Tough ques­tion for hos­pi­tals: Who’s too risky to re­lease?

Kuwait Times - - HEALTH & SCIENCE -

NEW YORK: Four days be­fore Alexan­der Bonds am­bushed and killed a New York City po­lice of­fi­cer, he was in a hos­pi­tal emer­gency room get­ting a psy­chi­atric eval­u­a­tion. The hos­pi­tal re­leased him the same day. Now the hos­pi­tal’s ac­tions are un­der a gover­nor-or­dered state re­view. St Barn­abas Hos­pi­tal says it han­dled Bonds ap­pro­pri­ately and wel­comes the in­quiry. The de­ci­sion was one psy­chi­a­trists across the coun­try make reg­u­larly: whether pa­tients pose enough dan­ger to them­selves or oth­ers to re­quire hos­pi­tal­iza­tion. Prac­ti­tion­ers say it’s often a dif­fi­cult call to make and that even an ex­pe­ri­enced eval­u­a­tor can’t pre­dict some­one’s be­hav­ior.

“Most of the time, it’s very com­pli­cated. You’re try­ing to make an as­sess­ment: Is the per­son go­ing to a home? Is there fam­ily? Are they re­li­able? What was the spe­cific rea­son they were brought in? Is that likely to oc­cur again?” said Bea Grause, pres­i­dent of the statewide hos­pi­tal and health sys­tem as­so­ci­a­tion HANYS and a for­mer emer­gency room nurse.

Bonds, 34, ev­i­dently had a his­tory of men­tal health prob­lems. There were an­tide­pres­sant and anti-psy­chotic med­i­ca­tions in his apart­ment, and his girl­friend told of­fi­cers she took him to St. Barn­abas for the psy­chi­atric eval­u­a­tion July 1, po­lice said. He was ob­served for seven to eight hours in the emer­gency room, where he was seen by a physi­cian and then a psy­chi­a­trist, hos­pi­tal spokesman Steven Clark said. “We be­lieve the proper pro­to­cols and stan­dards were met,” he said.

By the night of July 4, Bonds’ para­noid, er­ratic be­hav­ior wor­ried his girl­friend enough that she called po­lice to look for him. They didn’t find him be­fore he marched up to a parked po­lice ve­hi­cle and shot through the win­dow just af­ter mid­night, strik­ing Of­fi­cer Mioso­tis Fa­milia in the head. Soon af­ter, of­fi­cers shot and killed him af­ter they say he drew a weapon on them.

The state Health De­part­ment said it plans to in­ter­view St Barn­abas staffers, con­duct in­spec­tions and ex­am­ine records to re­view Bonds’ case and the hos­pi­tal’s poli­cies and pre­scrib­ing prac­tices. Un­der state law, a per­son can be in­vol­un­tar­ily hos­pi­tal­ized for at least 48 hours if they pose a sub­stan­tial risk of caus­ing se­ri­ous in­jury to them­selves or oth­ers. “If you’re mak­ing a de­ter­mi­na­tion that some­one’s a dan­ger to them­selves or oth­ers, you bet­ter be pretty clear about it. Be­cause you’re tak­ing away their lib­er­ties,” said Grause, whose as­so­ci­a­tion rep­re­sents hos­pi­tals and nurs­ing homes.

Psy­chi­a­trists cau­tion that the risk can be dif­fi­cult to pin­point. “While psy­chi­a­trists can often iden­tify cir­cum­stances associated with an in­creased like­li­hood of vi­o­lent be­hav­ior, they can­not pre­dict dan­ger­ous­ness with de­fin­i­tive ac­cu­racy,” the Amer­i­can Psy­chi­atric As­so­ci­a­tion said in a 2012 po­si­tion state­ment. Doc­tors and other hos­pi­tal staffers can en­counter ag­i­tated emer­gency room pa­tients they’ve never seen be­fore.

While pay­ing close at­ten­tion to what pa­tients say and do, doc­tors also might test to de­ter­mine whether a med­i­cal prob­lem or med­i­ca­tion might be spurring the be­hav­ior. They con­sider whether the cause could be al­co­hol or il­le­gal drugs, a clue some­times il­lu­mi­nated by ob­serv­ing pa­tients for hours. They may look into whether some­one has de­men­tia. Some pa­tients ar­rive clearly vi­o­lent, and oth­ers are just hav­ing a bad drug re­ac­tion that will wear off. But “there’s this vast gray area in the mid­dle that takes a lot of ex­pe­ri­ence, a lot of knowl­edge and bal­anc­ing all of the fac­tors that go into a good as­sess­ment,” said Dr. Vi­vian Pen­der, a New York City psy­chi­a­trist and pub­lic af­fairs rep­re­sen­ta­tive for the New York County Psy­chi­atric So­ci­ety.

Po­lice have been work­ing to de­ter­mine Bonds’ mo­tive in shoot­ing Fa­milia. Bonds, who had served prison time for a 2005 armed rob­bery, had railed about po­lice and prison of­fi­cers in a Face­book video last Septem­ber. Fa­milia, 48, was a 12-year New York Po­lice De­part­ment vet­eran and a mother of three. She was self­less, “in­cred­i­bly funny” and full of warmth and wis­dom, her daugh­ter, Gen­e­sis Vil­lella, 20, said Fri­day. — AP

Alexan­der Bonds

Mioso­tis Fa­milia

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