美国国家公共电台 NPR 'Failing Patients': Baltimore Video Highlights Crisis Of Emergency Psychiatric Care

 

LULU GARCIA-NAVARRO, HOST:

Emergency room doctors and mental health advocates say there's a crisis happening in ERs. Surging numbers of patients with psychiatric disabilities are not receiving the care they need. NPR's Merrit Kennedy reports the issue has gained new focus after a video from Baltimore went viral.

MERRIT KENNEDY, BYLINE¹: Imamu Baraka happened to be walking by the University of Maryland Medical Center in downtown Baltimore on a cold night in January when he saw something that shocked him. He started filming.

(SOUNDBITE OF VIDEO)

IMAMU BARAKA: Wait. So y'all just going to leave this lady out here with no clothes on?

KENNEDY: Baraka's video shows security guards walking away from a bus stop next to the emergency room. One is pushing an empty wheelchair. The woman they left there is wearing a thin yellow hospital gown and socks.

BARAKA: Are you OK, ma'am? Do you need me to call the police?

KENNEDY: The woman later identified as a 22-year-old named Rebecca staggers next to the bus stop. She appears distressed² and confused.

(SOUNDBITE OF VIDEO)

REBECCA: (Screaming).

KENNEDY: Rebecca has a visible wound on her forehead. And her breath forms white clouds in the cold. Baraka calls for an ambulance, which brings her back to the hospital she was just discharged from. His video has been viewed more than 3 million times. Rebecca's mother, Cheryl Chandler, says she happened to click on the video, not knowing it showed her daughter.

CHERYL CHANDLER: Once he focused on her face, I realized it was her. And I think I went into shock initially³.

KENNEDY: That set off a desperate search. The hospital wouldn't tell her where Rebecca was. Chandler called the police. They found out that the hospital didn't readmit Rebecca, even though Rebecca told workers in the ambulance she didn't feel normal. Hospital staff put her in a cab to a nearby homeless shelter, where family members found her the next day.

CHANDLER: She could've got hypothermia. She could've died. She could've been raped⁴. She could've been killed.

KENNEDY: Rebecca was clearly asking for treatment, her mother says, which ERs are legally required to provide. Several years ago, Rebecca was diagnosed with bipolar and schizoaffective disorders⁵.

CHANDLER: That - what I saw in the video was my worst nightmare for Rebecca.

KENNEDY: Her mom says she's a shy and lovable introvert⁶ who loves animals and making art. Rebecca has insurance and had been in a residential⁷ home when she went missing. The hospital has apologized and says it has already put in place measures to correct the issues. Chandler says she hopes that means it won't happen to other patients, but she adds that Rebecca will continue to suffer from the hospital's decisions.

CHANDLER: No part of Rebecca, because of this, is going to heal. No part. We can't make the scars go away.

KENNEDY: An investigation⁸ by the Centers for Medicare and Medicaid Services found that, among other things, the hospital failed to discharge the patients safely. The family's lawyer, James E. Farmer, says they're investigating now and considering filing lawsuits⁹. Nationwide medical systems are struggling to provide adequate services to people with psychiatric disabilities, even under the best of circumstances. The number of psychiatric emergency patient visits have increased dramatically in the last decade. Between 2006 and 2013, ER visits for these patients went up by more than 50 percent.

JOHN ROGERS: We're just failing patients with mental illness. And this is getting worse as time goes on.

KENNEDY: That's John Rogers. He's the president-elect of the American College of Emergency Physicians. Rogers says that there have been cuts to inpatient beds and to community and outpatient resources, which mean that the emergency department is often the only place for them to go.

ROGERS: Every emergency physician in the country knows this problem well and wants to do something about it.

KENNEDY: Often the ER is not properly equipped with staff, he says, that can offer treatment to psychiatric patients. The emergency rooms mission is to assess and stabilize¹⁰, but the actual care they can provide psychiatric patients is fairly limited.

ROGERS: And that's where it starts breaking down.

KENNEDY: ERs sometimes hold patients for too long before they can transfer them somewhere that can treat them. And they're often few options.

ROGERS: The time that it takes to get someone transferred for something like that is just unacceptable.

KENNEDY: Rogers believes that stories like Rebecca's are rare, and long holds are more common. But there are other families with similar experiences. Here's another story from Baltimore. It's about Laura Pogliano and her son Zaccaria, who'd suffered from schizophrenia. At her home, she shows us photos of Zac.

LAURA POGLIANO: This is him about 14. And he was very athletic¹¹.

KENNEDY: Zac was sensitive and empathetic and loved playing the piano. He died in 2015 of heart failure. He was just 23 years old.

POGLIANO: And he'll sort of be forever young, right?

KENNEDY: He started showing symptoms of the disease when he was 16. He became paranoid and started doing things like hiding kitchen implements¹², out of fear that someone was trying to kill his family.

POGLIANO: His personality just drastically changed. He had a thousand rituals around things so that he wasn't harmed.

KENNEDY: Then as part of his illness, Zac started to think he actually did have dramatic injuries, like a gunshot wound or a smashed ankle. He'd call 911. This happened repeatedly in 2013 and '14.

POGLIANO: He took probably 20-plus trips to the ER in about a year's time.

KENNEDY: Often Zac was taken to Good Samaritan Hospital, where Pogliano says that the doctors would typically call her to let her know he arrived and would provide appropriate care for him. Later, hospital staff would call her to pick him up. But one night after Zac went to the ER, Pogliano woke up hours later worried that she hadn't received a call.

POGLIANO: So I just got in the car and drove over there. And he was sitting outside. It was early spring, but it was still wintery probably 40 degrees out, 45 degrees out. He was sitting outside. All he had on was what he wore at the hospital, which was a pair of white linen¹³ shorts - I know he didn't have shoes on - and a hospital gown and no shirt. So I said to him, oh, my gosh. What are you doing here? He said they told me to leave.

KENNEDY: A hospital spokeswoman acknowledged that Pogliano was a patient there but said she found no indication that he was ever inappropriately evaluated or mistreated. She said she couldn't comment further because of federal privacy laws. The crisis happening in the ERs across the country is a bad situation for everyone, for psychiatric patients and for other patients who have lengthy¹⁴ wait times because ERs are overwhelmed.

SUSAN STEFAN: And they're being turned into essentially¹⁵ 24/7 social service agencies.

KENNEDY: Susan Stefan is a lawyer focusing on rights of people with psychiatric disabilities. She says it's common for ERs to transfer people to homeless shelters because they're not equipped to find people stable housing. And there's another crucial point here.

STEFAN: The emergency department is probably the worst place for somebody in psychiatric crisis. It's loud. It's chaotic¹⁶.

KENNEDY: If there were adequate services in place, most of the people coming to ERs for psychiatric crises wouldn't need to go there at all, says Jennifer Mathis of the Bazelon Center for Mental Health Law.

JENNIFER MATHIS: As much as everybody loves to talk about the need for mental health services, that doesn't translate into state policy and funding for community mental health services.

KENNEDY: The problem here, she says, is political will. There's a big gap between politicians talking about mental health and actually making sure people are getting the services they need. Merrit Kennedy, NPR News.

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 distressed   

痛苦的

参考例句：

• He was too distressed and confused to answer their questions. 他非常苦恼而困惑，无法回答他们的问题。
• The news of his death distressed us greatly. 他逝世的消息使我们极为悲痛。

3 initially   

adv.最初，开始

参考例句：

• The ban was initially opposed by the US.这一禁令首先遭到美国的反对。
• Feathers initially developed from insect scales.羽毛最初由昆虫的翅瓣演化而来。

4 raped   

v.以暴力夺取，强夺( rape的过去式和过去分词 )；强奸

参考例句：

• A young woman was brutally raped in her own home. 一名年轻女子在自己家中惨遭强暴。 来自辞典例句
• We got stick together, or we will be having our women raped. 我们得团结一致，不然我们的妻女就会遭到蹂躏。 来自辞典例句

5 disorders   

n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调

参考例句：

• Reports of anorexia and other eating disorders are on the increase. 据报告，厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
• The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》

6 introvert   

n.性格内向的人

参考例句：

• You are very much an introvert.你是一位地道的内向性格者。
• The same conversation that energizes the extravert also drains the introvert.同样的交谈能让外向者荣光焕发，却让内向者精神颓靡。

7 residential   

adj.提供住宿的；居住的；住宅的

参考例句：

• The mayor inspected the residential section of the city.市长视察了该市的住宅区。
• The residential blocks were integrated with the rest of the college.住宿区与学院其他部分结合在了一起。

8 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

9 lawsuits   

n.诉讼( lawsuit的名词复数 )

参考例句：

• Lawsuits involving property rights and farming and grazing rights increased markedly. 涉及财产权，耕作与放牧权的诉讼案件显著地增加。 来自辞典例句
• I've lost and won more lawsuits than any man in England. 全英国的人算我官司打得最多，赢的也多，输的也多。 来自辞典例句

10 stabilize   

vt.（使）稳定，使稳固，使稳定平衡；vi.稳定

参考例句：

• They are eager to stabilize currencies.他们急于稳定货币。
• His blood pressure tended to stabilize.他的血压趋向稳定。

11 athletic   

adj.擅长运动的，强健的；活跃的，体格健壮的

参考例句：

• This area has been marked off for athletic practice.这块地方被划出来供体育训练之用。
• He is an athletic star.他是一个运动明星。

12 implements   

n.工具( implement的名词复数 )；家具；手段；[法律]履行（契约等）v.实现( implement的第三人称单数 )；执行；贯彻；使生效

参考例句：

• Primitive man hunted wild animals with crude stone implements. 原始社会的人用粗糙的石器猎取野兽。 来自《现代汉英综合大词典》
• They ordered quantities of farm implements. 他们订购了大量农具。 来自《现代汉英综合大词典》

13 linen   

n.亚麻布，亚麻线，亚麻制品；adj.亚麻布制的，亚麻的

参考例句：

• The worker is starching the linen.这名工人正在给亚麻布上浆。
• Fine linen and cotton fabrics were known as well as wool.精细的亚麻织品和棉织品像羊毛一样闻名遐迩。

14 lengthy   

adj.漫长的，冗长的

参考例句：

• We devoted a lengthy and full discussion to this topic.我们对这个题目进行了长时间的充分讨论。
• The professor wrote a lengthy book on Napoleon.教授写了一部有关拿破仑的巨著。

15 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

16 chaotic   

adj.混沌的，一片混乱的，一团糟的

参考例句：

• Things have been getting chaotic in the office recently.最近办公室的情况越来越乱了。
• The traffic in the city was chaotic.这城市的交通糟透了。