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Emergency room nurses pay price for parked psych patients

Laura Arguija still remembers the taste of the blood in her mouth from the time she was attacked by a psychiatric patient in the emergency room of a large hospital in San Bernardino County, where she worked as a trauma nurse.

“I had long hair, and she wrapped her hand in it and started wailing on my face,” the 38-year old Laguna Hills resident recalls. “She was high on meth and she was a psych patient. It wasn’t a good combination.”

Parking that patient – and a few from the local jail – out in the hallway alongside regular patients with garden-variety medical ailments was also not a very good combination. But it is not uncommon among overstretched emergency rooms these days.

Violent behavior by patients, or their families, has always been a major challenge for ERs, because of the long waits, stressful circumstances and prevalence of drugs and alcohol. Throw in mentally unstable patients who are often held there for hours or days because there are no psych beds available and no psychiatrists in the hospital to evaluate them, and the situation can be explosive.

Peter Anderson, an emergency room physician who works at three hospitals in Orange County, says one of his fellow physicians was choked by a patient who had been in the ER for five days.
“You hear stories like this all the time,” he says. “It’s a dangerous, dangerous situation.”

A 2011 study of ER violence by the Emergency Nurses Association showed that over 48 percent of nurses said they had been grabbed or pulled, 41 percent said they had been punched or slapped, and 36 percent said they had been spit on. Smaller numbers said they were kicked, bitten, strangled, stabbed and even sexually assaulted. Nearly half of those assaults were committed by psych patients.

It’s hard to know exactly how often violent incidents occur in the ER and who the perpetrators are, because the attacks are usually not reported. One study of California emergency rooms found that 72 percent of workers who had been victims of patient or family aggression failed to report it, according to an article in Lifeline, a publication of the American College of Emergency Physicians.
Some hospitals have begun to keep track.Michael Brant-Zawadski, executive medical director of Hoag Hospital’s Neurosciences Institute, said Hoag has 26 reports over the past year of violence by patients with mental health disorders who were being held in its Newport Beach and Irvine emergency rooms.

The California branch of the Emergency Nurses Association is hoping to survey nurses at hospitals around the state three times a month about violence they’ve encountered on the job. The idea is to be able to predict the probability of being attacked at different types of hospitals and determine what types of patients are committing the violence.

But hospitals are reluctant to participate, says Marcus Godfrey, an ER nurse who is heading up the effort to design the survey. They fear that unions might use reports of violence in their organizing drives, and they are concerned about attacks showing up in surveys that have not been reported to the authorities, he says.

Mental health experts and ER doctors say that despite the assaults on hospital staff, most mental health patients are not inclined to attack others.

“Psych patients are most often a danger to themselves,” says Marc Futernick, president-elect of the California Chapter of the American College of Emergency Physicians.

To the extent they do lash out, it is often because of long waits in comfortless ERs.

“The patient comes in and wants to be treated, but they’re not getting treated. And the longer they go without treatment the worse it gets,” says Sheree Kruckenberg, head of behavioral health at the California Hospital Association.

“For every story you can tell me about somebody getting injured, I can tell you a horror story about a patient who spent seven or nine days in the emergency department.”

As angry as she was about being assaulted, Arguija says she understood why her attacker felt compelled to beat on her. “I think she did it just to get out of there,” Arguija recounts. “She just wanted the process to go quicker.”