Pepper spray use at Riverview Hospital decried

Pepper spray use at Riverview Hospital decried
(March 2009 Issue)

By Nan Shnitzler

Few people consider the use of pepper spray an appropriate health care intervention. Yet it was used three times this past fall at Connecticut's state-run Riverview Hospital for children and youth by police that hospital staff had summoned for assistance.

"On occasion, due to high acuity, we'll call for police assistance. They responded with the support they felt was adequate," says hospital Superintendent Joyce Welch.

The Department of Children and Families, which runs the hospital, has been under scrutiny for years and the Child Advocate, Jeanne Milstein, has been one of its most persistent critics. Since 2007, her office has been overseeing a Riverview corrective action plan via a governor-ordered independent monitor. In the December 2008 quarterly report, Milstein wrote that the pepper spray incidents are "an unacceptable escalation in aggressive intervention as a means to manage children's behaviors."

"We don't believe any one of these incidents presented a life-threatening situation," says Associate Child Advocate Mickey Kramer, M.S., R.N.-C. "These kids at Riverview all have extensive trauma histories, but we don't believe they are so beyond the scope of clinical thinking that the only result is a use of force."

One incident involved an 11-year-old boy who was pushing over a TV console, according to the Hartford Courant. Another involved an adolescent girl with suicidal tendencies who had barricaded herself in her room and turned out the lights.

The police called to Riverview are posted at nearby Connecticut Valley Hospital and are employed by the Department of Mental Health and Addiction Services (DMHAS), which runs the state hospital, a psychiatric facility for adults. Officers are academy trained and certified, and carry handcuffs, batons and pepper spray, but not firearms. Their actions are considered law enforcement, not health care.

The question, Kramer says, is whether Riverview inappropriately relies too much on the police, rather than their own staff interventions.

Welch was upset that police used pepper spray, and the hospital does not condone its use. She says de-escalation techniques are always used first in a crisis and even when police are called, they take direction from hospital staff as far as possible.

"My staff are the leads in interactions with the kids," Welch says. "But at the point the police feel someone is at risk, whether staff or child, they will intercede with what they feel is the appropriate response. They did, in their minds, the lowest level intervention they could to help us."

DMHAS spokesman Wayne Dailey, Ph.D., says that nobody wants to see pepper spray in a psychiatric facility, especially one that treats children and adolescents. But in urgent situations, authorities have to assess a situation very quickly and use their best judgment to avert potential tragedy. In the pepper spray incidents, all other measures had failed.

"It's a razor's edge kind of judgment sometimes," Dailey says. According to Dailey, Riverview made about 118 calls to police in the 2008 calendar year.

With respect to the Child Advocate's assertion that the pepper spray situations did not rise to the level of imminent harm, Dailey says that was not the assessment of the police officers that were there.

"We reviewed their reports and have no reason to conclude otherwise," Dailey says.

Child Advocate Milstein and Connecticut Attorney General Richard Blumenthal have written to the Center for Medicare and Medicaid Services (CMS) office in Boston to request an outside "quality of care review" of the pepper spray incidents. CMS classifies pepper spray, mace, tasers and nightsticks as weapons that are not appropriate in the application of restraint in healthcare settings.

CMS spokesperson Roseanne Pawelek says that since Riverview does not currently participate in the Medicare program, CMS has no authority to investigate the letter's "serious allegations."

"We are asking CMS, even if they don't run the facility, to conduct an expert outside review of each child's treatment plan and determine whether less intrusive means might have been used," Blumenthal says. "We're talking about juveniles."

Since the incidents, DCF and DMHAS commissioners and staff have met to compare policies and procedures, seeking ways to reduce the need for urgent police involvement and the subsequent use of weapons.

One avenue is training. DMHAS police do not have specific training with troubled children or adolescents, Dailey says. Welch wants to make police aware of behavioral manifestations of certain diagnoses, so they know what to expect. She describes involving police in child-specific pre-planning for the most complex cases.

Contrary to fears expressed by Kramer that exposure to police will hasten young patients' transition from the mental health care system to the criminal justice system, Welch promotes community policing at Riverview. There's a DARE (Drug Abuse Resistance Education) program and bike patrol officers teach bicycle safety. Police are occasionally invited to dinner and to school activities.

"For most of our kids, their exposure to police has been negative," Welch says. "But we have an obligation to take a holistic approach so our kids get to see people in different ways. And some officers have developed a good rapport with the kids."