Hospital calls cops and feels the sting

June 17, 2008
Taser response to disturbed patient leads to ruling from federal and state officials

Jun. 16--When the emergency room staff at Northfield City Hospital thought an obviously disturbed patient was about to turn violent, they did what many hospitals do in that situation: They called the police.

In this instance, officers used a Taser to shock the man. The patient dropped to the floor, was injected with medications and transferred to the psychiatric unit at another hospital, according to an official report about the February incident.

Now federal and state health officials have cited the Northfield hospital for violating the patient's rights.

The hospital and the Minnesota Hospital Association are perplexed by the ruling, which could have implications throughout the state.

"They did nothing wrong here," said David Feinwachs, general counsel for the association. He said it's not uncommon for hospitals to call police in cases like this. "And now they're being faulted for it."

The Minnesota Department of Health, which investigated the incident, cited the hospital for failing to protect the patient's safety. Under federal law, the hospital could lose Medicare funding if the problem isn't corrected.

"It wasn't an easy case," said Darcy Miner, director of complaints monitoring for the department. Still, she said, health officials concluded that "something happened that shouldn't have" and that the hospital could have done more to avoid it. "We felt that in this situation, that level of force was not warranted," she said.

The incident tapped into growing concern about the use of Tasers on patients who turn violent or dangerous. Just last month, Canadian police came under fire for using a Taser on a bedridden 82-year-old man, who had become delirious and wielded a knife at a hospital in British Columbia. The American Psychiatric Association has called for national guidelines on Taser use in hospitals.

The Northfield case was the first time a Taser was used on a patient there, according to Ken Bank, the hospital's president. The patient, who was not identified, was not injured beyond the initial Taser shock, he said.

The Health Department's criticism, he said, "came as a bolt out of the blue to us." He said the hospital has had the same policy for handling unruly patients for 20 years.

"It's difficult to figure out how to handle those fairly rare situations differently than we're doing now," he said. "We don't have round-the-clock security. Most hospitals under 100 beds don't. So that's what we've been struggling with."

Hours of effort

It was just after 2 a.m. when the patient arrived at Northfield's emergency room on Saturday, Feb. 23. He began pacing the halls, rambling incoherently and yelling, according to the Health Department's investigative report.

A nurse heard him talking about "poison coming out of the walls, poison in his blood and about Jesus." The staff tried to calm him, using "verbal deescalation." But he became more agitated. The nurse called police, fearing he "could go off and hurt someone," the report said.

Two officers arrived about 7 a.m., and tried to get him to return to his hospital room. An officer shot him with a Taser, which uses electric shocks to temporarily stun a person. The patient never lost consciousness, "but went to the floor and said he would cooperate," the report said.

He was cuffed, given several medications and held in the emergency room until 8:15 a.m., when he was transferred by ambulance to an unnamed hospital with a psychiatric bed.

Northfield's police chief, Mark Taylor, defended the use of the Taser. Department policy says the Taser can be used "if an officer feels that either he is in danger or someone else is," Taylor said. "In this case, that's what we feel happened."

In April, the Health Department investigated after receiving a complaint about the incident. Its report, dated May 7, cited the hospital for violating three federal rules. Although it gave no specifics, it referred to rules on the use of restraints and the patient's rights "to receive care in a safe setting."

Bank, president of the Northfield hospital, was stunned.

Feinwachs, of the Hospital Association, was outraged.

"To suggest that somehow seeking the intervention of law enforcement is an impropriety on the part of a health care provider seems to be illogical," Feinwachs said. "In case of bizarre circumstances, throw yourself in harm's way before you call the police? That's the way I read it."

Miner, of the Health Department, said that isn't the intent.

They didn't cite the hospital for calling police, she said. "Our question was what was happening in those five hours before the police arrived."

She said the staff needs more training in deescalation techniques. They report seeing an average of two patients a day for psychiatric or alcohol-related problems. "They knew that they should expect psychiatric patients and be prepared for them, and they were not," she said.

Since then, Northfield City Hospital has hired two security guards. They will try to negotiate a plan for future incidents with the Health Department.

"It is absolutely our commitment to make sure that we're providing a safe environment for patients," Bank said.