Bill proposes mental health exception in felony battery law

[nexus73]

What are your thoughts on this? To me, as an inpatient psychiatrist, I would not want my state to provide such an exception to felony assault on a health care worker. The majority of the time charges are pressed for assault it's because of Axis II pathology where the patient has the ability to control themselves but chooses not to do so.

Patients in crisis can become felons under battery law, warns lawmaker urging change

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[deleted480308]

What are your thoughts on this? To me, as an inpatient psychiatrist, I would not want my state to provide such an exception to felony assault on a health care worker. The majority of the time charges are pressed for assault it's because of Axis II pathology where the patient has the ability to control themselves but chooses not to do so.

Patients in crisis can become felons under battery law, warns lawmaker urging change

shouldn't be any mental health exceptions

 

[Fan_of_Meehl]

shouldn't be any mental health exceptions

Agreed. We don't need two separate systems of justice (and consequences) for violent behavior.

 

[FlowRate]

We already have too few staff choosing to file police reports/call police in these instances.

 

[thoffen]

Interesting. We have had a few cases where the behavior really was criminal but no one wanted to press charges. The last time we had the police come, they said they could only arrest the patient if the other inpatient he attacked went to the courthouse to file a report. Of course, even if the other patient wanted to do so, he wasn't safe to leave the unit for such a purpose.

 

[deleted480308]

Interesting. We have had a few cases where the behavior really was criminal but no one wanted to press charges. The last time we had the police come, they said they could only arrest the patient if the other inpatient he attacked went to the courthouse to file a report. Of course, even if the other patient wanted to do so, he wasn't safe to leave the unit for such a purpose.

It is possible the officers were lying, I’ve filed charges in a few municipalities and never once been told I had to go to the courthouse

 

[calvnandhobbs68]

It is possible the officers were lying, I’ve filed charges in a few municipalities and never once been told I had to go to the courthouse

Yeah wat? Police can take a report from you just fine in the field. Does every person who gets in a car accident have to go to the courthouse so they can "file a report"? They can also arrest people WITHOUT someone "filing a report" at all...they do it all the time. A person doesn't have to be charged with anything to be arrested. Sounds like a lie to me.

 

[birchswing]

I don't understand why there needed to be a bill to make battery against healthcare workers a felony to begin with. It's the same with laws that treat crimes against police officers differently. If it's worthy of being a felony, it's worth it for everyone. I don't see how the person's occupation putting them at higher risk of the crime makes the crime more heinous. It only makes it more likely.

So you've already created a special population of victims; now they want to create a special population of offenders. It seems needlessly complicated. Couldn't a person already be found not guilty by reason of insanity?

 

[NontradCA]

Patients in crisis? Give me a break. Sure people can have a bad day, but nothing should excuse violence towards others. Everyone in this field understands that there’s very little we can do for the repeat violent offenders. They just need to be in prison and away from the general public. I actually think it’s our duty to advocate for this.

Our system is broken. I didn’t used to think this way but when “patients” start shooting at you, your perspective changes. Especially when they’re out on bail for assault with a deadly weapon (gun).

 

[birchswing]

nothing should excuse violence towards others

I agree. But then why value the safety of a healthcare provider above anyone else? If you read the article you'll see that this is an exception to an exception. The first exception is that battery toward healthcare workers be considered a felony (in cases when it's otherwise a misdemeanor) and the second proposed exception is that this doesn't count in a mental health crisis. In a way I see the point of the second exception in that the first exception specifically penalizes a population who would more likely to be having a mental health crisis at the same time they're around the targets that would land them a more life-changing legal penalty. Under the current law if a person had a mental health breakdown and became violent, a similar act of violence would be a misdemeanor if they were in a grocery store and a felony if they were in a hospital. I think the problem is the original exception.

 

[nexus73]

I agree. But then why value the safety of a healthcare provider above anyone else? If you read the article you'll see that this is an exception to an exception. The first exception is that battery toward healthcare workers be considered a felony (in cases when it's otherwise a misdemeanor) and the second proposed exception is that this doesn't count in a mental health crisis. In a way I see the point of the second exception in that the first exception specifically penalizes a population who would more likely to be having a mental health crisis at the same time they're around the targets that would land them a more life-changing legal penalty. Under the current law if a person had a mental health breakdown and became violent, a similar act of violence would be a misdemeanor if they were in a grocery store and a felony if they were in a hospital. I think the problem is the original exception.

I think that's not an unreasonable position on the surface.

But I think the rationale is people typically protected by these laws are in positions where they are compelled to interact with people at higher risk of being violent. For example, an emergency room RN can't easily refuse care for a patient who was shot and bleeding, even if the person may give the RN concern they are likely to be violent (yelling angrily, heavily tattooed, clenched fists, etc). Similarly, a police officer can't easily refuse to arrest someone who has broken a law just because the person is angry and may be giving similar signals of potential violence. I think in these cases the law serves to raise the consequences of violence and hopefully decrease the likelihood violence will occur in the first place.

In the case of mental illness the water gets murky because we interact with patients who are violent for different reasons. In my experience, the most commonly violent patients are intoxicated and have cluster B personality disorders...in other words, people who could rationally choose not to be violent if they wanted. An example here is a patient who wants Valium and attacks an RN when he/she doesn't get it. This is clear acting out related to the person not getting what they want. We also have truly psychotic patients who become violent from delusional motivations...for example, thinking the hospital is a space ship and the staff are aliens planning to kill them. I don't think ethically we can hold the second patient nearly as responsible as the first. Ultimately the district attorney should have broad discretion to pursue charges or not...and it would make sense for the victim to be able to weigh in on the issue at a later date once the emotions have calmed down.

I think the motivation behind the proposed law change is for patients like the second example. But if the law was changed, every antisocial patient who attacked a nurse would be able to claim they were mentally ill. Beyond this it potentially opens up a pandoras box because any patient who attacked hospital staff could claim mental illness and it becomes difficult to prove the patient wasn't experiencing some diagnosable condition, even an adjustment disorder, because who in the hospital isn't experiencing some distress. This could broadly negate the previous laws in place to minimize hospital violence in the first place.

 

[deleted480308]

I think that's not an unreasonable position on the surface.

But I think the rationale is people typically protected by these laws are in positions where they are compelled to interact with people at higher risk of being violent. For example, an emergency room RN can't easily refuse care for a patient who was shot and bleeding, even if the person may give the RN concern they are likely to be violent (yelling angrily, heavily tattooed, clenched fists, etc). Similarly, a police officer can't easily refuse to arrest someone who has broken a law just because the person is angry and may be giving similar signals of potential violence. I think in these cases the law serves to raise the consequences of violence and hopefully decrease the likelihood violence will occur in the first place.

In the case of mental illness the water gets murky because we interact with patients who are violent for different reasons. In my experience, the most commonly violent patients are intoxicated and have cluster B personality disorders...in other words, people who could rationally choose not to be violent if they wanted. An example here is a patient who wants Valium and attacks an RN when he/she doesn't get it. This is clear acting out related to the person not getting what they want. We also have truly psychotic patients who become violent from delusional motivations...for example, thinking the hospital is a space ship and the staff are aliens planning to kill them. I don't think ethically we can hold the second patient nearly as responsible as the first. Ultimately the district attorney should have broad discretion to pursue charges or not...and it would make sense for the victim to be able to weigh in on the issue at a later date once the emotions have calmed down.

I think the motivation behind the proposed law change is for patients like the second example. But if the law was changed, every antisocial patient who attacked a nurse would be able to claim they were mentally ill. Beyond this it potentially opens up a pandoras box because any patient who attacked hospital staff could claim mental illness and it becomes difficult to prove the patient wasn't experiencing some diagnosable condition, even an adjustment disorder, because who in the hospital isn't experiencing some distress. This could broadly negate the previous laws in place to minimize hospital violence in the first place.

if you're clenched fist in a fighting stance? you get no care until you calm down.....if you're that sick you will go unconscious eventually and unconscious people don't assault staff

 

[Stagg737]

Legitimate question since some people here seem to be thinking of this as a purely black and white subject:

Are people really suggesting we hold a psychotic patient who isn't even A+O to themselves to the same level of accountability as someone who's just an a-hole who violently lashes out?

I mean, I agree that a blanket policy to cover all mental health is a terrible idea. However, even in my limited experience I've worked with patients who I would not hold responsible for their actions during certain periods of time due to their severe AMS. I'm not making suggestions about what policies should or should not be implemented, just that I don't think holding every mentally ill patient to the same felony standard is appropriate.

 

[deleted480308]

Legitimate question since some people here seem to be thinking of this as a purely black and white subject:

Are people really suggesting we hold a psychotic patient who isn't even A+O to themselves to the same level of accountability as someone who's just an a-hole who violently lashes out?

I mean, I agree that a blanket policy to cover all mental health is a terrible idea. However, even in my limited experience I've worked with patients who I would not hold responsible for their actions during certain periods of time due to their severe AMS. I'm not making suggestions about what policies should or should not be implemented, just that I don't think holding every mentally ill patient to the same felony standard is appropriate.

my nose doesn't care about their diagnosis if it's broken...I don't think exemptions are a good idea

I also agree with the other poster that there shouldn't be a higher penalty just because the victim is a health care/leo/politician etc

 

[Armadillos]

I got hit by a floridly psychotic patient once, blocked with my arm and was small patient, so no big issue. Regardless, would be absurd to say they should have been held to same legal consequences as if someone tried to sucker punch me in a store. If psychotic folks are hitting you on the unit that’s more on the docs, unit policies and staff than the patient in my opinion.

 

[Nasrudin]

Wow. Interesting thread. At first it surprised me. To see so many of us taking a hard line. Because, we're heavily weighted in the agreeable spectrum of personality structure by census. But then... it occurred to me. Empathy and agreeableness are the channels of in-grouping and out-grouping. Such that it doesn't surprise after thinking it over again. That our highly liberal, empathetic constituency would in-group staff and out-group patients.

It's a case a by case phenomenon in my book. With a high degree of context to psychotic illness. I'm protective of both staff and patients. And usually get directly, physically involved with agitation management and security. I don't ask anyone to cash a physical check on my behalf. But the groupthink of staff can be inimical and dangerous to individuals. Staff and patients. And must be counteracted by those with the stones and the forthrightness to stand alone if need be. Harmonized but separate. Able to steer the herd away from disaster.

A hard line of enforcing criminal law with psychotic patients is patently ridiculous.

 

[thoffen]

Wow. Interesting thread. At first it surprised me. To see so many of us taking a hard line. Because, we're heavily weighted in the agreeable spectrum of personality structure by census. But then... it occurred to me. Empathy and agreeableness are the channels of in-grouping and out-grouping. Such that it doesn't surprise after thinking it over again. That our highly liberal, empathetic constituency would in-group staff and out-group patients.

It's a case a by case phenomenon in my book. With a high degree of context to psychotic illness. I'm protective of both staff and patients. And usually get directly, physically involved with agitation management and security. I don't ask anyone to cash a physical check on my behalf. But the groupthink of staff can be inimical and dangerous to individuals. Staff and patients. And must be counteracted by those with the stones and the forthrightness to stand alone if need be. Harmonized but separate. Able to steer the herd away from disaster.

A hard line of enforcing criminal law with psychotic patients is patently ridiculous.

I don't think psychosis should be the dividing line, but in general I agree. I was surprised at the responses, but you are right to say case-by-case basis. Some behavior on psychiatric units is definitely criminal, and such exceptions as the proposed should not apply in those cases.

 

[Fan_of_Meehl]

I think everyone would consider psychosis and delirium exceptions. I think most folks are objecting to some kind of a priori, formalized approach of: 'if a person has a mental illness (of any type) then they aren't responsible for their actions (even violent actions).' Maybe it has something to do with the loose definition of 'in crisis' that floats around these days. I'd imagine that the original posting conjured visions of antisocial/narcissistic drug abusers trying to avoid the consequences associated with their physical assault on a healthcare worker because they were 'in crisis.'

 

[splik]

I agree. But then why value the safety of a healthcare provider above anyone else? .

well its not above anyone else. it is usually a felony to assault police officers, other first responders, judges, lawyers, public transit workers etc as well. healthcare workers are lumped in with this under the notion that people should feel safe to work without intimidation or risk of violence when their job is in the service of others and their profession puts them at a risk of instrumental aggression/violence. as a society, we have decided that it is a worse offense for people to be assaulted in the line of duty, especially when that assault is the result of who you are.

usually these things get plead down to a misdemeanor anyway. however i have been involved in some truly ridiculous cases that should have never made it to court. so it's interesting which cases people press charges and in which the DA decides to prosecute.

 

[WisNeuro]

Wow. Interesting thread. At first it surprised me. To see so many of us taking a hard line. Because, we're heavily weighted in the agreeable spectrum of personality structure by census. But then... it occurred to me. Empathy and agreeableness are the channels of in-grouping and out-grouping. Such that it doesn't surprise after thinking it over again. That our highly liberal, empathetic constituency would in-group staff and out-group patients.

I think you overestimate both of these qualities in this specific forum sample.

 

[Stagg737]

healthcare workers are lumped in with this under the notion that people should feel safe to work without intimidation or risk of violence when their job is in the service of others and their profession puts them at a risk of instrumental aggression/violence.

While I get where you're coming from and do think everyone should be able to feel safe at work, the ideal world and reality don't mesh. The reality is that we know (or should) before starting this route that we may be putting ourself at higher risk due to working with a patient population which isn't always capable of controlling their actions. It's like an animal control officer saying they shouldn't have to worry about being attacked by an animal. That would be nice, but that's just not reality.

To a certain extent I think those entering the careers you mentioned have to acknowledge and accept the risks associated with their line of work, as they chose those fields. In medicine, that means understanding the risks associated with certain patient populations like those seen in inpatient psych units or in the ER.