Friday, July 25, 2008

Deadly Consequences of Negligence

A Double Tragedy Unfolds in Florida
On the evening of July 21, chronic psychiatric patient Mark Rohlman was brought in twice to Fort Walton Beach Medical Center for emergency psychiatric evaluations. Both times, he escaped. How, exactly, no one’s telling just yet, but the story ended tragically for Mark and Sheriff’s Deputy Anthony Forgione.

After his escape from Fort Walton Beach Medical Center, Mark found his way to his deceased father's home where he barricaded himself with a gun. When sheriff's deputies arrived to take Mark back to the hospital, he fired on them. His bullets killed Okaloosa County Deputy Anthony Forgione, a 33-year-old deputy from Niceville. Mark then turned the gun on himself and pulled the trigger.

In these last few days after the tragic series of incidents, politicians and pundits alike have been hammering at Florida’s Baker Act. But do they have the right culprit in their crosshairs?

What is the Baker Act?
Like many other involuntary detention laws across the nation for psychiatric patients, the Baker Act allows that individuals unable to care for themselves or presenting imminent danger can be detained for psychiatric assessment. They are taken to a designated facility where, within 72 hours, they are evaluated. Afterwards, the individual can be released into the community, involuntarily committed to an inpatient psychiatric hospital, or mandated to accept outpatient treatment. Inpatient hospitalization under this law extends up to six months.

The law has multiple patient's rights safeguards built into it, but many are arguing these protections are simply creating a loophole through which potentially dangerous patients can escape.

The Community Outraged
Reporter Tom McLaughlin of the Northwest Florida Daily News wrote a blog post headlined, "In FWB, little is done to secure mental patients. " McLaughlin is one of a growing chorus of understandably outraged citizens suggesting that maybe restraints or seclusion are the best antidote to dangerous psych patients.

On the other extreme, probably laying the groundwork for her hospital's defense, is Fort Walton Beach Medical Center's risk management officer Evelyn Ross. She is quoted in McLaughlin's blog stating, “The Baker Act does give us the opportunity to evaluate the patient even if they don't want to be here, but it does not give us the opportunity to secure them here. You don't restrain people just because they've been Baker Acted." True, but you don't just let them walk off, either. And twice in one day, no less.

Adding his voice to the cacophony was Okaloosa County Sheriff Charlie Morris who said the tragedy "absolutely a wake-up call" to change the Baker Act.

For their part, officials at Fort Walton Beach Medical Center have been mum on the particulars of how Mr. Rohlman escaped. Probably a good idea.

Who's really at fault here?
Vilifying a mentally deranged man who killed one of our finest might make sense of an otherwise senseless crime. Calling for legislative reforms makes better politics and press than examining the mundane details of this incident.

The fact is Fort Walton Beach Medical Center has been notorious for insufficient management of psychiatric patients, put mildly. Really, it’s downright incompetence. As McLaughlin has pointed out, the hospital has placed 45 calls to the Sheriff's Department reporting elopements of Baker act patients since January 1, 2007. They have made 21 such calls this year alone. These are simply staggering statistics for any one hospital.

Any hospital is responsible for their patients and that often means guarding them with one-to-one attention. Could it be that these deaths were needless not because the law is weak but because the hospital bungled the case? That one staff member taking care of the patient could have saved two lives? Right now, it’s too disconcerting to think that way.

But, experience tells me that the real story here is what’s going on at Fort Walton Beach Medical Center, not in Tallahassee.
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