Lebanon PA June 24 2019

WellSpan Good Samaritan Hospital has been faulted by the Pennsylvania Department of Health for using pepper spray and handcuffs on a patient in need of mental health care.

It’s second time in a month a local hospital was faulted for using too much force against a patient in mental health crisis. In the other case, security staff at UPMC Hanover Hospital in York County used a stun gun.

In each instance, the department faulted the hospital for using the tool as a “healthcare intervention” rather one which should be used only to enforce the law, and for using it before all less forceful options were tried. In each case, the force was used when police had been called but hadn’t yet arrived. In each, police found no cause to arrest the patient, and the patient was involuntarily committed for psychiatric treatment.

Tom Harlow, the president of Good Samaritan, said the hospital is responding by “re-doubling” efforts to calm and control highly agitated patients without using force.
The effort includes tapping its WellSpan Philhaven hospital, which specializes in mental health care, for help in “de-escalating” situations and caring for people in mental health crisis.

Thomas Harlow is the president of WellSpan Good Samaritan Hospital in Lebanon, Pa. Harlow is leading an effort to make sure patients in mental health crisis get the needed care, with little or no use of force.

It also includes expanding a special emergency response team that already exists at WellSpan’s York Hospital to Good Samaritan, WellSpan spokesman Brett Marcy said.

Harlow said he fully agrees hospitals must put the patient’s medical needs and well-being above all else, and refrain from tactics such as pepper spray until exhausting all possibilities to “talk someone down.” Still, he said staff often straddles a difficult, blurry line between protecting the patient and protecting themselves and other patients. Further, staff often feel legitimate fear, and must decide how to react in an instant, he said.

“It’s a fine line … it’s not always clear and well-defined what we can and can’t do,” he said.

The patient came to the Good Samaritan emergency room on April 26. According to the health department, the patient spoke of substance abuse and intent to “kill a girlfriend.”

As staff attempted to conduct a medical test, the patient made threats and threw a chair. Eventually, the patient swung an IV pole and put a security officer in a headlock, according to the health department. A security officer used the pepper spray. The patient, described by staff as “continuously aggressive and psychotic,” was eventually put in restraints and given medication.

The health department said Good Samaritan “failed to ensure that interventions and alternatives were attempted prior to the use of the handcuffs and pepper spray.”

Shortly after the incident, Good Samaritan ended its policy of allowing security staff to use pepper spray. Similarly, UPMC Hanover had immediately collected stun guns from security staff and announced they would no longer be used.

The incidents reflect a serious and growing problem in hospitals: dealing with highly-agitated, often threatening patients or patients’ relatives. Health care settings are now considered the most dangerous private workplace in terms of violence toward employees. With hospitals, much of the problem is attributed to the shortage of mental health treatment, and the fact that people in mental health crisis often end up in the hospital emergency room.

“While many EDs are improving their ability to effectively assess and triage patients in need of psychiatric care, they aren’t set up for this kind of treatment, and there can be delays in transferring patients to appropriate inpatient and outpatient treatment settings. You can imagine the toll this takes on patients, families and providers,” said Rachel Moore, a spokeswoman for the Hospital and Health System Association of Pennsylvania.

HAP pointed to Penn State Health Milton S. Hershey Medical Center as an example of a hospital which devised an approach that seems to be greatly reducing both force against patients and harm to staff.

The effort centers on a carefully selected and specially trained “Behavioral De-Escalation Response Team.” The team has been available at all times since January. It consists of experts in areas including nursing, mental health, security and pastoral care. Team members are practiced in tactics that include avoiding triggers that can add fuel to a volatile situation and using calming talk and actions. Upon arriving, the team forms a “huddle” outside the view and hearing of the patient, and outlines strategy for “de-escalating” the situation.

Penn State Health began devising the new approach in 2018 after two serious incidents where staff was seriously harmed by patients. It also realized it was having a higher-than-average number of such incidents compared to other hospitals, with incidents on the rise. Last September, for example, there were 41 instances of staff being harmed. Early on, Penn State Health realized part of the problem resulted from failing to fully recognize the potential for such behavior on the part of the patient or family member when the patient arrived.

In the early weeks of the team’s existence, it was called on an average of once per day, and calls “have all resulted in successful de-escalation of the patient or family member.” Incidents of harm toward staff fell to 11 in January, according to a summary by the medical center, which is sharing the plan with other hospitals.

Penn State Health said part of the effort included an organization-wide effort to change language and perceptions regarding highly distressed patients. The patients are now looked at as “patients in crisis” rather than patients exhibiting “aggressive behavior.” They are approached with “a patient centered model rather than a defensive or escalating method.”

Penn State Health said the team is comprised of people already on staff and therefore hasn’t added labor costs.

Harlow, the Good Samaritan president, is also a WellSpan executive who oversees safety and security.
He said lessons learned from the pepper spray incident will be applied to all WellSpan hospitals.

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