcement motive, i.e. if we make their time miserable enough, they won't try it again. This may work for attention-seekers, but for the truly mentally ill, it obviously doesn't.

It is an extremely dangerous situation and it is no surprise to me that people die.