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Psychiatric Patients Ill-treated in Emergency Rooms, US Officials Say

rs and nurses say they have made improvements but are doing the best they can in an impossible situation. They said the number of complaints statewide is small considering the thousands of psychiatric patients who seek care in Massachusetts ERs each year.

In 2005, ERs reported 168,000 visits by psychiatric patients, 10 percent more than in 2003, according to the Massachusetts Health Data Consortium. And they usually have to wait longer for care. The average ER stay for patients who are eventually sent home or to another hospital is nearly three hours; it's nearly six hours for psychiatric patients. And many of these patients wait two to three days in the ER for an inpatient bed in a psychiatric facility to open.

"The emergency departments are overwhelmed," said Dr. Paul Bulat, medical director of the emergency room at St. Luke's Hospital in New Bedford. "We are seeing more violent patients and out-of-control patients. We're seeing mental health problems much worse than we should be."

Public health investigators also found that lack of training is an issue, including in cases where staff used excessive force. Better training in techniques to calm patients is especially important as frustrated psychiatric patients with no where else to go spend hours in the ER .

In the case of the patient whose arm was broken at Lawrence General Hospital, investigators found a range of problems, including that the hospital's internal investigation of the complaint did not include interviewing the patient. Investigators also found no evidence that staff and security had been trained in patient's rights. And they said the nurse should have explored the patient's reasons for wanting to keep on his jeans before resorting to force.

Hospital spokeswoman Ellen Murphy Meehan said the hospital "expressed deep regret to the patient" for what it considers an accident. She said Lawrence General has since changed its policy to allow some psych
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