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erg923

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hmmm...so whats going on at that place... Any gossip?
 

Hurricane

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hmmm...so whats going on at that place... Any gossip?

Well, I don't have any "gossip" to add. The Dallas Morning News has a more detailed article that is mostly accurate. Can't really talk about the details or respond to specific statements by family/media without violating HIPAA. Suffice it to say that the events over the past couple of months have been very sad, but the residency and the VA are handling things appropriately. There is an ongoing investigation with people from the national VA and suicide experts coming down. The unit is semi-closed pending that investigation, but the plan is for it to reopen, hopefully in the next month or two. Physically, we have needed a new unit for some time, and part of the new unit is supposed to open next year. Technically, the unit is not completely closed. The patients who were already there are still on the unit until they are ready for discharge, and involuntary admissions that come to the ER after hours are still admitted (due to the mental illness court deadlines). But the majority of the patients can be transferred to other VAs or area hospitals that have agreed to help out for the next couple of months.

As far as the residents go, we are still there to take care of the patients that are there, and take call for ER and consults. The VA is only one of our multiple sites, so the census being low for a couple months doesn't affect our training much as a whole.
 
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Anasazi23

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Staffing issues aside, I'm not sure how this is the fault of the hospital. One patient hanged himself on a door corner, the other on his own wheelchair, and two others when they weren't even in the hospital. The last two had met in the hospital and likely had some sort of substance abuse issues and a "pact."

There are blips in the radar occassionally. Sentinal events happen. Sometimes they occur in clusters. The beaurocrats demand investigations and paperwork. Little of that is for the interest of the patient. I imagine even less so for the VA - the epitome of beaurocracy.

With our hospital entering its paranoid psychotic state with the approach of that corrupt money laundering organization, JCAHO, I'm sensitive to this. Just because people who are non-experts "think" they can understand how to handle mental illness because it's not more "complicated" like cardiology, they bombard us with regulations, and will with this VA now as well. They harp on our treatment plans to have "measurable outcomes" which 90% of the time, don't make sense. Do they go to the tele floor or CCU and demand that tx plans write that the patient will have 50% less chest pain over the next 4 weeks? Only psychiatry is a victim of this nonsense. Sorry for the marginally related rant.
 

Faebinder

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The government has a habit of showing that they are doing something in order to calm down the masses of "idiotic" concerns. Who can blame them? People don't understand... many are not realistic.

Recently, medicare has stopped paying for some "hospital errors". Amongst those errors are "Patient wandering off and falling". Well jee... what do you expect us to do on the floors? Tie up every single patient to a bed? People wander off and people fall. If they were demented then I understand, but when you got 20 year old patients that wander off and fall, I mean come on lets be real a little. Likewise what do you want us to do for depressed patients? Tie all of em up to their beds?

So... to sum it up. I conclude this is a government fast reaction of pressing down the crowd of "idiotic" concerns. Basically, someone is trying to make sure they get reelected. It's unfortunate. And my nickname for JCAHO remains the same... the Medical Mafia Enforcers.

(Medical Mafia aka Medical Insurance Companies).
 

Therapist4Chnge

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Cluster suicide is a complex issue in and of itself, but add in the hospital environment that already has a greater %'s of at-risk patients, and it is gets tricky. Cluster suicides can happen amongst an 'average' population, but they are far from 'predictable'....so I'm not sure if they can pin that idea in this situation. What a mess.

For those interested, The Journal of Suicidology* should have some good info on cluster suicides.

*I'm pretty sure that is still the name, awhile back some wanted to change the name.
 

Anasazi23

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Cluster suicide is a complex issue in and of itself, but add in the hospital environment that already has a greater %'s of at-risk patients, and it is gets tricky. Cluster suicides can happen amongst an 'average' population, but they are far from 'predictable'....so I'm not sure if they can pin that idea in this situation. What a mess.

For those interested, The Journal of Suicidology* should have some good info on cluster suicides.

*I'm pretty sure that is still the name, awhile back some wanted to change the name.

I think it's called 'Suicide and Life-Threatening Behavior' or something like that now. Suicidology just sounds weird to me.
 

ronin12

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It is an extremely unfortunate event. Jumping on to the conclusions about who's fault it is would be premature. it seems highly unlikely there will be negligence of mental health. pt's suicide is something we all psychiatrist dread and try to do our best to intervene . I can imagine the whole bandwagon of "VA investigators" would be looking into this tragedy. Unfortulately psychiatry is the feild of medicine in which there are lot of "non-psychiatrists" poking their noses , thinking they know a lot. the whole buerocratic intervention in psychiaty is much worse than anyother feild. In one of the VA's, the administrative staff "non-psychiatrist" come and assess performance of psychiatrists by looking at documentations, consult responses etc. i wonder they would dare to ask cardiaology,gi, surgeons or other doctors to allow this, they will eat them alive. just one of many issues you face being a psychiatrsit in a va. Utterly frustrating
 

Anasazi23

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It is an extremely unfortunate event. Jumping on to the conclusions about who's fault it is would be premature. it seems highly unlikely there will be negligence of mental health. pt's suicide is something we all psychiatrist dread and try to do our best to intervene . I can imagine the whole bandwagon of "VA investigators" would be looking into this tragedy. Unfortulately psychiatry is the feild of medicine in which there are lot of "non-psychiatrists" poking their noses , thinking they know a lot. the whole buerocratic intervention in psychiaty is much worse than anyother feild. In one of the VA's, the administrative staff "non-psychiatrist" come and assess performance of psychiatrists by looking at documentations, consult responses etc. i wonder they would dare to ask cardiaology,gi, surgeons or other doctors to allow this, they will eat them alive. just one of many issues you face being a psychiatrsit in a va. Utterly frustrating

I couldn't agree more. And it's getting worse. When a cardio surgeon has someone code on the table, nobody thinks twice about it. There is a certain amount of deaths that will occur despite all required precautions. With psychiatry, the non-psychiatrists and non-physicians act as though every adverse outcome could have been prevented.

We need to take back our profession, and get it out of the hands of the people that don't even belong in the same room.
 

Anasazi23

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Nothing like throwing around some senatorial beaurocracy to get the job done in medicine. Would you ever see a bill in the Senate if a bunch of ESRD patients died in a cluster? I'm sure that'll fix the problem.

Lots of fallout from this:

from The APA Headlines digest:
Senators introduce veteran suicide-tracking bill.
The AP (4/23) reports that on Tuesday, Sen. Tom Harkin (D-Iowa) and Sen. Russ Feingold (D-Wis.) "introduced legislation" to require the Department of Veterans Affairs (VA) "to track veteran suicides." A "companion bill to legislation introduced by Rep. Leonard Boswell (D-Iowa) in the House," the senators' Veterans Suicide Study Act "would require the VA to report to Congress within 180 days how many veterans...committed suicide since Jan. 1, 1997, and continue to issue reports annually." While the VA currently "records suicides and suicide attempts in [its] facilities," it "does not track how many veterans commit suicide each year outside of those facilities." In light of a "recent report by the Rand Corp." which "shows that nearly 300,000 American military personnel returning from Iraq or Afghanistan suffer from post-traumatic stress disorder or depression," both senators said that many "returning veterans [are] at risk for suicide." Sen. Harkin stated, "We are looking at a real crisis among our veterans, and it is high time the VA recognizes it." Sen. Feingold added that the "lack of data on veteran suicides shows how much needs to be done to address their mental health needs."
Senate Democrats call for resignation of VA's head of mental health. In continuing coverage from yesterday's edition of Headlines, the CBS Evening News (4/22, story 7, 0:30, Couric) reported that on Monday, Sen. Daniel Akaka (D-Hawaii), "chairman of the Veterans Affairs Committee, called for the resignation of" Ira Katz, M.D., Ph.D., "the head of mental health for the VA," following "allegations that the VA tried to cover up an epidemic of suicide among military veterans." Sen. Patty Murray (D-Wash.) "also called for his ouster, saying, 'The number-one priority of the VA should be caring for our veterans, not covering up the truth.'" For his part, Dr. Katz "has denied there was any cover-up."
According to the AP (4/23, Daly), both senators said that Dr. Katz "withheld crucial information on the true suicide risk among veterans." In a letter to the VA's Under Secretary for Health, Michael Kussman, M.D., Sen. Akaka said that Dr. Katz's "'personal conduct and professional judgment' had been called into question by his response to veteran suicides." Therefore, the interests of "[v]eterans, and the VA itself, 'would be best served by his immediate resignation,'" Sen. Akaka stated. On its website, the Hawaii Reporter (4/22) ran the full text of Sen. Akaka's letter to Dr. Kussman calling for Dr. Katz's resignation.
Currently, a "national lawsuit by veterans rights groups in California court is accusing the agency of not taking any measures regarding a mental health crisis among veterans," AHN (4/23, Sharma) reports. And, "[a]s part of the lawsuit, internal emails written by" Dr. Katz "have been used as proof." In these emails, Dr. Katz "repeatedly suggested that though the risk of suicide among veterans 'is serious, it's not outside the norm.'"
On its website, CBS (4/22, Malbran) explains that it had "been trying to obtain veteran suicide and attempted suicide data from the VA. Earlier this year, the agency provided" the network "with data that showed there were a total of 790 suicide attempts in all of 2007 by veterans who were under the VA's care." But, on Feb. 13, however, Dr. "Katz sent an email" to his top media advisor, Everett Chasen, "indicating the total number of attempts was much higher." In the email, Dr. Katz wrote, "Shh! Our suicide prevention coordinators are identifying about 1000 suicide attempts per month among veterans we see in our medical facilities." Dr. Katz then asked, "Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" And, in another email message to Dr. Kussman, Dr. Katz mentioned "that there are 'about 18 suicides per day among America's 25 million veterans.' This is a figure that the VA has never made public."
In its On Deadline blog, USA Today (4/22) added, "In an email Monday to CBS News," Dr. Katz "wrote that the numbers were not released because of questions about the consistency and reliability of the findings."
 
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