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Jim Kenyon: Choking incident involving D-H patient, nurse shows need for change

  • Jim Kenyon. Copyright (c) Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Columnist
Published: 12/3/2019 10:19:39 PM
Modified: 12/3/2019 10:19:32 PM

Last month, an out-of-control psychiatric patient allegedly choked an emergency room nurse at Dartmouth-Hitchcock Medical Center to the point where the nurse lost consciousness. The patient was arrested.

The incident raises a bunch of questions.

The main one: Is DHMC doing enough to protect its workers against acts of violence? After all, health care providers sign up to heal patients, not to become their punching bags.

When I broached the subject in an email to Dartmouth-Hitchcock spokesman Rick Adams, he wrote back, “We have taken a number of steps, including new signage posted in the Emergency Department, around the hospital, and at all of our ambulatory locations, that communicate to everyone who enters our facilities that abusive, threatening or violent behavior will not be tolerated.”

Nothing better to keep workers safe than a strongly worded wall poster.

Other than what’s in the court affidavit written by the Lebanon police officer who investigated the incident, the public hasn’t been told much about the circumstances that led to Isabelle Montgomery’s altercation with DHMC staff. (The hospital hasn’t released any information, citing federal patient privacy laws. I called Montgomery and her attorney but didn’t hear back.)

According to the affidavit, here’s what happened:

Montgomery became agitated when nurses and a security guard informed her that she couldn’t leave the hospital, where she was being held on doctor’s orders.

Montgomery, who is 5 feet, 10 inches tall and weighs 165 pounds, grabbed David Luther, a security guard supervisor, and pushed him toward a wall before grabbing nurse Jennifer Martin.

It took a couple of people to “pry Montgomery’s arms out from around (Martin’s) neck.” When they finally succeeded, Martin fell to the floor, unconscious. She was treated at the hospital for neck injuries.

Court records don’t mention how long Montgomery, 45, had been held at DHMC or whether she was being kept under what’s called an “involuntary emergency admission certificate.” (That’s a topic for another column.)

Adams, the hospital’s spokesman, also informed me that many of DHMC’s health care providers and security guards have been trained in a “number of de-escalation techniques that can be employed in most cases of abusive or aggressive behavior.”

The Nov. 4 altercation, which resulted in the patient’s arrest, suggests the hospital might want to offer a refresher course. It seems likely that DHMC’s in-house security department is either understaffed or lacks the training to handle life-threatening emergencies.

Probably both.

Maybe DHMC doesn’t want to look like it hadn’t been doing enough, but Adams failed to mention the hospital has beefed up security since the incident.

About two weeks ago, “at the request of DHMC,” Lebanon police began stationing an off-duty officer in the emergency department from 6 p.m. to 2 a.m., Richard Mello, the city’s police chief, told me Monday. The hospital pays $65 an hour (the city’s standard rate) for the service.

It’s a start, but what about doctors and nurses who work other shifts? I’m not sure why DHMC doesn’t spring for around-the-clock police coverage in the emergency department.

Money can’t be the reason — not for a health care giant that in 2017 paid its then-CEO, James Weinstein, a base salary of $1.6 million.

While a police presence could raise employees’ comfort level, it’s not a panacea for curbing violent attacks in hospitals.

Adams pointed out that “aggressive and violent behavior by patients and visitors has been increasing nationally, and unfortunately, D-H is seeing increases in behavior that mirror those national trends.”

Assaults from patients can be particularly prevalent in high-risk settings, such as emergency departments and psychiatric units, The Washington Post reported last year.

Violent attacks aren’t limited to patients suffering from a mental health episode. But if DHMC and other hospitals are serious about de-escalating altercations between psychiatric patients and staff — or better yet, stopping them before they happen — they might consider Ken Norton’s suggestion.

Norton, executive director of the nonprofit National Alliance on Mental Illness — New Hampshire, would like to see hospitals hire peer counselors to work with psychiatric patients in emergency departments.

By definition, emergency departments can be chaotic, stressful places. For patients who are struggling with mental illness and may be at the hospital against their will, peer counseling could help “humanize the process,” Norton said.

Maybe that would have helped Montgomery, who lives in Lempster, N.H., and was charged with second-degree assault, a felony, that carries a potential prison sentence of 3½ to seven years in prison.

Montgomery waived arraignment and was released on personal recognizance. Her case is now in the hands of Grafton County Attorney Marcie Hornick.

I mentioned to Hornick that I didn’t see how making the incident a criminal matter was going to help. If anything, it could have a chilling effect, making people battling mental illness or their families reluctant to seek treatment at DHMC.

Hornick, a former public defender, said she couldn’t talk about an ongoing case, but she’s well aware the criminal justice system has become a “repository for those who are mentally ill.”

About 2 million people with mental illness are booked into jails each year, according to NAMI. That’s not where they belong.

The only real solution lies in the state of New Hampshire building more capacity into the mental health system. In the meantime, DHMC needs to make sure that when its doctors and nurses report to work, providing excellent health care is all they have to worry about.

Jim Kenyon can be reached at jkenyon@vnews.com.




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