Las Vegas Sun

March 28, 2024

SUN EDITORIAL:

Protect patient rights

State psychiatric hospital criticized for lack of reporting serious incidents

An investigation revealed last week that the state Rawson-Neal Psychiatric Hospital in Las Vegas failed to properly report when staff used medicines to subdue out-of-control patients.

As Marshall Allen reported in Saturday’s Las Vegas Sun, investigators looked at 10 randomly selected cases and found that the hospital failed to disclose the use of medicine as a “chemical restraint” in all of them. Investigators said that in two of those cases the hospital staff failed to give any reason for using the drugs.

A chemical restraint can be used only in an emergency to control a patient’s aggressive behavior. By law, staff members are expected to document the incident. As well, the hospital is supposed to investigate the incident and report it to the state Health Division.

However, the state official who oversees the Las Vegas hospital said it did nothing wrong and plans to appeal the finding to a hearing officer. Howard Cook, head of the state’s Mental Health and Developmental Services Division, said the hospital does not use chemical restraints. Instead, he said, the drugs in those cases were used as part of the treatment for psychological issues that caused behavior problems.

Although this appears to be a matter of semantics, it is an important distinction. There is a significant difference between using a drug in a crisis to calm someone and using medication therapeutically to treat a mental illness. The investigation paints a picture of the use of medications as a chemical restraint. It says that drugs were given to patients, without their authorization, in response to specific behaviors or situations, including aggression, threats or agitation. Three of the patients were not only given medication, but they were also physically restrained.

The documenting and reporting of these incidents isn’t to create more paperwork, it’s for safety. Documenting why patients are given medication gives patients and their doctors a record of what happened. Because they are being given the medications without patient consent, there has to be a solid reason for it, otherwise the hospital is violating patient rights.

This most recent issue with the use of chemical restraints is a serious matter, just like using a physical restraint. It comes with its own set of dangers, as well. State officials and investigators need to get on the same page. And we would hope they would make this a priority, given the problems at the hospital over its lifetime. The hospital has experienced plenty of issues, ranging from staffing to patient care.

Last month, for example, the hospital was criticized for its care after a patient died. The investigation found that the woman, who was admitted after a schizophrenic episode caused her to become combative, was supposed to have one-to-one supervision — meaning a hospital staff member was supposed to keep her in direct sight at all times. The staff failed to closely monitor her and eventually found her dead. The cause of death has not yet been determined, but Cook described the care as “less than adequate.”

Last year the hospital was fined for not doing enough to protect a female patient who was allegedly attacked by a male patient. The hospital admitted it knew the male patient was potentially violent, but it didn’t have a procedure to protect other patients.

We would hope state and hospital officials see these problems for what they are and move quickly to address them.

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