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In spite of progress,
emergency room rights bill delayed until 2009
(August/September
2008 Issue)
By Jennifer Chase Esposito
Increasing the rights of mentally ill patients in Massachusetts'
emergency rooms will wait for the next legislative session as House
Bill 2042 did not make it to the Floor in summer 2008. In spite
of the setback and until a bill can be passed, bill sponsors and
stakeholders, during nine months of meetings to solve problems in
lieu of no legislative solution, created a consumer's document that
is being mailed to Massachusetts hospitals calling for a stop to
forcibly undressing mentally ill patients and an evaluation of emergency
room use of restraints and seclusion to protect patients' rights.
The bill - An Act To Protect The Mentally Ill In Emergency Rooms
- would add a section to Chapter 111 of Massachusetts' General Laws
requiring the Department of Public Health (DPH) and the Department
of Mental Health (DMH) to write new regulations concerning psychiatric
and behavioral health patients in emergency rooms. The bill would
give mental health advocates a chance to negotiate more humane and
effective treatment and would allow DMH investigators to handle
complaints about mistreatment.
Rep. Ruth B. Balser (D-Newton) of the Mental Health and Substance
Abuse Committee sponsored the bill. It was designed by the Boston-based
advocacy group M-POWER (Massachusetts People/Patients Organizing
for Empowerment, Wellness & Rights), a member-run organization of
mental health consumers and current and former psychiatric patients
advocating for political and social change and human rights for
the mentally ill in Massachusetts.
M-POWER's grassroots initiatives have most notably included the
Act to Protect Five Fundamental Rights, which was enacted in 1998
to ensure certain civil rights to patients in Departmental of Mental
Health licensed facilities. But similar rights don't apply to mentally
ill patients seeking attention in Massachusetts' emergency rooms,
which fall under the jurisdiction of the Department of Public Health
and not DMH. In M-POWER's experience, there has been a history of
emergency room staff unnecessarily fearing mentally ill people because
of the stigma of mental illness and a lack of psychology training,
which leads to discrimination and abuse.
Cathy A. Levin is the chairwoman for M-POWER's Emergency Room Rights
Campaign and has a file brimming with more than 60 testimonials
from patients claiming they were abused in emergency rooms. It was
a June 2006 Boston Globe story of a woman who sued Beth Israel hospital
for going in for treatment of a headache and being strip searched
- after stating she'd been raped by her father as a child and refusing
to remove her clothes - that prompted her to encourage M-POWER to
create a bill.
"A lot of time people go to the ER for adverse reactions to medical
prescriptions," says Levin, who has worked with M-POWER since 2004.
"They're taken to the ER and go through intake and for some reason
they are separated from their advocate ... which is what you really
need in an ER."
A top complaint in Levin's pile is the requirement to strip and
enrobe in a "johnny," a practice not required of non-mentally ill
patients in emergency rooms. Levin says it is not a requirement
at Boston Medical Center, Bay State Hospital or UMass Medical Center
in Worcester.
"The theory is that people may be hiding drugs or weapons on their
person," says Levin. "There's a fear for psych patients, but not
for physical patients."
Mandatory undressing can be the least of mentally ill patients'
worries. "A lot of things can go wrong with your interaction with
staff which will result in harsh interventions," says Levin. Raising
your voice can get you sedated.
"In other words, you are required to behave as if you do not have
a problem because staff is not trained in mental health matters
and can't deal with you on the level of your emotional distress,"
she says.
Susan Stefan is an attorney with the Center for Public Representation
in Newton, Mass., and an expert in mental disability law and adviser
to M-POWER. In her book, Emergency Department Treatment of the Psychiatric
Patient: Policy Issues and Legal Requirements, she states that the
difference in emergency room treatment between psych patients and
non can include security guards being placed outside their door
and being restrained and left unattended if a patient refuses to
undress.
"Certainly if you have an experience in restraints in an ER you
don't want to go back," says Levin.
Passing two of the three required committees for it to hit the
House floor, sponsors and advocates of House Bill 2042 will re-submit
it next year.
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