Tell me where it hurts

ER Rights bill tells discriminating doctors where to stick it

By ELLEN PRZEPASNIAK

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When Rachel Klein suffered a debilitating headache she couldn't diagnose, she did what anyone would do. She went to the emergency room. When she told the admittance desk she had a history of mental illness and listed the medications she takes, she received atypical care. After waiting for four hours, the first doctor who came to see her was a psychiatrist, not a physician. She was stripped down, injected with tranquilizers and restrained.

Klein, the vice president of Massachusetts People/Patients Organizing for Wellness, Empowerment and Rights (M-Power), lobbied in favor of the emergency room rights bill at the Statehouse last week. The bill—proposed by Rep. Ruth Balser, D-Newton, chair of the Joint Committee on Mental Health and Substance Abuse—would determine the rights of people with histories of mental illness in the emergency room.

Klein says doctors and the Department of Public Health (DPH) don't acknowledge the many reported cases of abuse in emergency rooms across the state. Charges of mistreatment include patient restraint, patient seclusion and being disrobed.

"At the lowest level, it's disrespect, but at the highest level, it's discrimination," Klein said, adding that the only recourse for improper patient care is to go to the hospital's complaint division or to the DPH, but those offices claim they can't do anything without procedures in place. This bill would provide those regulations.

Discussion on this topic has escalated in recent years after one psychiatric patient broke his arm while restrained and another died in the emergency room. The DPH and the Department of Mental Health (DMH) then formed the Emergency Department Workgroup to investigate over 21 claims of abuse in emergency rooms in an 18-month study.

Susan Stefan, a long-time proponent of the ER Rights bill, is currently representing a mental health patient in an emergency room discrimination case. She also wrote a book on the subject, entitled Emergency Department Treatment of the Psychiatric Patient.

"Hospitals and the DPH have to be told to regulate this area because they are so busy and they have so many obligations that no matter how well-meaning they are, it's not going to happen, except in response to the legislature's direction," Stefan said.

The DPH recognizes the need for increased quality of care for those with mental illnesses, but does not support the proposed legislation.

"Our position is that further legislation is not needed right now," Donna Rheaume, DPH spokesperson, told the Dig in an email. "We believe that the culture of care needs to change, not necessarily the regulatory environment."

Rheaume said hospitals are already subject to regulations from the Joint Commission on the Accreditation of Healthcare Organizations and Centers for Medicare and Medicaid Services with issues of restraint and seclusion. The DPH does not support piling more regulations upon these.

Stefan says poor treatment in emergency rooms can also be re-traumatizing for many patients. It could exacerbate an existing condition.

Klein says lobbying for the bill has had the opposite effect. "M-Power has really given me a voice on this topic," Klein said. "I feel very passionate about it."