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NC medical center studies law enforcement’s handling of EDPs

A pilot program will determine how long a police officer is needed to guard a patient

Winston Salem-Journal

FORSYTH, N.C. — Determining the most effective way of handling a mentally ill patient in the emergency room has vexed law-enforcement, health-care and mental-health officials for years.

A pilot program at Forsyth Medical Center is showing promise for resolving one of the biggest obstacles - determining how long a law-enforcement officer is needed to guard a patient.

In many instances, a patient has been taken into custody through an involuntary commitment. In such cases, state law requires an officer to stay with a patient until it is determined that a physician or eligible psychologist is available to conduct an examination. It is recommended that the officer ensure the respondent is left under appropriate supervision.

The program, which involves assessing the risk of combativeness in a patient, has reduced significantly the amount of time required of local law-enforcement officers.

“After checking with some of my sergeants, the average time officers spend now is less than two hours, which is huge because we used to spend days,” said Capt. Patricia Murray, who includes serving as a mental health-care liaison among her roles with the police department.

In the past three years, there have been instances in which officers, sometimes working rotating shifts, stayed with a mental-health patient in an emergency department for up to eight days. In some cases, such as an incident at the hospital last May, a patient is confined with handcuffs.

Under the pilot program, “if the risk is low, the law-enforcement officer is allowed to resume their duties in the community,” said Karen Olsen, the director of nursing emergency services at Forsyth.

“If the risk is high, the officer will stay and we’ll do the nursing assessment again at least every four hours or sooner if that is best for the patient. The officer can be called back to the hospital if the patient does become combative.”

Olsen said that since the program began, the hospital has had to recall an officer just once.

Local advocates have expressed concern that long waits have become more common, primarily because of a lack of beds in local and state hospitals and psychiatric facilities. Those waits can try the patience of the patient, family members, officers and medical staffs because more people are using an emergency department for primary care when they don’t have insurance.

In the first 30 days of the Forsyth Medical Center program, police officers experienced a drop of about 390 hours spent in the emergency department. Although the same data wasn’t available for the sheriff’s office, it typically handles fewer involuntary commitments.

Maj. Brad Stanley of the Forsyth County Sheriff’s Office said that the program has reduced the need for most deputies to a range of four to six hours.

“When we’re struggling to put 10 personnel on the street at any given time to answer calls, freeing up officers from potentially 10- to 12-hour shifts in the emergency department is a benefit to the whole community,” Stanley said.

The assessment of combativeness is determined by the nursing staff, according to a protocol list, after the patient is under a physician’s care and has been evaluated for mental- and physical-health condition. Part of the assessment includes whether the patient appears violent or has a history of violence, a section in which law-enforcement officers can have input.

Part of the assessment, Stanley said, is to have officers leave the room to see if that results in a change in behavior. Olsen said that process can provide time for hospital security and staffers to build trust with the mental-health patient.

“If someone needs to be guarded or restrained to prevent them from hurting themselves or others, we’re not going to leave,” Stanley said. “Those are the reasons for restraining, not as a form of punishment.”

Olsen and Stanley believe that the pilot program has statewide implications because of the ambiguities in the general statutes regarding involuntary commitments, particularly when law-enforcement responsibility ends and responsibility of the health-care provider begins.

“If this program is successful, it could be used throughout the state or elsewhere as a best-practice model,” Stanley said.

A similar program is not expected at Wake Forest University Baptist Medical Center. Typically, that hospital’s internal security takes over the guarding of many mental-health patients within hours.

Jason Carter, a vice president of operations and emergency services at Forsyth hospital, said that its security spent more than 2,500 hours last year assisting mental-health patients. That includes having a full-time security officer in the emergency department around the clock.

Although the initiative got a boost from at least two high-level meetings between health--enforcement officers last year, Forsyth hospital officials said they had been working on its security standards since 2007. The impetus was the state’s decision to decrease the number of beds for mentally ill patients at state hospitals.

“There has been more traffic through the local emergency departments...,” Carter said. “There was definitely an increase in their hours and our need for change in handling this process in a more therapeutic way for patients.”

It could take months to determine whether the program will become standard procedure, Carter said.

Copyright 2010 Winston Salem-Journal