June 22--On June 4, a so-called "never event" -- a medical error that health-care quality experts say should not occur -- did indeed happen at St. Luke's University Hospital in Fountain Hill.
That day, Jonathan Hanchick, a 26-year-old Bethlehem Township resident who was being treated for a head injury following a motorcycle accident, broke a locked sixth-floor window and jumped out, sustaining internal injuries that caused his death five days later.
The rare, tragic event illustrates a major challenge facing hospitals around the country: How can a therapeutic institution provide needed care and reasonable access while ensuring the safety of all patients, including some who may be panicky, psychotic or brain-damaged and want to leave against medical advice?
It is an enormous challenge, not only because sometimes a patient like Hanchick leaves without warning and dies, but also because it can lead to costly lawsuits, increased regulatory scrutiny and a threat to the hospital's Medicare payments.
Doctors cannot simply strap down or anesthetize an unruly medical patient for long periods of time as they once could, said Marilyn Hollier, president of the International Association for Healthcare Security and Safety. "Back in the day, you could put patients in restraints for a few hours, but you can't do that anymore," she said.
Now, hospitals can restrain patients only as a last resort, according to the Joint Commission, the health-care accreditation agency. If restraints are used, they can only limit movements that could harm the patient or caregiver, and must be removed as soon as the threat of harm is over.
St. Luke's officials have declined to answer questions about Hanchick's case.
What is known from police reports, Hanchick's family and a statement issued earlier by the hospital, is that Hanchick was involved in a motorcycle accident May 17 and suffered a head injury. He was hospitalized and four times tried to leave St. Luke's against medical advice. He was successful twice and was picked up by police and returned to the hospital.
Those incidents, as well as his head injury, should have been a red flag that Hanchick was a risk for further "elopement," a term used in hospitals for situations when a patient leaves against medical advice and without telling medical personnel, said David Meek, founder of the National Institute for Elopement Prevention and Resolution.
"Brain injury can be an increased risk for elopement," he said.
While confused or delirious patients may wander off, he said, "exit-seeking" patients often try to leave repeatedly.
"They're sitting by doors, waiting for the door to open; they may go out a window," Meek said. "The exit-seeking is a much higher risk for elopement than a patient who is a wanderer."
Speaking about elopements in general, Ken Szydlow, St. Luke's vice president for marketing and public relations, said the causes and risk factors for elopement vary.
"Patients can have changes in behavior," Szydlow said. "Their mood, attitude and behavior can change by the hour. The need and ability to restrain patients changes accordingly."
St. Luke's has control stations on every nursing unit. Security and front-desk staff are trained to observe comings and goings in their areas, he added.
The hospital's elopement policy states that competent patients or their surrogates have the right to have the patient discharged against medical advice. Whenever possible, it says, the patient's attending physician or advanced practitioner should be contacted to explain the ramifications of leaving and then present the patient with a form acknowledging that he would be leaving against medical advice. The departing patient also should get care instructions with "an open-ended invitation to return to the hospital."
But before things get to that stage, hospitals try to keep patients where they need to be. Patients who are not on mental-health-care floors, which have separate safety rules, can be monitored with tracking devices and alarms, Hollier said.