Tasers and Health Care

Posted July 31, 2009, at 6:04 p.m.

Having a Taser available at Eastern Maine Medical Center’s emergency room is, in the parlance of medicine, treating the symptom rather than the underlying problem. The problem — too many people with mental illness or under the influence of drugs and alcohol spending long hours in the ER — won’t be solved with weapons, although a Taser may ensure the safety of ER workers and patients.

Because of an increase in violent incidents at its emergency room, officials from EMMC plan to keep a Taser there, primarily for use by the city police officer who works there overnight. Hospitals in other large Maine communities don’t hire private police details and haven’t asked for Tasers.

A nurse was nearly stabbed this spring by a violent patient who was in the emergency department for treatment, according to a memo describing the Taser plan to hospital employees.

Karen Clements, the department’s administrator, told the BDN that a scarcity of inpatient psychiatric beds and outpatient counseling and support services is among the factors behind a rise in assaults and aggressive behavior at hospitals across the country.

A move away from institutionalizing those with mental illness was well intentioned but not followed up with the complementary buildup of community services and housing, pushing problems onto medical facilities and jails. Jails house eight times as many people with mental illness as psychiatric hospitals do.

Carole Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness, is right in asserting that not all ER violence should be attributed to the mentally ill. “You assume that people who go to the hospital are there because they need help with health care,” she said this week. “You would hope they would get that care rather than getting arrested or Tasered.”

Hope and reality, however, often don’t overlap.

Erik Steele, an emergency room physician and chief medical officer for Eastern Maine Healthcare Systems, described one patient’s 55-hour stay at a Bangor hospital emergency room. A woman he called Paula in a 2004 column in the Bangor Daily News was brought to the hospital by police be-cause she was having suicidal and homicidal thoughts. An evaluation determined she needed admission to a psychiatric hospital. Ten hospitals were called: None would take her. Some lacked an available bed, some said that Paula was too complex for them to handle. Fifty-five hours later, a hospital that had previously been called four times accepted Paula. As Dr. Steele wrote, fortunately Paula was peaceful.

“Some [patients] are downright dangerous for the staff in the small emergency departments who are waiting for a bed and waiting for help,” he wrote. A 55-hour wait is a little on the long side, he added, but 15- to 30-hour waits are commonplace.

This March, Dr. Steele wrote about overuse of emergency departments. “The patient with mental illness who comes into the ED 30 times a year feeling depressed and scratching his wrists with broken glass needs community access to a good crisis worker, a regular counselor, family and commu-nity support, someone to ensure he takes his prescribed psychiatric medications, a physician, etc. None of that help is consistently available to every such patient in Maine either.”

Instead of providing those services — which cost money neither the state nor the federal government has at the moment — we put weapons into emergency rooms. That won’t solve the real problem.

http://bangordailynews.com/2009/07/31/opinion/tasers-and-health-care/ printed on September 23, 2014