King/Drew Draws Warning on Tasers

Federal health inspectors are threatening to cut off funding to Martin Luther King Jr./Drew Medical Center for using Taser stun guns to subdue psychiatric patients, saying the unusual practice puts patients in “immediate jeopardy.�

The threat comes two years after state inspectors cited King/Drew for the same practice -- and the hospital promised to halt it.

The U.S. Centers for Medicare and Medicaid Services informed the Los Angeles County-owned hospital Thursday night that it must come up with policies to subdue patients more safely within 23 days or risk losing more than half of its $350-million budget.

The Willowbrook hospital’s staff has relied too heavily on county police to shoot aggressive mental patients with incapacitating jolts of electricity without trying less-extreme methods first, said Steven Chickering, a regional manager with the federal health agency. The police, who work for the county Office of Public Safety, have also used handcuffs too often, he said.

Since March 2003, eight patients have been shocked with Tasers and some were injured as a result, Chickering said. He did not have details on the cases.

Using Tasers in a hospital setting is rare, according to Chickering and a national accrediting group. Most hospitals call in specially trained medical personnel to calm patients or subdue them with medication or minimal force.

At King/Drew, “rather than having a response team, they called the hospital police,� Chickering said.

The warning marks the second time in three months that the Medicare agency has threatened to cut off federal funding at King/Drew, a 233-bed hospital serving a mostly minority population around South Los Angeles. The same threat was made in March after systemic errors were found in the administration of patient medications at the hospital.

Federal health officials say it is extremely uncommon for two warnings to be made in such close succession.

Late Thursday, the county Department of Health Services instructed police stationed at King/Drew not to use any force against patients unless they were being arrested. But county officials said they hoped to negotiate a compromise that would allow police to use force, including handcuffs and Tasers, to subdue patients in the most extreme circumstances.

“I think they’re saying that they would like to see an additional step before the police get involved,� Dr. Thomas Garthwaite, director of the health department, said of federal officials. “I’m not against that. Our goal is to increase the safety margin for our employees and our patients.�

But Garthwaite said King/Drew sees some very tough psychiatric patients, who may be beyond the control even of well-trained medical staff members. “We had a patient literally destroy a room not too long ago,� he said. “He just went ballistic. We get the toughest psych patients at their worst time.�

County officials said they were worried about banning Tasers, which are employed by police at other county hospitals as well, because doing so might jeopardize the safety of employees.

King/Drew banned the use of Tasers in April 2002 after state health inspectors cited the hospital for allowing county police to use the devices without any guidelines in place.

In one case detailed by the inspectors, a patient “came to the nurses’ station, took off his shirt and threatened everybody. Patient was Tasered to be subdued.�

The inspectors said there was no evidence that “alternative interventions were attempted� to subdue the patient beforehand.

County officials lifted the moratorium in March 2003 after they determined that the Taser was a useful tool but that police needed additional training.

Taser guns fire two darts connected to thin electrical wires up to 21 feet. The darts can deliver up to 50,000 volts of electricity over five seconds, immobilizing a person and causing him or her to fall down.

Use of the Taser has been controversial. Nationally, about 40 criminal suspects have died in custody after police use of the device, although the manufacturer maintains that medical examiners have attributed all of the deaths to other causes, such as drug overdoses. The device causes minor skin burns and can inflict serious injuries if the darts strike the eyes, neck, genitals or open mouth. Violent muscle spasms sometimes cause people to suffer injuries when they fall.

The guns are used primarily by law enforcement to subdue suspected criminals, but the manufacturer, Taser International Inc., said sales to hospitals were increasing.

Company spokesman Steve Tuttle said 46 hospitals around the country used Tasers to help security or police officers respond to dangerous situations. About 4,500 law enforcement agencies use the device.

“Really, where they’ve been used quite a bit is with violent, combative subjects who have been putting personnel at the hospital at risk,� Tuttle said. “The same person that’s arrested on the streets often goes to the hospital and continues that same behavior.�

In one recent case in which county police used Tasers at King/Drew, a 230-pound man was resisting staff members trying to put him in restraints, according to a county police use-of-force report. The 39-year-old man began swinging his arms with closed fists and kicking a wall, the report said, then swore, vowing, “I am not going in restraints.�

When the man suddenly turned toward a nurse, an officer fired his Taser, the report said. The patient was handcuffed, examined in the emergency room, then placed in restraints, the report said.

Tuttle said people often calmed down at the sight of the weapon. “If we take that tool away, we have no bite behind the bark,� he said. He provided The Times with several news reports that mentioned the successful use of Tasers in a hospital setting.

The private agency that accredits hospitals, however, said it had not heard of any such case.

“I’m very surprised,� said Mary Cesare-Murphy, executive director of behavioral health accreditation at the Joint Commission on Accreditation of Healthcare Organizations. “If anything, there’s been so much emphasis on the reduced use of any kind of restraining device, even the more traditional restraining devices,� such as soft wrist restraints or seclusion.

Amnesty International USA has been a vocal critic of Tasers, calling on police departments to stop using the device until more research is done.

“It’s disturbing and alarming to hear that hospitals -- places that are supposed to be safe for people with illnesses and people with mental health problems -- are using electric-shock weapons on their patients,� said Edward Jackson, a spokesman for Amnesty International in Washington.

The federal inspectors’ threatened sanction this week comes just three months after the hospital scrambled to correct lapses in patient care that led to the threat of a funding cutoff in March.

That citation and the one this week come as the hospital is under the direct control of a crisis management team, led by the county health department’s second-in-command, Fred Leaf.