On August 26th, 2015, Alan Christopher Pean went to St. Joseph's Medical Center in Houston, Texas, to seek mental help. He was admitted and then denied the help he needed. While hospitalized, Alan was attacked by two cops. He was tazed and shot by one of them. And he is being criminally charged with assaulting them. This article is a means to get to the real issues of this hazardous hospital.
- Who: Patient is Alan Christopher Pean; Cop is O. Ortega
- What: Allegedly combative patient was shot by off-duty cop in stomach
- When: Shooting August 27, 2015
- Where: St. Joseph's Medical Center, Houston, Texas
Reported as Facts- Patient drove self to hospital with complaints of anxiety and disorientation
- Patient was admitted to the 8th Floor
- Discharge was planned for next day
- On discharge day, nurse called security for combative patient
- Responding security staff consisted of two off-duty Houston Police cops
- Cop tazed and then shot patient in stomach (conflicting reports as to which cop tazed)
- Patient went to ICU
- Patient has been charged with two counts of aggravated assault of a police officer; bail set at $60,000.
- Patient's family not allowed to see patient for 48 hours after shooting
- Patient was combative with nurse
- Nurse called security staff (off-duty cops) for help
- Patient assaulted and injured the two hospital cops
- Patient's father is a physician
- Patient's brother is a 4th-year medical student
- Patient is in college to be a physician's assistant
- Family retained high-profile lawyer to defend against criminal charges (George Zimmerman's attorney)
- An electronic petition denouncing events surrounding shooting circulates among health care professionals with some 2,900 signatures
- Much of main stream media is addressing guns in hospitals
Putting it all into context
This is a tragic story of a 26 year old man, Alan Christopher Pean, who was shot and nearly killed while hospitalized. He was tazered then shot by a hospital security guard who is an off-duty cop.The incident spawned an angry iPetition signed by some 3,000 healthcare workers nationally and internationally. While the letter denounces the shooting, the more vociferous condemnation is against the malpractice and abuse suffered by Alan at the hands of "fellow medical professionals" of the St. Joseph Medical Center staff, Houston Texas.While this drama unfolds, the media seizes the opportunity to blame guns. But few are addressing the real problems that get to the important lessons of this story. This article intends to remedy that.
What this tragedy teaches is that no patient is safe from predation while hospitalized - not even the son of a doctor. Could this tragedy have been prevented? In my experience as a former contract nurse of nine years - and as a nurse familiar with the internal operations of St. Joseph's Medical Center - absolutely YES! Read on.
The quotes and some of following timeline are taken from the iPetition that is being circulated for signatures by members of the health care community.
On August 26, 2015, Alan Pean went to the hospital to seek help for "intense anxiety and general disorientation." On parking his car he "grazed other parked vehicles." Alan sustained minor injuries while parking and was admitted to the eighth floor of St. Joseph's Medical Center, to assess those injuries.
The eight floor is a medical and medical/surgical floor that tends to adult patients with relatively minor health problems. On that floor is a small section devoted to psychiatric patients with medical problems. It makes sense that Alan would have been assigned to a bed in that unit, but this is not confirmed.
Alan Pean's parents flew to Houston the day after Alan was admitted to check on their son. From the iPetition:
They visited Alan at the hospital and, upon interacting with their son, they were struck by his unfamiliar behavior, speech, and general disorientation.Especially concerning is Alan's "unfamiliar speech, and general disorientation." This reeks of over medication.
They communicated their observations with the personnel and implored hospital personnel to obtain a psychiatric evaluation. [...]they desired to speak with Alan’s physician. Both requests were denied.At first glance, this appears to be a case of too many patients and too few nurses. The crucial questions here are: What are the dynamics between the nurses and the doctors? Are the nurses afraid to speak to the physicians? If so, why?
Also, who exactly was the "personnel" to whom the family spoke? Typically, requests like speaking to a doctor and getting a psychiatric evaluation are made to the nurse that is taking care of the patient. If unsuccessful, the family can appeal to a charge nurse, hospital supervising nurse, hospital chief of staff or even higher.
And, given that Alan was admitted to the eighth floor where psychiatric patients are sent, why were these requests not honored?
It is surprising that Alan's father, a physician, didn't take control to advocate for his son to DEMAND appropriate care. The fact that a medically savvy family chose not to pursue stronger patient advocacy is in question. Why didn't they make noise? Were they intimidated by the "authority" that they felt they faced? Did they have a need to be professional in spite of the gross negligence that was obviously being inflicted on Alan?
While the hospital staff behavior is deplorable, it is much more common than most people know and more common than those responsible would care to admit. What is uncommon, however, is that the behavior was imposed on a father who is also a physician and who was attempting to advocate for his son.
Not only did St. Joseph Medical Center deny Alan the psychological care that he needed, but:
St[sic] Joseph’s personnel communicated that they would [...] discharge the patient against his and his family’s wishes.When Alan's parents returned to the hospital to pick up their son, they were notified that Alan had been shot.
Alan ended up on a ventilator fighting for his life in the intensive care unit. Alan's family was not allowed to see him for the next 48 hours. When the family was granted permission to see Alan, it was only for 10 minutes at a time in a controlled, prison-like environment.
Likely, the reason for the extra vigilance was because Alan was being charged with two counts of assaulting a cop and had a $60,000 bond.
In summary, Alan went to the hospital seeking mental help. He was denied the help he needed. He was attacked by two cops. He was tazed and shot by one of them. And he is being criminally charged with assaulting the cops.
A closer analysis
According to several reports, a nurse called hospital security staff to help with a combative patient. This very important piece of information is at the root of everything that later transpired.The two questions to ask about the nurse are: (1) Was the nurse inexperienced? And, (2) was the nurse a seasoned sociopath who demands obedience of her patients?
From the iPetition, when Alan initially went to the hospital:
He was in such dire straits that he could barely get to the hospital without grazing other parked vehicles. Alan presented to the ED [emergency department, aka ER] complaining of new-onset, intense anxiety and general disorientation. He was admitted to the hospital to assess his injuries from his minor MVA [motor vehicle accident].From this data, it appears that Alan was a true psychiatric patient. But there is a tendency for most emergency room personnel to ignore psych issues and to focus on physiological problems. Alan was transferred to the eighth floor. The eighth floor is a section of the hospital that houses medical and medical/surgical patients. As a secondary service on that floor, a small section of hospital beds are reserved for psychiatric patients with minor medical problems. It is not clear if Alan was assigned to one of these beds.
But if Alan's "parking lot" motor vehicle accident injuries were very minor, I have to question why, then, he was even admitted to the eighth floor. The minor injuries might have easily been resolved in the ER. And it appears there was no genuine intention to address Alan's psychiatric problems. Did Alan possess the right type of health insurance that benefited the hospital's bottom line? Or did Alan advocate sufficiently well for himself to convince the ER doctor to admit him? What, exactly, did the ER doctor document in his notes about Alan's mental status?
In the ER, typically, a patient who is admitted will be assigned a "primary care doctor." That doctor, is then in charge of deciding what specialty doctors are needed for the patient, if any. In Alan's case, he clearly needed a psychiatric consultation. Was a psychiatric evaluation ever done? It appears not. Why?
How many nurses were assigned to Alan's care? Most hospitals staff their nurses on eight or 12-hour shifts. Depending on the time of day Alan was admitted, he could have had between two and five nurses assigned to his care before he was shot. Why does it appear that no nurse advocated to have Alan's psychosis addressed? It is likely that the nurses assigned to Alan were one or more of three types of nurses: overworked, "float," or sociopath. The following explains.
Sometimes nurses are just "bodies" to fill required staffing. If there were not enough nurses for the eighth floor where Alan was residing, it is quite possible that hospital management decided to let the floor be "short-staffed." That means that the nurses have a ridiculous number of patients to see.
A personal story: I worked at St. Joseph's in 2002 on their maternity floor. It was my first three-month contract. While I had been accustomed to caring for not more than six mothers OR six babies, at St. Joseph's medical center, I once cared for as many as 12 mothers AND 12 babies for a total of 24 patients! Never before or since in my nine-year career, did I have such a high number of patients in a maternity setting.
Besides being short staffed, it is possible that management might have "floated" a nurse to Alan's floor from another area of the hospital. Float nurses are often scared to death to be forced to work in settings unfamiliar to them.
In both of the these scenarios - overworked or floating nurses - it is likely that an inexperienced nurse was unable to deescalate Alan, if he had indeed become aggressive. An inexperienced nurse might have quickly resorted to bringing in "the guns." But there is a third problem nurse: the sociopath.
There do exist nurses who get so full of themselves that they demand patient obedience and respect. Could it be that one of these nurses met her match? After all, Alan Pean was no ordinary patient. His father is a physician, his brother is in med school, and he, too, is studying in the healthcare field. Patients with that type of background often know what they want out of their hospital experience. That knowledge, combined with slow or poor care, and a nurse who is trying to bully them or bullshit them, can cause even a sane person to go off.
It's unclear why Pean became combative. His family describes him as a kind person, who recently went to Haiti to do community service. He was the senior class vice president at Sharyland.Given all the data, the most likely scenario that would have caused this patient to become combative is a combination of factors including some sort of disconnect between him and his nurse AND very likely, a medication error or unexpected reaction to a medication.
For liability reasons, medication errors are something that no hospital administrator or spokesperson will EVER willingly admit. But consider that Alan's complaints, when he first went to the hospital, were "anxiety" and "disorientation." If Alan presented to the emergency room with psychiatric complaints, there is a good chance that he was ordered something to calm him down. There is no telling what some non-psychiatrist doctor decided would be good for Alan. And based on the data, it is unlikely any doctor even had a complete and accurate account of his psychiatric history.
If Alan was given an antipsychotic, this is serious!
A PERSONAL STORY: An obstetrician once ordered the wrong dose of an antipsychotic to be given to a postpartum patient of mine. I, and other nurses, gave that wrong dose to the new mom. The patient got so disoriented that she dropped her baby into the hamper. The nurses cut her off from her baby - case closed. When I realized she had been taking the wrong dose of an antipsychotic, I went to bat for her. The doctor hung up on me and told me I was "full of shit." So I contacted the hospital psychiatrist. That psychiatrist straightened out the mess and force the doctor to fix his error. The patient was allowed to see her baby again and all was well with her world (and my shift.)
So, did Alan have a similar reaction to an antipsychotic medication? Or was it a matter of poor nursing communication? Or both? This combination of stacked breakdowns was a potentially lethal problem. And Alan and his family are lucky he wasn't killed.
The security staff at St. Joseph's are armed, off-duty Houston cops who work at the hospital for extra money. Since cops lack training in dealing with the mentally ill, and since their training is all about THEIR safety and THEIR well-being, it is far too likely that a trigger-happy cop will overreact to the slightest disturbance. The vast majority of cops have no training, desire, or capacity to deescalate a person with mental problems. That puts the issue of cops - off duty or not - as yet another hazard to patients, and a very serious one.
A word about the moral aspect of the cop shooting. There is a lot of on-line buzz about how cops have a right to defend themselves. That's fine and dandy. But there are countless nurses and other hospital staff that have been attacked by psychotic patients. I don't know of any that have defended themselves by killing a patient. What makes a cop's life any more valuable than that of a nurse or sick patient - or any one else's? The notion that cops put their lives on the line for us is utterly ridiculous. The U.S. Supreme Court ruled that cops are under zero obligation to protect us. Therefore, their only function in society is to enforce laws. It is extremely dangerous to use these types of individuals to tend to sick people. When a rabid unthinking grizzly is let out of it's cage, how can the victims blame the bear when harm results?
While medical community spokespeople have condemned the presence of police officers in hospitals, their harshest criticism was against the health care professionals at St. Joseph's Medical Center. The online letter of protest that has been circulating has been signed by thousands of unverified health care providers across the country and beyond. Here are some of the complaints in that letter and my assessments of them.
Professionally, we have been trained in truth seeking and healing. As doctors and medical students, as nurses and care partners, we are trained in how to safely restrain and tranquilize patients, no matter how aggressive, or irritable, or anxious, or threatening they may be. Never is it appropriate or warranted for a patient to be tazed, never is it appropriate for a patient to be struck, never, never, never is it appropriate for a patient seeking care, to have their life threatened in our arms.Given that the medical establishment is the third leading killer in the U.S., isn't it disingenuous of the petition supporters to cast such a judgmental tone against their Houston colleagues?
The following excerpt establishes keen insights related to the care given to Alan by St. Joseph Medical Center. The insight is particularly telling of the in-depth knowledge that these practitioners possess with regard to how hospitals should operate:
St. Joseph's medical professionals enabled their security division to commit an act of violence against one of their patients. Anyone who has worked in a hospital setting for any period of time is aware of the protocols and medical resources -pharmacological and nonpharmacological--at its disposal to manage any patient’s agitated or combative behavior non-violently. There are multiple methods of intervention and amelioration to protect a disoriented patient from hurting himself or others.Clearly, the authors and the supporters of this letter are professionals who are, "aware of the protocols" that St. Joseph's staff failed to follow. How do they know about internal breakdowns? I would argue that each one of them KNOWS what takes place behind the scenes in hospitals. At some point in their careers, each one of them has witnessed it. And it's a fair assumption that not one of them has ever done a damned thing to rescue a patient that was being victimized by a higher-ranking health care provider. Why? Because to do so would jeopardize their own career. With that insight, doesn't it make the letter of protest somewhat hollow? Where is this community's outrage when other victims are abused, harmed, or killed by the DIRECT actions of a health care provider? Why the outpouring of compassion for this particular patient?
Maybe one reason is because the direct harm caused to the patient was by a police officer and not by a health care provider. In this tragedy, the harm to the patient was INDIRECTLY caused by health care providers. Thus, is it easier to lash out against colleagues who "dropped the ball" rather than against colleagues who committed direct harm?
But wait. There's something else that might have played into the politics:
"...no son of a doctor, no college student, no tender-hearted soul of color remains immune. We stand with shaken hearts and rooted conviction, to speak our collective outrage for Alan Christopher Pean, our gentle friend, a 26 year old who was inexcusably shot in the chest by a police officer, while seeking care as a patient."BINGO! This is not an ordinary patient. The father is a doctor, the brother is a med student, the patient is in college majoring in healthcare. This patient represents the medical establishment itself. He is one of them. How dare a hospital ignore one of them?!
The other noise surrounding this tragedy was the issue of guns. Several main stream media outlets used the opportunity to villianize guns. But what is gun control if it isn't a means to ONLY give guns to cops? That is exactly what gun control is. How will people be disarmed if not by armed police? How can the public be sure that off-duty cops who are working as hospital security guards will not be armed? Who will enforce this policy? Who will disarm the off-duty cop?
As underscored in my book, the best means to stay safe in a hospital is with the services of a patient advocate. If such a near-deadly outcome and such violence can be inflicted to a medically-literate son of a doctor, then imagine how much more vulnerable the rest of the public is.
I said above, that a nurse could have prevented this tragedy and a good one could have. But as the details of this story become more clear, there is a strong case to be made that what Alan needed most was a vigilant and strong patient advocate! While it is understandable that Alan was in crisis and not in his "right mind" when he went to the hospital, a pit-bull patient advocate is what he needed. He didn't need a polite doctor-dad or polite medical student brother. What Alan needed was an advocate who has both spine and intelligence to demand acceptable patient care.
Rarely will main stream media address the need for a patient advocate when these types of tragedies occur. Instead, it seems the narrative becomes agenda-driven into other issues, like gun control, racism, or health rights. As much as I hate to admit it, I would even go as far as to say that this issue is not primarily about bad cops. Those who get distracted by tangents are ignoring the much bigger issue.
The less obvious but much more insidious malefactors of this tragedy are those health care workers who were in charge of Alan's care - ALL OF THEM! From the nurse who made the wrong call to call the cops - to the hospital administrators who make decisions based on profits instead of patients - to the doctors who failed to ensure the patient was well enough to be discharge - they all have blood on their hands. What more evidence is needed to prove this argument than the letter from the health care community that places the blame squarely on the shoulders of their Houston colleagues?
In the next edition of my book, I will be adding another hospital hazard: COPS. While cops are known to kill on average three people a day, the medical profession is responsible for killing up to 50 PEOPLE AN HOUR! St. Joseph's Medical Center, Houston, proudly advertises itself as being owned by physicians. I cannot think of a more sadistic and deadly combination of professions coming together to "help" anyone - let alone vulnerable sick people.
Thank you for reading and please post a comment.
Author's note: The hospital topics in this article are explained in detail in the book, Hospital Hazards: A Former RN's Guide to Get Out Alive
Sources:
http://www.huffingtonpost.com/entry/patient-shot-in-hospital-after-seeking-mental-health-treatment_55e4abdee4b0b7a96339dfcc
http://www.houstonchronicle.com/news/houston-texas/houston/article/Family-of-man-shot-in-Houston-hospital-struggles-6481756.php
http://www.khou.com/story/news/local/2015/08/27/hpd-officer-shoots-patient--st-joseph-medical-center/32479103/
http://www.krgv.com/news/local-news/Valley-Man-Shot-by-Police-while-at-Hospital/34981754
http://www.ipetitions.com/petition/alanpean
http://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals
http://www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results/
http://abc13.com/news/police-off-duty-officer-shoots-combative-person-at--hospital-downtown/959137/
http://www.nytimes.com/2005/06/28/politics/justices-rule-police-do-not-have-a-constitutional-duty-to-protect-someone.html
http://www.click2houston.com/news/family-of-patient-shot-by-officer-at-st-joseph-medical-center-hires-attorney/34981114
https://www.facebook.com/sjmctx/info?tab=page_info
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