The following is an explanation to much of what I had hinted at in my last post. I have copied and pasted the narrative of a experience with a patient.
This report, led to the patient being charged with Second degree manslaughter. Ten days after this incident, I resigned from this facility. There is much more that has transpired since. A lot more. But this is already long enough.
So…. Here is a start……(the names have been removed to protect, well, everyone)
I have been asked to prepare a statement regarding the events of the evening of July 30, 2013, into the beginning of July 31 2013, with patient ___________
I am preparing this informal preface to the statement so that I may explain how it came about that Mr. ______ and I were outside of the facility at the time of the conversation we had. I feel without knowing the reason Mr. ______may have felt more comfortable speaking to me will help in understanding how it came to be that he said what he did.
I am writing this while all events are as fresh in my mind as possible, and I wish to preserve the chain of events with as much accuracy as possible.
I am completely unaware of what if any legal obligation rests with me, as to the statements made by Mr._________were quite serious, and very disturbing.
As someone considered a mandated reporter of suspected or actual abuse I am at a loss as to what is expected of me as what Mr. _____ stated as to the cause of his injuries could be considered, I imagine a number of serious crimes.
I hope that since the conversation took place as I was in good faith with him as part of my employment that the facility and/or its corporate office would assist me with any legal guidance I may need.
I reported the “majority” of what was said to me directly following this “episode” to _________ the RN supervisor immediately following the conversation, for “guidance” as to what to do; she suggested I write the statement. I was quite shaken up and knew that the drive home would provide me with clarity and I would be more effective in communicating where I was able to focus with less distraction.
Mr. _____ was admitted to the facility while I worked A wing. All I had heard was that the pt we expected was involved in a terrible vehicle accident that involved multiple vehicles and it was my understanding that three people were killed. (I do not watch much news, so I really had very little knowledge of the incident)
I was what I thought, momentarily at least “ALONE” on the unit when soon after arriving the pt was beginning to become quite angry and very insistent that he was leaving the facility. An aide called out to me for assistance when he pushed her out of the way in order to leave. I had just come from a pt that was on the complete opposite side of the hall that had been found bleeding, and I asked the aide where the nurse was for that “side”. I was told it was only me. So I approached the angry pt and asked what the problem was. He quite angrily stated he was not told this was a “Nursing home, he thought he could smoke….” He was carrying a bag of his belongings and donning a hospital gown, and blue slipper socks.
My immediate concern was the patient was standing on a leg with a cast. I had no idea what his weight bearing status was, so I wanted to calm him and get him at the very least in a wheelchair. I asked one of the aides to get a chair, the Overnight supervisor emerged from the narcotic room during the exchange and when I asked “How can we get him a wheelchair?” I was told “We can’t get him one; PT has not seen him yet.”
I stated that “This patient is in more harm standing on this leg then in a wheelchair that has not been approved.” We got one; he sat, and continued to talk to me. I assumed that the patient had injured his head and was possibly being belligerent and anxious due to a brain injury, or perhaps PTSD as a result of the gravity of the incident.
After acquiring the chair he seemed receptive to a few minutes of conversing, and it became a bit noticeable to me that mental illness was a factor as well. I helped the patient back to his room, and he started to speak a bit about the accident. But he was so “disorganized” in his speech, and saying things to me that did not connect, I really attributed his words to a brain injury, and anxiety to his surroundings. I also still had a patient bleeding down the hall, and assumed the supervisor who was now the nurse for him and way more experienced than I could handle it.
The evening of the incident of July 30-31st I had not seen him until about 1045pm had no knowledge of his whereabouts I was assigned to the other hall. As I was prepping for change of shift, I began to hear an unfamiliar alarm sound and a yellow light above my head was lighting up, I was told it was a wanderguard signal. I knew no one left, so I was confused, as was the agency nurse that was on the other side. We were told from the other unit it was the main door. A patient’s husband had just left so we were questioning whether it could have somehow been him that caused this. Then Mr. _____ appeared through the door. He had apparently, I would find out a few minutes later, been involved in a situation that had police involved and a hospital visit.
Within minutes of arrival he began to insist he was leaving, AMA. He made phone calls, and the agency nurse called the supervisor for assistance.
Apparently the supervisor had gotten doctor approval for him to have a smoke if a staff member was willing to take him out and the issue that was causing his desire to leave would be better addressed with more staff.
I volunteered to escort him. I told him I would make a “deal” with him, if I took him it would be to calm him to help make clearer decisions about the future of his care in the morning. My hope was that by my doing something so simple the “skeleton crew” on the overnight shift would be at least a tad safer.
He agreed. He came out with me. I had explained to the Overnight supervisor and the male LPN (whose name I am unsure of) present that because of the situation and it being a special circumstance, I would be right out the door, where I could be heard if any actions on Mr. ____’s part were in anyway dangerous to me or to himself.
So we went out the side door by the time clock. Mr. _____and I spoke. I provided him with a cigarette and a light, I also had a cigarette, and I did not need it, but was trying to make this as “normal” and “relaxed” a few moments that I could. The Nurse and supervisor we had left inside said they would prepare his pain and anti-anxiety meds while we went out. Within a few minutes the male nurse came out. Saying nothing he just stood there. Almost as if he was protecting us. I was just answering some questions Mr. ____ had regarding whether I agreed with his family that “he had sustained a head injury in the accident” I tried to provide medical explanation to him as to why I thought it possible, and the mood was getting lighter. We stood not far off the door, and “chatted” (again I wished to both calm him and stay within earshot if help was needed.)The male nurse was suddenly gone. Within a minute or two the male nurse came out again and with an aide. The aide saw us smoking and started to point at a camera behind us and said “You gotta move. You can’t SMOKE here. That camera is gonna see you so close to the building, and they will hand you your butts tomorrow, you need to go to the ROAD, this IS a non smoking facility!” And she and the male nurse walked to the Gazebo to smoke! I was wearing a name badge, and scrubs and in a lighted area, and she was with a nurse that was AWARE of what I was doing at the time. She really had no business interfering, and she could have (should have) returned into the building and spoke to the supervisor! I was nervous now that the “chewing out” we just got was going to undo the whole point of this.
Mr. _____did start to get a bit “unwound” said “She really didn’t need to talk to you like that, doesn’t she know you work here? Let’s go and we can talk some more.” He had not finished the cigarette, and started to move the wheel chair, and started to say things that show me paranoid ideation. I simply kept the conversation light and stopped walking as he moved the wheelchair as he finished the smoke. He stopped too. He asked me for one more. I said “Ok, but then I really have to insist we go back in as soon as it is done, my husband will worry”
I should have stated earlier in this that I had previously worked for 15 years with people who were developmentally disabled as well as dually diagnosed with many mental illnesses and again only offered to do this so that Mr. ____ would remain in the safety of the facility until morning, after hearing his statement to me, I wonder if he is safe to be in the facility. If he has the ability to construct so vividly what he told me transpired as part of his “accident” whether it is a true reflection of the real events or not, especially in a facility where the staff are ill equipped to “handle” someone with such a potential for apparent violence.
The remainder of the incident will follow as my “formal “statement as requested on a separate page.
WHAT WAS SUBMITTED TO POLICE:
July 31, 2013
On July 31, 2013, at about midnight, I escorted patient ________ outside of the ____ _____Rehabilitation and Nursing Center to just outside the side door, in an attempt to get him to stay in the facility as opposed to going AMA, and possibly endangering his health further as he had no responsible person to care for him, and did not seem capable of making a decision in the best interest of his health.
While outside Mr. _____ and I were instructed to move by a staff member apparently unaware of who I was, and what I was doing. When we had been moved Mr. _____began to make statements regarding a variety of topics. I responded in calm, short answers, in an attempt to reduce his anxiety. He quickly jumped from items about Native American spiritualism to the “voices he received through the Bose speakers” he has. When he made mention of the “voices” I calmly and as non alarmingly as I can ask,
“By voices, you mean like “spirit voices” not like voices instructing you to do things you would not do, just so I get what you are trying to say, right, I mean I don’t want you wasting what little time there is with you saying things, that I am getting wrong”
Mr. _____then directed the conversation to his recent accident.
He asked me “How good are you at reading between lines?”
Confused, yet trying to “go along” to keep a sense of calm, I said “Ok I guess.” He then stated “Well, I mean, what if I told you, my accident, it wasn’t an accident. I got into my car, wanting to die”
I said “You wanted to die? I am confused” I really was not expecting this.
He then said “What if I told you, between the lines, that I was at ___(convenience store) ___, and I waited for cars, the first one, wasn’t right. The second one wasn’t right, then the third, or the fourth, but then the fifth there was two cars. I had two cars coming at me I wanted to die, but I didn’t. I was flipped over and the cop came up as they were opening it up and shoves a straw in my face, and says “Here, blow into this” I mean, I was upside down! He is pushing a straw in my face! I wasn’t even out of the car!”
I was confused and incredulous as to what I had heard. I asked “So, you mean you were trying to kill yourself, by hitting the cars on purpose?” I still maintained a calm demeanor as it is still, and remained throughout, my intention to at the very least, keep Mr. _____ from escalating in his agitated state, and had thus far, seemed to be successful.
He responded, “Well, between the lines, yeah, but I put my seatbelt on. How bad did I really wanna die if I put on my seatbelt before I picked the cars? My airbag went off and I mean, I only had a second, just a second to hit the brake. And I didn’t ”
Still in disbelief from what I was hearing, I said, “So you now feel guilty because, wait, I know that some other people died, but you feel guilty that you lived? Am I understanding this right? I mean I am just trying to get the whole picture here.” I then non-chalantly start to push the wheelchair back to the building, as I was now very scared and by doing so, controlled the actions that got us back in the building.
He replied, “Well I said a prayer for the lady, and I told my wife about it, she said ‘Well there is nothing you can do to change it now.’”
I pointed out “You sound like you have a lot going on in your head that has to be sorted out. It will take some time.” He then started to cry, and thanked me for listening. I assured him that it was all “good” as I was trying to keep him in the calm state he was in.
Signed, LPN
Just for clarity, and as you will see in subsequent posts, I returned to work for my next shift, the day after this happened. I did not get home from work this night until nearly 2 am. It took me hours to type all of this, and I had no sleep after. When I returned to work, I discovered the RN supervisor reported only the fact that the Doctor ordered the cigarette, not what happened during it.
