As suicides rise, hospitals adapt

Joseph Passante tried to kill himself twice in the fall of 2009 and wound up both times at Mayo Clinic's St. Marys Hospital in Rochester.

After his second attempt, staff in the hospital's psychiatric and psychology unit placed him on an every-15-minutes suicide watch, according to court records. Nonetheless, Passante tried to hang himself with a television cord, and the incident left him permanently disabled. Ten days ago his sister, Jane Carey, sued Mayo for negligence, arguing that the hospital had failed to "suicide-proof" her brother's room. State records show that another patient committed suicide at the same hospital the previous year.

A Mayo spokesman declined to comment on the lawsuit, but today Mayo finds itself among a growing number of Minnesota hospitals that are trying to address the risk of patient suicide. Whenever patients "experience undesired outcomes of any kind, we carefully examine our processes, environment and culture, seeking ways to reduce the future risk of harm," Mayo's safety officer, Dr. Timothy Morgenthaler, said.

Suicides in hospitals are rare, but last year four patients killed themselves, or tried to, in Minnesota hospitals — the highest number since the state began tracking the data in 2003. Two occurred at the University of Minnesota Medical Center, and one each at United Hospital and Fairview Lakes Medical Center in Wyoming, Minn.

Now hospitals across the state are trying to improve facilities and training to address those risks, according to state health and hospital officials.

The University of Minnesota Medical Center-Fairview, for example, redesigned bathrooms in the psychiatric units after seeing an increase in attempted suicides within the past five years.

Last year's spike in numbers occurred against the backdrop of a wider increase in suicides. Minnesota's overall suicide rate of 12.4 per 100,000 residents in 2011 was the highest since the early 1990s, according to the state Health Department.

Last May the agency hosted a special suicide-prevention training session at the request of hospitals. "Folks were saying we need help with this," Jokela said.

Most hospitals with psychiatric units are safe, according to Dr. Dan Reidenberg, executive director at SAVE, a nonprofit dedicated to preventing suicides, who conducted the training session.

"That's why there are relatively low numbers of suicides,'' Reidenberg said. "But … there is no way to suicide-proof a hospital completely. The goal is to say it's as safe as possible."

When a patient does attempt suicide, Reidenberg said, hospitals often respond by reviewing their safety procedures and even modifying rooms, such as changing the door knobs or ensuring that cords are not exposed. Reidenberg said it's also important for hospitals to take the initiative and not simply respond after a tragedy.

Mayo Clinic would not say what modifications were made after Passante's attempted suicide. Passante's sister and her attorney declined to comment.

"Patients who are determined to harm themselves can do so by self-strangulation or by banging their heads on the floor or on a wall,'' Knight said. "It's very challenging to prevent suicide when there is a deep determination to die."

Nonetheless, the hospital has made major changes to its psychiatric units.

Most attempts were concentrated in patient bathrooms, Knight said, so Fairview decided to make that a focal point for safety measures.

"There are no pinch points in the doors anymore. We have breakaway shower heads. The handles on the faucets are modified. We don't have door knobs," Knight said. "There really isn't anything that we don't constantly look at."