Advocates: Violent Rex patient incident emphasizes need for more mental health beds

Rex Hospital employees should not be held completely responsible for their inability to handle a violent psychiatric patient who was in the emergency department for more than two weeks, mental health advocates said.

Posted 10:45 p.m. May 6, 2015 — Updated 10:57 p.m. May 6, 2015

RALEIGH, N.C. — Rex Hospital employees should not be held completely responsible for their inability to handle a violent psychiatric patient who was in the emergency department for more than two weeks, mental health advocates said.

“I don’t blame the people at Rex,” said Ann Akland, past president of Wake County’s chapter of the National Alliance on Mental Illness. “I think they were trying to do the very best they can in a very bad situation.”

Akland is the mother of a 35-year-old daughter who has had psychiatric issues since childhood.

“I’ve been there when my daughter was violent,” she said. “You do the best you can, and you protect yourself.”

Rex was cited by federal officials for a “lack of coordination and communication” between nursing and security staff while caring for a “psychiatric patient with known violent behavior.”

In a 281-page report from the U.S. Department of Health and Human Services, provided to WRAL-TV on Tuesday following a Freedom of Information Act request, interviews with directors, nurses and doctors involved in the care of a 24-year-old man in January revealed a lack of preparation by hospital staff for the type of violence exhibited by the patient.

During his 17-day stay, the patient was forced to wear a spit mask, was restrained daily due to being verbally and physically abusive to hospital staff, and a Taser was used on him twice.

The hospital was placed in “immediate jeopardy” due to the citation, meaning it could lose federal Medicaid reimbursements if issues were not addressed. Rex officials said the hospital is now in compliance.

The incident illustrates how emergency rooms are not equipped to handle violent mental health patients, said Dr. Linda Butler, Rex’s chief medical officer.

"They really need help, and we need to have more in-patient beds for this patient population," she said.

North Carolina has fewer than 900 mental health beds available at the state’s three psychiatric hospitals in Butner, Goldsboro and Morganton.

In Wake County, 8,500 people were involuntarily committed last year due to psychiatric issues.

"We just don't have enough beds within North Carolina to accommodate all these patients, so it is a bigger societal issue," Butler said. "We are holding involuntary commitment patents every day and it can vary from two to as many as 11, and some other hospitals hold even more. We have held patients as long as 21 days while they are waiting for a bed."

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