On-the-spot fines for drunken patients who abuse casualty staff

[tlls13]

A busy ED in England fines drunken and abusive pts. I wonder if this would work in America. From the BBC:


Praise for 'fine-a-yob' scheme

On-the-spot fines for drunken patients who abuse casualty staff have been hailed a success by trust bosses. A three-month pilot was carried out at the Royal Bolton Hospital in Greater Manchester to curb misbehaviour and will now be extended indefinitely. It followed a rise in incidents of staff being sworn and spat at, threatened or attacked.

But the deterrent of an £80 fine is changing the culture of the department, police and staff said. Visitors and patients are now aware that anti-social behaviour will not be tolerated in the hospital. Police patrols were also increased in the accident and emergency (A&E) ward to help prevent trouble.

Abuse figures

Ch Insp Martin Greenhalgh, of Greater Manchester Police, said: "Before we started this pilot, while there were a number of disruptive incidents in A&E, there were very few indeed that were actually reported to the police.

"However, this scheme has sent out a very clear message that any type of disruptive or anti-social behaviour will not be tolerated and the results of such can be serious for the offender."

The pilot scheme was the first of its kind in England and followed a rise in anti-social behaviour towards A&E staff across the country.

At the Royal Bolton between April 2006 and September 2006 there were 40 incidents where security staff had to escort people out of A&E, 41 members of staff were verbally abused and there were 38 incidents of threatening behaviour. There were 78 incidents of disruptive or anti-social behaviour during the pilot, although the hospital said warnings were usually sufficient to make people behave.

Incidents 'tolerated'

Procedures for reporting incidents were also improved during the pilot, leading to an increase in recorded cases, a hospital spokeswoman said. Previously, staff often accepted incidents of abuse as part of the job and so they went unreported, she added. Dr Richard Parris, Consultant in Accident and Emergency Medicine, said: "For too long hospital staff have accepted aggressive behaviour towards them as just part of the job."

Royal Bolton Hospital's A&E treats about 100,000 people every year, with between 300-320 patients every day. It is one of the busiest accident and emergency departments in the North West of England.

http://news.bbc.co.uk/2/hi/uk_news/england/manchester/6335303.stm

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[docB]

Yeah that might be nice. Right now we just have to put up with it and hope no one gets really hurt. There's supposed to be some law here that says assault on a helth care worker is an automatic felony. We have these little signs posted up around the ED with the law and a picture of the attorney general. I've never tried to file a charge on it but many of the nurses have and I've never seen anything happen even when the injury was serious enough to warrent an ED evaluation, xrays and missed work. Once when a nurse called the police to report an incident the dispatcher laughed at her.

 

[zinjanthropus]

Yeah that might be nice. Right now we just have to put up with it and hope no one gets really hurt. There's supposed to be some law here that says assault on a helth care worker is an automatic felony. We have these little signs posted up around the ED with the law and a picture of the attorney general. I've never tried to file a charge on it but many of the nurses have and I've never seen anything happen even when the injury was serious enough to warrent an ED evaluation, xrays and missed work. Once when a nurse called the police to report an incident the dispatcher laughed at her.

drunken patients are part of the disease process and patient population we should expect to treat in the ED. Emphasis should be on keeping these patients from hurting themselves and others - but not on punishment for actions part of their overall picture of illness.

 

[SoCuteMD]

drunken patients are part of the disease process and patient population we should expect to treat in the ED. Emphasis should be on keeping these patients from hurting themselves and others - but not on punishment for actions part of their overall picture of illness.

So, if they assault a police officer who is trying to arrest them (and thus, in some way antagonizing them) outside the ED they should be held accountable, but if they do the same to the staff in the ED who try to HELP them, we should turn the other cheek? The same disease process is at work in both situations, so why should the standards be different?

 

[crewmaster1]

If most of the drunks I see had enough money to pay the fine, they wouldn't be in the ED trying to find a blanket and warm meal in the fist place!

 

[ERMudPhud]

We have fines. They're called leathers, haldol, and a foley

 

[mikecwru]

We have fines. They're called leathers, haldol, and a foley

We need to videotape the first 10-20 minutes of a patient coming in and being put in leathers. Then play it in an endless loop in their room as they sober up and as their family arrive.

Obviously wouldn't help for the homeless/chronic drunks, but what about the first time teenagers, etc?

Would at least be entertaining.

mike

 

[Hayduke]

drunken patients are part of the disease process and patient population we should expect to treat in the ED. Emphasis should be on keeping these patients from hurting themselves and others - but not on punishment for actions part of their overall picture of illness.

EtOH intoxication is not a disease. It is one endpoint of a behavioral process. The CHOICE is made to drink. I would argue that violent behavior is also a choice.

As a person who has caught a loogie in the eye, been kicked in the gut, been threatened, and stuck in the back of a rig with troll weilding a screwdriver, I am a strong advocate for aggressive behavioral modification. Screw the fine. Confirm they can maintain an airway then go to jail. Go to directly to jail etc.

 

[docB]

drunken patients are part of the disease process and patient population we should expect to treat in the ED. Emphasis should be on keeping these patients from hurting themselves and others - but not on punishment for actions part of their overall picture of illness.

Of note I never specified drunk patients. My staff and I frequently get threatened and/or assaulted by patients who are not intoxicated or demented or delirious. Many people in the public just plain think it's OK to take out their aggressions and frustrations on ED staff.

As far as drunk patients go society has decided to place these patients in EDs rather than jails because the litigation climate has eliminated drunk tanks and directed these people into overcrowd EDs. That fact alone shouldn't indemnify a patient if they engage in behavior in the ED (assault) that would clearly be criminal outside the ED.

As society dumps more and more social problems into the EDs such as substance abuse, domestic abuse, mental illness, homelessness, elder care, etc., etc., etc. it needs to provide more protection, not less, to the people who are being forced to pick up the slack. The implication that workers in EDs chose to be there so we deserve to be physically attacked with impunity is just outright ridiculous.

 

[Febrifuge]

We need to videotape the first 10-20 minutes of a patient coming in and being put in leathers. Then play it in an endless loop in their room as they sober up and as their family arrive.

Obviously wouldn't help for the homeless/chronic drunks, but what about the first time teenagers, etc?

Would at least be entertaining.

It's better for the fine institution that employs me (not to mention, for my employment) if I don't say too much, but I know for a fact that this sort of a thing is considered uncool, by today's JCAHO standards.

There are some pretty good stories... from way, way, WAY back in history.

And, re: this from DocB:

As society dumps more and more social problems into the EDs such as substance abuse, domestic abuse, mental illness, homelessness, elder care, etc., etc., etc. it needs to provide more protection, not less, to the people who are being forced to pick up the slack. The implication that workers in EDs chose to be there so we deserve to be physically attacked with impunity is just outright ridiculous.

We aren't always in synch politically, but that is hitting the nail on the head. I'd buy you a beer if I could.

 

[NinerNiner999]

This would be a great revision to the EMTALA laws. If a patient shows up in an ED and becomes combative/violent/harms ED staff, they are to be treated for that visit, but can be blocked from further admissions to that ED. That would be nice...

 

[doctawife]

The pediatric relative of the fine - if the mother/father/babydaddy becomes abusive to ER staff, CPS custody automatically applies to the patient until the matter is resolved.

In other words, we keep the kid and you get to go to jail. Welcome to the mutherfrakin' ER, dumb@$$.

 

[GeneralVeers]

None of our patients at King/Drew had money for a fine. If a patient struck a doctor, nurse, or other staff member, their "fine" was to be wheeled behind the curtain with the (male) charge nurse for 2 minutes. Usually behavior improved substantially after that.