Psychiatric patient's long hospital wait raises questions about care

December 21, 1992|By Donna E. Boller | Donna E. Boller,Staff Writer

Deborah D. Martin says it seemed like a long wait at Carroll County General Hospital's emergency room.

It was.

The 38-year-old Westminster resident spent more than eight hours locked in the bare, windowless "quiet room" where the emergency room staff places psychiatric patients.

Her wait was nearly three times as long as the hospital's reported average emergency room wait for psychiatric patients, 2 1/2 to 3 hours.

Miss Martin never protested during the wait or in subsequent interviews. But when Nancy Martin of Finksburg learned how long her daughter had spent at the emergency room, she was furious.

"That outraged me," said Mrs. Martin. "I think the thing that made me the maddest was that she expected this treatment."

Westminster police took Miss Martin to the Carroll County General emergency room at 3:30 p.m. Nov. 4, after she became disruptive at her apartment. She was admitted to Gundry/Glass Hospital, the psychiatric unit of Harbor Hospital in Baltimore, at 12:50 a.m. the next morning.

She spent most of the time alone in the mauve-painted quiet room, with occasional breaks to go outside and smoke, accompanied by a city police officer. The room has a glass panel in the door so that the emergency room staff can observe patients inside.

"They were humane," Miss Martin said. "At various intervals, people would say [things such as], 'I would like to give you lunch.' "

Mrs. Martin took her protest to hospital administrators and to the Carroll County Mental Health, Alcoholism and Drug Abuse Advisory Committee. The committee forwarded her letter to the state Department of Health and Mental Hygiene.

Mrs. Martin said she is now satisfied with the response from Mary Ann Kowalczyk, one of two Carroll County General staff members who investigate complaints. Mrs. Martin reported that Ms. Kowalczyk told her the hospital had to perform tests to rule out a medical problem before calling a psychiatrist.

Mrs. Martin also said that a reply letter to the advisory committee from the state health department said the state agency officials had talked to Ms. Kowalczyk, who had assured them she would check with the hospital's psychiatric administration to see if new emergency room procedures are needed.

Carroll County General officials refused to explain why Miss Martin's tests took so much longer than average, even after the patient gave permission for them to discuss her case.

"We just feel it would be totally inappropriate to comment on this case," said hospital spokeswoman Gill Chamblin.

Ms. Chamblin said the hospital complied with state law requirements that psychiatric patients who come to hospital emergency rooms with petitions for emergency evaluations must be seen by a physician within six hours.

Any interested person can file an emergency evaluation petition for someone believed to be a danger to himself or others.

Later, Miss Martin refused to go to the hospital to obtain her medical records, which would show what tests had been done and what time the psychiatrist saw her.

"I don't want to return to that place ever again," she said.

Long emergency room waits are not uncommon for psychiatric patients, according to reports from individuals who are familiar with the mentally ill.

"The issue is not confined to Carroll County General Hospital, but in fact has improved slightly at Carroll County General since they've hired a full-time psychiatrist," said Spencer Gear, executive director of Granite House, a local rehabilitation, housing and counseling program for the mentally ill.

Mr. Gear said he traces the wait problem to two sources: psychiatric patients are low on the triage list that emergency room nurses use to ensure that the most seriously ill patients are seen first, and many emergency rooms do not have a psychiatrist readily available.

Bette Stewart, program manager for Alliance for the Mentally Ill of Maryland, said she didn't have documentation, "but I do get calls, people who say, 'Can't they speed this process up?' They have to wait and they have to wait."

Mrs. Stewart said the problem is statewide, but the alliance has no plans to tackle it.

"Yes, it is something we should be doing," she said. "We're not doing it. We don't have the manpower at this point."

Bruce Regan, a psychiatrist and medical consultant for planning and program development with the state Mental Hygiene Administration, said he is surveying hospital emergency rooms that receive grants from the state agency, including Carroll County General. But his task is not to look at patient waiting times.

Dr. Regan said the hospital's quality assurance program provides a mechanism for investigating complaints. He said the administration's survey focuses on how patients are evaluated, what alternatives to hospitalization are available and whether the emergency room's resources are up to date.

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