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When a Patient is Shot in the Hospital

When a Patient is Shot in the Hospital

Yesterday I was shocked to read a very disturbing article in the Sunday New York Times.1 An internet version of the story can be read at http://www.nytimes.com/2016/02/14/us/hospital-guns-mental-health.html.

The article, by reporter Elisabeth Rosenthal, was entitled “When the Hospital Fires the Bullet”. On August 26th, 2015, Alan Pean, a 26 year old student had been admitted to a Houston hospital. Alan, who had a presumptive diagnosis of bipolar psychosis, drove himself to the hospital seeking treatment. As he approached the hospital, he crashed his car and was seen in the emergency ward. He is reported to have been screaming I’m manic…I’m manic, as he was ushered into the E.R. to assess his injuries from the car crash.

Mr. Pean was admitted to a surgical ward with the diagnoses of hand abrasion, substance abuse (blood tests showed positivity for THC), and motor vehicle accident.

During his period of observation on the surgical ward, it is reported that Mr. Pean became difficult to control. The clinical staff called security to assist with the issue.

According to the Times report, the security guards who responded were two Houston police officers who were moonlighting as hospital security personnel that evening.

The exact details of what happened next are a bit vague, but it is reported that Mr. Pean was violent and out of control and struck the officer who was trying to subdue him. Apparently, in an effort to gain control of the situation, Mr. Pean was first Tasered by the security officer and then, when the Taser was insufficient to subdue Mr. Pean, he was shot in the chest.

Mr. Pean survived the bullet wound to his chest, was ultimately discharged from the hospital, and is currently being treated for his psychiatric condition. Mr. Pean, is now being charged with two counts of felony assault of a police officer, including the use of four “deadly weapons”, “an unspecified piece of furniture, a wall fixture, a tray table and his hands”, according to the Rosenthal article. He was released from the hospital, after a four-day stay, on $60,000 bail.

 

As a Canadian physician who has worked the better part of my life in a hospital, I must say I was stunned. First, I, like most other physicians who have worked in an acute care institution, have been involved in difficult situations where we have had to restrain patients. I certainly remember deploying strategies that included attempts at calming down the patient verbally, the use of physical restraints, and the use of sedatives.

In reading the article I couldn’t ever imagine that one of the techniques that might be used to deal with the situation of a psychotic patient being out of control would include the use of a Taser, or the use of a firearm.

In fact, not having ever thought about it, I didn’t process that there might be guns in the hospital. Apparently not. Rosenthal, in her article, quotes that according to a 2014 U.S. national survey, 52% of medical centers reported that their security personnel carried handguns and 47% said they used Tasers.

Apparently, the incident has caused public outrage. This has included a petition campaign against gun use in hospitals.2 “I think there is no circumstance under which it is acceptable for a Taser or gun to be used to subdue a patient seeking care,” said Sonya Shadravan, a Los Angeles-based resident physician in psychiatry who signed the petition in support of Pean, in a report by Alma Almendrala and Erin Schumaker of the Huffington Post.3

The issue, however, may not be as straight forward as it might seem. In an article in Canadian Security4 a report from the IHSSF, the International Healthcare Security and Safety Foundation, it was stated that “while the debate continues about whether the availability and utilization of weapons by security personnel in the hospital setting is wise, especially the use of TASERS®, this study shows a lower risk of physical assaults in hospitals in which TASERS® (or similar devices) were available to security personnel, which suggests these devices may be useful tools for de-escalating and controlling potentially violent (or already violent) situations.”4

All that said, Alan Pean was quoted in the Times article as saying ”I thought of the hospital as a beacon, a safe haven. I can’t quite believe I ended up being shot”. 1

If you have any thoughts about this issue, respond the the blog, or better yet…please stop by the Macklem House, my door is always open.

Richard

  1. The New York Times, Sunday February 14th, pages 1, 16, 17. Article by Elisabeth Rosenthal
  2. http://www.ipetitions.com/petition/alanpean
  3. http://www.huffingtonpost.com/entry/patient-shot-in-hospital-after-seeking-mental-health-treatment_us_55e4abdee4b0b7a96339dfcc
  4. http://www.canadiansecuritymag.com/news/health-care/ihssf-releases-study-on-weapons-use-among-hospital-security-personnel-2502

Leda Raptis

Mon, 06/26/2017 - 13:40

What weapons did the patient have? A stapler perhaps like Djiekanski? Who knows if he was in pain and scared after the accident, and this made his condition worse? In the US they do not think much before shooting, it works for ANY problem…

Leda Raptis

Laura McDiarmid

Mon, 06/26/2017 - 13:40

Thank you for writing your blog on this story, I just finished listening to the This American Life podcast about it: http://www.thisamericanlife.org/radio-archives/episode/579/my-damn-mind. What I found most shocking (on top of the race, mental illness, training issues) was the CEO of the hospital’s statement that if it happened again he would not change anything, in contrast to the statements from a hospital employee saying that similar situation happen regularly. If anything can be gained, it would be to learn from the situation so it does not happen again.

Laura McDiarmid

Laura,

Thanks for including the video which I will watch. It certainly seems typical that when it comes to security issues, the U.S., in particular, is extremely hard line.

Richard

reznickr

Bill Moore, Meds '62

Mon, 06/26/2017 - 13:42

Richard, I try to hang back commenting but feel I must thank you for blog-sharing about hospital security and recently about palliative care. In my opinion, people with weapons shouldn’t be allowed in hospitals. And, people who need palliative care should get it. Of course, I don’t know how best to achieve those goals but I fully support what you may be doing to reach them.

Bill Moore, Meds '62

Thanks Bill,

I do believe Canada is making great progress in palliative care, and certainly there has been a fairly dramatic acceleration in palliative care training capacity.

With respect to guns in hospitals, you and I are on the same page.

Richard

reznickr

D.H. Braden M.D.,C.M. FRCPC

Mon, 06/26/2017 - 13:43

In all of my 40 years of practice I was unaware of the “treatment ” of mania with Taser or hand gun. It is rather frightening to learn that over 50 percent of Health Care facilities have security armed with guns and just under 50 percent with Tasers and that in this instance both were used.
The availability of many rapid acting sedating medications would seem more appropriate , along with the presence of sufficient staff to provide physical restraint until such medications take effect.
One wonders if the fact that the security people involved were “off duty” police might have been a significant factor-especially in the gun ready culture of our neighbours to the South. Don Braden

D.H. Braden M.D.,C.M. FRCPC

Dear Don,

Thanks for your comment. This story certainly took me by surprise.It sounds like you and I have the same perspective with respect to available methods to deal with difficult situations in a hospital setting.

Richard

reznickr

Patricia Forsdyke

Mon, 06/26/2017 - 13:45

But there’s the rub. Giving timely appropriate medical treatment in the form of an injection to someone who is trapped by a psychosis and in need of some relief for devastating symptoms is not easy .The impediments to appropriate treatment are many . I will not labour the points here , but believe me it is hard to do the right thing when the barriers are prohibitive. All is not well this side of the border particularly in Ontario ! I get to hear about the messes on a regular basis ! They are not pretty or right. Prisons have replaced mental hospitals. The work of Dorothea Dix has been undone.

Patricia Forsdyke

M David Low MD, CM,, PhD, FRCP(C) Queens Meds '60

Mon, 06/26/2017 - 13:46

Sir: I too am a Canadian physician, having spent roughly equal amounts of time (20+ years each) in hospitals in the US- specifically Houston Texas, and Canada- primarily Vancouver, BC. It is shocking for Canadians to see guns in hospitals. There is no question of the seeming incongruity of a tool for extreme violence in a place dedicated to healing. But the two countries have in some ways created very different cultures and behavioural standards over the years- I saw handguns routinely carried by guards in a hospital ER in Philadelphia in 1959, and again in our city/county hospital in Houston in 1962. The duty policeman in the Houston hospital, on one occasion while I was working there had to shoot a patient who was preparing to kill a nurse with a butcher knife that he stole from the floor kitchen. That nurse was very happy the guard was armed and prepared to use his gun to protect her. Other nurses, even in Canada, have not been so lucky- they have been killed by their patients. I don’t advocate having armed guards in all hospitals, but there are times when it is very difficult indeed to predict when a patient or visitor will become violent. And I don’t condemn hospitals or their staffs for doing whatever is necessary to ensure the safety of the ones who are working to heal.

M David Low MD, CM,, PhD, FRCP(C) Queens Meds '60

David,

Thanks for your two comments. You certainly bring up a valid point. The issue of a security guard being armed in order to protect patients and staff, is of course, more understandable and clear cut. There is a line however, that may be crossed, when a patient, with an active mental illness, is the subject of firearm use.

Richard

reznickr

M David Low MD, CM,, PhD, FRCP(C) Queens Meds '60

Mon, 06/26/2017 - 13:47

In reply to by student

PS; Jeb Bush Republican candidate for President, recently tweeted a picture of his own gun:
When a man hoping to be president of the United States can sum up his own country with a photograph of a monogrammed gun and the single-word caption “America”, it may be time for the rest of the world to worry.

M David Low MD, CM,, PhD, FRCP(C) Queens Meds '60

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