Tuesday, April 28, 2015

Some thoughts on Authority and Victimization

This is our blog, and it's my place to vent some, and on this beautiful morning in Baltimore with all the trees in bloom in pink and white, I could really use some space to vent.  While none of us were in the middle of the unrest, it is awful to watch our beloved city on CNN -- this isn't how it should be.
I'm not going to write about riots or police brutality, but I do want to write a little about authority and  victimization, and for that I'm going to ask you to surf over to my friend Pete Earley's blog where he talks about a psychiatric patient who was arrested after biting a nurse in an Emergency Room.  And Pete is my friend, but I may not be gentle here, but I'll trust that he'll still be my friend even if we don't agree about everything.

Before I start, I want to make it clear: I oppose violence of all kinds by all people.  I strongly oppose police brutality, and I strongly oppose  throwing bricks at anyone or destroying businesses and property.  Let there be peace in Baltimore today and tonight and for all days to come. 

  #Black lives matter.  #Blue lives matter.  #Patient lives matter. #Nurses lives matter
 # All lives matter. 

So Mr. Earley wrote a post not long ago titled  We Took Our Daughter to the ER for Help. She Ended Up Being Arrested. 
     A parent writes in:
My daughter was then informed that she was going to be involuntarily hospitalized. She became even more agitated and when she threatened to leave, a nurse confronted her and a scuffle broke out. My daughter was forcibly restrained by five hospital personnel.
The nurse prepared an injection to calm her and my daughter, who was terrified, said: “’I’ll take the pill. I’m scared of needles.” The nurse proceeded to give her the shot anyway and my daughter would later tell us that she went black.
The nurse was pushing her elbow into my daughter’s chest and our daughter bit the nurse’s arm. She didn’t break the skin and there was no blood. 
Our daughter was put in restraints. Her arms and legs were all restrained, so tightly that her hands began turning purple. I thought things couldn’t get worse but they did. Two officers showed up at the ER to arrest my daughter for aggravated battery against the nurse.

The parent continues -- she's angry that the charges weren't diverted to a mental health court because the nurse wouldn't agree to this.  The parent is distressed and doesn't feel her daughter should be criminalized.

When you look at it, this post is rich with material on so many levels and there are so many things to take issue with.  I wasn't in the room, so I don't know if there wasn't some kinder and gentler way of dealing with this patient besides restraining her, injecting her, and escalating her fear and anger.  And really, if the story is accurate, then perhaps it would be reasonable for the patient to plead self-defense, or to press charges herself for the brutal treatment she received (I have no idea if a patient can do that).  Here, however is what Mr. Earley has to say:

"It is even tougher to understand why some victims insist on pursuing charges when the infraction seems so minor, as it appears to be in the case of the nurse who was bitten."

I, like Pete, believe that people in authority need to have special training in dealing with difficult populations and that people should not be unnecessarily provoked.   But we know nothing about the nurse besides the fact that she went to work, did her job (for better or for worse) and was bitten.  I don't know that the right answer here is to press charges, but I also know that it's not reasonable to tell people they need to go to a job every day where they must tolerate being assaulted without any recourse.  Perhaps the nurse had been assaulted numerous times -- mental health staff often are --  and this can lead to a traumatized staff.  I heard one story recently about a psych nurse whose eye was poked out by a new patient on a unit with no warning (~not in the course of restraining someone) by a patient who had a history of violent crimes.

I don't have an answer for this.  People get angry when they are mistreated, and as a society, we've become sympathetic to the victims of an aggressive authority and some people have decided that the resultant violent  response is understandable.    But the assumption is that the person in authority should be focused on doing the exact right thing, even if it means tolerating a work environment where they are in danger, often repeatedly, and that's just part of the deal.  The story above is told from the patient's perspective, not from the nurse's, and her side is dismissed for her lack of understanding and for insisting on pursuing charges for a minor infraction.  The assumption is that those in authority are somehow immune to the traumatization, fear, exhaustion, and if not, they should stay home or find another job.  And actually, perhaps someone who's sticking their elbow into a patient's chest should stay home, but then again, it's a third hand account and and we don't know the details of what transpired in the heat of the moment.

What's my point?  Simply that we're all human and perhaps these stories need to be heard from all sides before judgement is passed.  Perhaps if we could hear from the nurse, we might understand why she insisted on pressing charges, or perhaps we still might think this too extreme a response.  But it does nothing to encourage people to go into the field if you make the statement that they'll need to tolerate human biting without recourse.

Please don't read this as the idea that I'm condoning brutality by anyone.  I'm a huge proponent of kinder, gentler care, and I'm totally opposed to anyone biting nurses.  Some stories, however, lose something when you only hear one side. 


Jen said...

I work with people with severe Autism...I have 15 years of training and all the degrees to match, and I get bitten to the point of broken skin and deep bruising at least twice a year, sometimes more often. Tetanus boosters every five years and a few courses of antibiotics every year, most of which I have horrible reactions to (non stop vomiting) are the norm and a given. I have insurance, but worker's comp typically covers those costs anyway, if I'd fill everything out. Usually, the $15 copay isn't worth the piles of paperwork, at least not to me. Yes, people shouldn't be "victimized," and of course there are always two sides to each story but honestly, my instinct is to say that if the nurse is seriously pressing charges against a patient that mentally ill in a psych ER, she may be in the wrong profession, or at least the wrong specialization....

Steve said...

I don't know. The guy is a journalist beating on shitty customer service. I'm not endorsing riots, but like the police and Comcast, hospitals are known for incredibly poor service and journalist have to beat on them (with words).

I once carried my wife into the emergency room because she was screaming in pain and I didn't know what was wrong. The nurse told her basically to "man up" and that she had to stand and fill out paperwork before getting treatment, then told her her problem wasn't serious and basically to get the fuck out. Can you imagine going to a restaurant and being told you aren't hungry enough and get the hell out?

I once got an EKG and the nurse decided my skin was too soft and I had too much chest hair so shaved it off with a razor... without asking. I can't even think of how another business could be so invasive and not even bother to ask.

Gloria said...

Yeah...I've had more than a few war veterans in the family. Yes, it is reasonable to expect a certain amount of risk in high risk occupations. If you join the SEALS and get pissed you were in harms way then you shouldn't be there. If you work with high risk, really unstable patients, then you are running a certain amount of risk. And if she injected the patient, even after the patient agreed to take the medication orally, I would call that assault. Nurse better hope no one corroborates the patient's story...

Anonymous said...

"And if she injected the patient, even after the patient agreed to take the medication orally, I would call that assault. Nurse better hope no one corroborates the patient's story."

Exactly Gloria. But sadly, if the patient files assault charges, even with corroboration, it will most likely be dismissed because as a psych patient, she has zero credibility.

Dinah said...

Jen -- bless you, sounds like very difficult work.

Anon -- I'm not much for 'don't bother, no one listens to psych patients.' See my Please Complain post. In this one, the case eventually settled: http://www.nyaprs.org/e-news-bulletins/2006/2006-06-08-5691.cfm

Anonymous said...

Exactly what I feared would happen, while I was reading the Shrink Rap post, is what happened when I went to the original post -- another suicide attempt, without telling anyone of her distress.

Why in this world would someone incarcerate (what involuntary commitment really is) someone that reached out for help? In addition, the young lady's parents were with her and willing to provide care.

While I do not condone any form of violence, the nurse seemed to be using her position to bully someone else, and one could argue self-defense.

All lives matter, including those with mental illness. Provoking anyone is foolish. What happened to kindness and decency, especially in healthcare?


Anonymous said...

Dinah - most psych patients do not have the means, strength or ability to take on a lawsuit like that. Others fear the shame and discrimination from a public lawsuit identifying them as mentally ill. I had the option of pursuing a lawsuit for medical negligence and malpractice that was virtually certain to win through the state attorney's office against an MD therapist who "treated" me for several years but ultimately decided against it as I did not want my name associated publicly with mental illness in any way. Kudos to the woman in the article you listed, but for most people, the potential repercussions for a public acknowledgement of mental illness are too huge to overcome in reality.

Anonymous said...

So let me get this straight. She was considered incompetent to refuse treatment, yet when she refuses treatment she's suddenly considered competent again? Why? Because they didn't like the outcome?

If she was competent to make decisions, then why were they treating her against her will? None of this makes any sense. It seems like competence is defined as whatever they want it to be.


Anonymous said...

Also just -- COME ON. The nurse was not actually injured. She was not actually injured. The skin did not break, there was no blood, there was no bruise, there was no broken bone.

In contrast, 5 security officers restrained one patient. The nurse jammed her elbow into the patient's chest -- this was necessary for her safety while 5 officers were restraining her? Seems unlikely that she was needed to assist. The nurse administered an injection after the patient verbally consented to take oral medication. These are assaults.
Are we really going to compare the two?? Are we really going to argue that the nurse was the traumatized and assaulted one here? Of course everyone deserves safety in their workplace but if you work in a high risk environment, there are risks. The nurse should have been well-versed in them. Even an elementary school nurse knows there is a chance of being bitten -- and significantly more severely then what this nurse experienced. Perhaps she should transfer to an ICU somewhere.

I know this is Shrink Rap, but seriously. Give me a break.

Anonymous said...

Where to begin with these comments?

First, no, it is not "part of the job" to be assaulted. If you believe that, I suggest you try that logic out on the next cop you meet. They are emergency responders too. EMS, fire, police, the ED -- we are 24/7 and we deal with anything, anytime. That does not mean you are in a consequence-free zone where the laws of the land and ordinary human decency do not apply. But don't take my word for it; the next person who writes you a traffic ticket, just haul off and bite them. Let me know how that goes.

Sunny CA said...

I had a 15-year old Australian Shepard in emergency care at a veterinary teaching hospital known for quality care. I picked up the dog when she was improved, but still in the process of dying. She lived for one thing... her daily walks. A few days after she was home, a state policeman showed up at my door. While one of the students was shoving pills down my dog's throat, she "bit" him, so he filed a bite complaint against my dog with the aurthorities, and I was not told when I picked up my dog. The police arrived at my house to put my dog under "house arrest" for two weeks, which meant that during the final days of her life, it was illegal to allow her beloved dog walks.

Anonymous said...

Anon, I am not arguing it is just part of the job to be assaulted. But, it does happen when people have altered mental status. I was once assaulted by a patient with dementia. He dug his nails into my arm and wouldn't let go. I didn't like what he did to my arm, but I didn't file criminal charges against him.

The issue I have with the example in the OP is that I don't understand how someone can be criminally responsible for biting a nurse while staff were attempting to treat her against her will because she was psychotic. They can't have it both ways. We are supposed to believe she was incompetent when they were attempting to inject her with medication, she then suddenly became competent just for a split second when she bit the nurse, and then instantly became incompetent again when the needle entered her skin. That doesn't make any sense.


Gloria said...

I wasn't saying it's part of the job to put up with sane, rational human beings biting hospital staff. But if a dementia patient thought I was a young version of his wife and slapped my ass, I wouldn't press charges against him for sexual assault. Now, if a man in an unaltered mental state grabbed my ass, that'd be whole other story...

I'm just saying that allowances should be made when the person is obviously impaired. Also, I'm not convinced this biting case was really assault. That sounded more like self defense. Also, I want to know who ordered the woman into restraints. I was told by a nurse that it's illegal for anyone besides a doctor to order a patient into restraints. And the patient can't be tied down for biting, it has to be because there was a real fear the patient would harm him or herself. If the patient is tied down for assault, the defense lawyer will just argue self defense (the patient was assaulted by staff) and will probably win. The lawyer will just ask the nurse why she didn't give the medication orally or back off when the patient requested.

Jen said...

Food for thought for another post sometime? I happen to agree with it 100%, especially the last paragraph (above the last two lines).

Jen said...

Apparently I did not leave you the link for the article that I thought might be food for thought for a future post. Sorry about that:


I happen to agree with it 100%, especially the last paragraph (above the last two lines).

Dinah said...

Thanks Jen -- great post. I commented on this a few years ago:

Anonymous said...

If you're being locked up and imprisoned, you have the moral right to defend yourself in any way you can(yes, 'criminals' as well; 'resisting arrest' is not a crime it is the response of a healthy and unbroken spirit). Nurse got off lightly considering this and yes if she doesnt like it she should consider not oppressing people... the idea that authority is owed submission is the real sickness, not my voices or beliefs that do not match with what is 'acceptable' to the hive mind.