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News: A schizophrenic homeless man became unruly and was placed face down on an ambulance gurney and a backboard was strapped to him. He suffocated and died. An Ohio jury returned a $2 million verdict against the ambulance company.
Background: A 32-year-old, chronically mentally ill homeless man was brought to an emergency department (ED) on Christmas Eve after he threatened to kill his psychologist. At first, the patient was calm and remained quiet, but became violent when the ED physician informed him that he would be committed to the county psychiatric hospital. It took six police officers and additional hospital security personnel to restrain him. He was involuntarily restrained to a gurney with four-point restraints within the ED security area.
A private ambulance company arrived, and the patient was given a sedative. Emergency medical technicians determined they would transport the patient face down on the gurney with a backboard placed over him, which was tightened down considerably. Police officers helped transfer him to the ambulance. Though Mr. Doe complained he was unable to breathe, a towel was loosely held around his mouth to prevent him from spitting and he was covered from head-to-toe with a sheet. No one evaluated his vital signs.
As Mr. Doe was wheeled out, the ED physician noticed that his arm just below the sheet appeared to be blue. The sheet was removed and Mr. Doe was found to not be breathing. He was pronounced dead. The county coroner determined that Mr. Doe died from positional asphyxia and that his death was a homicide. Local authorities felt there were no grounds for criminal prosecution.
The plaintiffs alleged negligence against the hospital, the ED physician, and the ambulance company that the hospital and ED physician had failed to follow appropriate procedures. The plaintiffs said the ambulance company caused the death by an unorthodox transfer method.
The defendant argued the man had died of a fatal heart arrhythmia and the damages were minimal. They pointed out that the decedent’s mother also was diagnosed with mental illness, that she had given Mr. Doe up to her own mother (Doe’s grandmother, now deceased) to raise, that Mr. Doe had spent most of his life in various institutions in involuntary placement, and that the total time Mr. Doe spent with his mother was less than six months in his life.
The plaintiffs settled with the defendant hospital and the ED physician and pursued the ambulance company, which said the decedent did not die of positional asphyxia. It was agreed to try the case in a summary jury trial with a binding high/low agreement. Following the presentation, the jury returned a verdict against the defendant for a total of $2 million. The sum of $1.6 million was allocated to the survival claim, and $333,334 was allocated to the wrongful death claim. The verdict was adjusted according to the agreed upon confidential high/low agreement.
What this means to you: "The severe restraint of the patient is unconscionable. It is difficult to believe that in this day and age, that a patient was treated with such force. The four-point restraint should have been sufficient under most circumstances, but it does not seem that any other interventions, such as counseling or medications were utilized," observes July Davis, director of Risk Management at Tallahassee (FL) Memorial Hospital.
"At our facility we utilize a team of PERP nurses to handle such situations. PERP stands for psychiatric emergency response program, which is staffed by nurses with specific training in the handling and care of psychiatric patients. We have found this approach to be particular effective with patients with no acute medical needs. By systematically triaging such patients using specialized documentation and protocols, psychiatric patients are generally responsive and assisted through counseling," adds Davis.
"Should particularly belligerent or unruly patients require additional interventions, the emergency room is equipped with a quiet room,’ where psychiatric patients can be taken away from the mainstream noise and emergency room treatment, and in some instances may be given medications to calm, not sedate them. Here, we utilize the services of the security personnel who are expressly assigned to the emergency department. On weekends, the security team is augmented by off-duty law enforcement officers. The combination of internal personnel — PERP and security — are still unsuccessful at managing a patient, from time to time on-duty law enforcement officers may be called in for further assistance, which in extreme instances seems to be effective," notes Davis.
"Handling difficult psychiatric patients is a challenge for any institution, but having a series of safeguards in place should be helpful in managing most situations. The use of force may become necessary, but overt force and over-restraining should be avoided," concludes Davis.
• Estate of Doe v. ABC Ambulance Corp., et.al., Lake County (OH) Court of Common Pleas.