There is no excuse or explanation for a woman to be escorted from a hospital emergency room by security guards and left at a bus stop wearing nothing but a hospital gown and socks on a near-freezing January night. The attorney now representing the woman calls that “cruel and inhumane,” and he’s right. We don’t know what happened inside the University of Maryland Medical Center Midtown — hospital officials say the woman, Rebecca, was treated appropriately for a medical condition and was discharged, but because of federal privacy laws, they cannot say more, and we have no way to confirm that or her attorney’s account. But as it pertains to assessing blame for her summary ejection onto the street, what happened in the ER doesn’t really matter. There is no set of circumstances for which that is an appropriate response, and the hospital is right to have taken disciplinary action against members of its staff as a result.
But beyond this one woman’s case, there is a broader story here, and to understand that, it does matter what happened in ER — and what happens routinely in ERs in hospitals across the country. The University of Maryland failed Rebecca on that night, but our society fails people like her every single day.
Rebecca’s lawyer, J. Wyndal Gordon, says she was experiencing a psychotic episode that night and is now receiving inpatient mental health treatment. We don’t know what she was treated for, what clinicians observed about her mental state or whether she was screened by the hospital’s psychiatry department, and we won’t, unless perhaps the issue lands in court. But we do know for certain that ERs and in some cases hospitals’ medical floors have become the de facto safety net for people facing mental health crises. The University of Maryland estimates that 80 percent of patients in its emergency rooms suffer from mental health or substance abuse issues or both, and that’s not unusual.
ERs at Maryland and elsewhere have protocols for assessing and assisting those with emergent behavioral health issues — and, again, we don’t know whether they were followed in this case, or whether Rebecca presented in such a way as to trigger them. But the fact that clinicians routinely have to employ those processes represents an obvious failure of the system. We need far greater availability and acceptance of primary care for mental health just as we do for physical health. As with chronic medical conditions like diabetes and heart failure, we need better routine management of mental health to keep people out of the hospital.
Inevitably, though, some people will experience acute behavioral health crises and will wind up in the ER. When they do, they present difficult challenges in terms of their treatment and, sometimes, in terms of maintaining the safety and security of staff and patients, not to mention fostering a conducive environment for others who are ill or injured to receive appropriate care. (Whether any of that was an issue in Rebecca’s case, we have no way to know.) The options available for clinicians to handle difficult patients in productive and sensitive ways that don’t involve hospital security or the police are underfunded, if they exist at all. Inpatient psychiatry beds are scarce and difficult to access, and involuntary commitment and/or sedation of a patient cannot be undertaken lightly, either legally or morally. It is in the best case traumatic and at worst can lead to terrible outcomes.
What happened to Rebecca outside the hospital was tragic, and it rightly got national attention after a passerby recorded it and posted it on the internet. What happens every day to people with behavioral health or substance abuse problems as a result of societal indifference, stigmatization and underfunding is tragic, too, if less dramatic. Will that get the attention it deserves?
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