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

Posted May 6, 2015

— 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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  • John Lee May 12, 2015
    user avatar

    I find it ironic DHSR cited the Rex ER for managing violent behavioral health patients when the state closed down many of the state licensed beds (Dix - Umstead) forcing emergency departments to deal with this patient population. In essence, THEY have created this problem and expect non-specialized ED's to deal with it. What's next? OSHA fining them for workplace safety? They should be ashamed.

  • Roger Way May 7, 2015
    user avatar

    Once again, a short-sighted government managed by incompetent, self-centered politicians with nonexistent leadership skills - on both sides of the aisle - leads us down a path to social ruin. Dorothea Dix is spinning in her grave.

  • Nicole Collins May 7, 2015
    user avatar

    Write governor McCrory and tell him thanks for inking the deal to sell Dix land. 3.8 day average wait time in emergency rooms for the mentally ill while waiting for a psych bed but at least we have a park. To answer mark farmer there were 400 beds at Dix, but the idea was to close those beds and manage psych patients in the communit by LMEs. Guess what? It's not working like all the mental health advocates predicted but Dix land was more valuable then the fate of the mentally ill. RIP Dorothea Dix

  • David Crabtree May 6, 2015
    user avatar

    Whatever happened to Dorothea Dix Mental hospital? Oh wait, that's right.

  • Mark Farmer May 6, 2015
    user avatar

    Dorothea Dix hospital closed.

    how many beds was that?