A group of doctors, nurses and other staff of Hennepin Healthcare say the hospital system too often resorts to sedating, secluding and physically restraining patients — especially patients of color — who are deemed uncooperative.
Calling these practices dangerous and overused, the coalition of medical workers published a petition demanding hospital leadership audit how often they use "medical force."
They also asked the hospital to stop training law enforcement on "excited delirium" — a controversial diagnosis used to describe dangerously agitated people — which they say is exploited to justify police force.
"When I admit patients to the ICU at night brought in with the diagnosis of 'excited delirium' I find it problematic, especially when there is a police officer at their bedside," said HCMC Dr. Max Fraden.
"In fact, this whole syndrome is problematic. I think it is fair to question if this should even be taught to police when doctors cannot agree if this is a real thing. ... I think it is fair to question that when we medicalize this entity and give it to police, are we providing cover? I wish our medical leadership would take a stand on this issue."
The petition, which has been signed by more than 1,100 people, comes three years after civil rights investigators for Minneapolis found Hennepin Healthcare paramedics were sedating agitated people at the request of police, sometimes when it didn't appear necessary. These revelations spurred community protests and promises from hospital leadership to reevaluate its research practices and repair fractured trust.
Hennepin Healthcare CEO Jennifer DeCubellis said she fully agrees with the goals of the petition.
"I think we have the same shared sense of urgency around actions, in particular to dismantle institutional racism," she said. "The surprise for me was that the petition even was necessary."
DeCubellis, who took the hospital's top position in 2020, said Hennepin Healthcare has committed to evaluating its own practices and reducing the use of restraints on patients.
But the hospital deals with Minnesota's most difficult patient population, she said. Sometimes staff must use these measures for patient and staff safety.
DeCubellis said the employees behind the petition should "roll up their sleeves and be part of the solution."
Disparity of treatment
The Star Tribune interviewed eight members of the group of more than 20 hospital workers about their effort to change the hospital's culture. Some spoke anonymously out of fear of retribution.
They described a system that inconsistently applies the use of involuntary restraints, sedation and isolation, and say Hennepin Healthcare resorts to these measures more than other hospitals.
One doctor described seeing the disparity in a single night. A white female patient attempted to remove a brace from her broken neck, which could have caused serious spinal injury. The hospital staff talked the patient down, played soothing music and placed a medical assistant at her bedside.
The doctor was then called to treat an elderly Black man who tried to remove his urinary catheter. When the doctor got to the room, the patient had already been restrained to his bed without a physician order. "Same night," the doctor said. "Same level of staffing."
In the inpatient psychiatry units, a staff member described seeing patients who were secluded for hours to days after an outburst, even though they had calmed down before intervention and posed no threat.
A patient of color on the COVID-19 unit was restrained even though psychiatric staff members judged seclusion was more appropriate. "We were told flatly that creating a seclusion option was too costly," the person said.
DeCubellis said restraints and other restrictive measures are only used as a last resort, such as when a patient is attempting to remove a medically necessary IV.
"You do everything you can to avoid utilizing a restraint, but there are times when it is essential to get to the quality outcomes," she said. "And we won't sacrifice quality outcomes nor safety of patients."
Police and medicine
Restraint methods, isolation and sedatives are used in medicine to protect patients from harming themselves or others. In 2018, medics credited ketamine, a powerful sedative used in hospitals across the world, for the safe rescue of 12 boys and their soccer coach from a Thailand cave.
But these practices also raise questions about civil liberties and patients' control of their own medical care, especially when police are involved.
In 2019, Elijah McClain, a 23-year-old Black man, died after being injected with ketamine while handcuffed by police in Aurora, Colo. The police officers who detained him said McClain was erratic and exhibiting superhuman strength, signs associated with excited delirium. Critics say the paramedics appeared to be acting on behalf of police, and not their patient. The city of Aurora subsequently paused the use of ketamine.
Hennepin Healthcare came under scrutiny for its use of sedatives in 2018. Auditing police body-camera video, investigators for the Minneapolis Department of Civil Rights found paramedics sedating patients with ketamine at the urging of police officers who sometimes helped restrain the person. "In many cases, the individual being detained or arrested was not only handcuffed, but strapped down on a stretcher in an ambulance before receiving ketamine," stated the report.
DeCubellis said the hospital has taken steps to improve its care in recent years. This includes creating a community advisory board and an internal committee examining how to reduce use of restraints.
"This isn't going to be fast. This is hard work," said DeCubellis. "We are totally changing how we as health care, how as a community, operate."
Some of the doctors behind the petition are on the restraint committee, however, and say their concerns are still not being addressed.
Those behind the petition say leadership has not met with them, and they took issue with DeCubellis saying they are not working to find solutions.
"I am very frustrated and confused by the suggestion by our CEO that we are not currently involved internally," said Abbie Mills, an office specialist for the hospital system. "A leader who has asked no questions of us, who has not inquired as to why we are concerned and why this petition was necessary. This leader has made her own story about who we are — and who we are not — without having the requested conversation to meet us."
Prompted by Floyd killing
Nathan Paulsen, a mental health worker for HCMC, said he's been assaulted "more times than I can count on two hands" by patients, and he believes restraints and seclusion are necessary in some cases. He said the hospital is under-resourced and his co-workers are compassionate. "But if front-line staff is heard, and resourced, we can do better," Paulsen said. "We can stay safer and reduce the use of medical force."
The group says it started meeting weekly after seeing video of George Floyd's killing by a Minneapolis police officer last summer.
The footage shows then-officer Thomas Lane suggest Floyd may be suffering from excited delirium. The rookie officer's casual mention of this syndrome prompted hospital workers to question their employer's role in propagating the diagnosis, they said.
DeCubellis said the hospital has not provided any training for Minneapolis police since 2018. The Police Department pays the hospital for one of its emergency doctors, Paul Nystrom, to consult, according to public contracts. DeCubellis said Nystrom works as the police medical director but does not provide training.
Hennepin Healthcare approves the training for Minneapolis police, said department spokesman John Elder. "We rely [on] and appreciate their expertise in medical matters," said Elder. "We draw from their knowledge to bring the most current best practices in medical training to our officers."
Hennepin Healthcare trains law enforcement on excited delirium and other topics as part through a program called "Tactical Emergency Medicine Peace Officer," or TEMPO, said hospital spokesman Thomas Hayes. He said these classes meet the requirements of the National Registry of EMTs.
Andy Mannix • 612-673-4036