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, BYLINE: 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.
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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 distressed and confused.
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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 initially.
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 raped. 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 disorders.
CHANDLER: That - what I saw in the video was my worst nightmare for Rebecca.
KENNEDY: Her mom says she's a shy and lovable introvert who loves animals and making art. Rebecca has insurance and had been in a residential 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 investigation 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 lawsuits. 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 stabilize, 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 athletic.
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 implements, 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 linen 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 lengthy wait times because ERs are overwhelmed.
SUSAN STEFAN: And they're being turned into essentially 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 chaotic.
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.
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