• March 15, 2016

When the Hospital Fires the Bullet

When the Hospital Fires the Bullet

By Elisabeth Rosenthal

When doctors and nurses arrived at Room 834 just after 11 a.m., a college student admitted to the hospital hours earlier lay motionless on the floor, breathing shallowly, a sheet draped over his body. A Houston police officer with a cut on his head was being helped onto a stretcher, while another hovered over the student.

Blood smeared the floor and walls. “What happened?” asked Dr. Daniel Arango, a surgical resident at the hospital, St. Joseph Medical Center.

The student, 26-year-old Alan Pean, had come to the hospital for treatment of possible bipolar disorder, accidentally striking several cars while pulling into the parking lot. Kept overnight for monitoring of minor injuries, he never saw a psychiatrist and became increasingly delusional. He sang and danced naked in his room, occasionally drifting into the hall. When two nurses coaxed him into a gown, he refused to have it fastened. Following protocol, a nurse summoned security, even though he was not aggressive or threatening.

Soon, from inside the room, there was shouting, sounds of a scuffle and a loud pop. During an altercation, two off-duty Houston police officers, moonlighting as security guards, had shocked Mr. Pean with a Taser, fired a bullet into his chest, then handcuffed him.

“I thought of the hospital as a beacon, a safe haven,” said Mr. Pean, who survived the wound just millimeters from his heart last Aug. 27. “I can’t quite believe that I ended up shot.”

Alan Pean, with his mother and father, after he was shot last August in St. Joseph Medical Center in Houston. Credit Christian Pean

Like Mr. Pean, patients seeking help at hospitals across the country have instead been injured or killed by those guarding the institutions. Medical centers are not required to report such encounters, so little data is available and health experts suspect that some cases go unnoticed. Police blotters, court documents and government health reports have identified more than a dozen in recent years.

They have occurred as more and more American hospitals are arming guards with guns and Tasers, setting off a fierce debate among health care officials about whether such steps — along with greater reliance on law enforcement or military veterans — improve safety or endanger patients.

The same day Mr. Pean was shot, a patient with mental health problems was shot by an off-duty police officer working security at a hospital in Garfield Heights, Ohio. Last month, a hospital security officer shot a patient with bipolar illness in Lynchburg, Va. Two psychiatric patients died, one in Utah, another in Ohio, after guards repeatedly shocked them with Tasers. In Pennsylvania and Indiana, hospitals have been disciplined by government health officials or opened inquiries after guards used stun guns against patients, including a woman bound with restraints in bed.

Hospitals can be dangerous places. From 2012 to 2014, health care institutions reported a 40 percent increase in violent crime, with more than 10,000 incidents mostly directed at employees, according to a survey by the International Association for Healthcare Security and Safety. Assaults linked to gangs, drug dealing and homelessness spill in from the streets, domestic disputes involving hospital personnel play out at work, and disruptive patients lash out. In recent years, dissatisfied relatives even shot two prominent surgeons in Baltimore and near Boston.


To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey. That was more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with people who have a mental illness.

Massachusetts General Hospital in Boston, for example, sends some of its security officers through the state police academy, but the strongest weapon they carry is pepper spray, which has been used only 11 times in 10 years. In New York City’s public hospital system, which runs several of the 20 busiest emergency rooms in the country, security personnel carry nothing more than plastic wrist restraints. (Like many other hospitals, the system coordinates with the local police for crises its staff cannot handle.)

“Tasers and guns send a bad message in a health care facility,” said Antonio D. Martin, the system’s executive vice president for security. “I have some concerns about even having uniforms because I think that could agitate some patients.”

But many hospitals say that with proper safeguards — some restrict armed officers to high-risk areas like emergency rooms and parking areas — and supervision, weapons save lives and defuse threatening situations. The Cleveland Clinic, which has placed metal detectors in its emergency room, has its own fully armed police force and hires off-duty officers as well. The University of California medical centers at Irvine and San Diego and small community hospitals are among the more than 200 facilities that use stun guns produced by Taser International, which has courted hospitals as a lucrative new market.

“I’ve worked in systems where everyone has a firearm and an intermediate weapon, and I’ve worked in systems where a call to security meant the plumber and every able-bodied man would respond,” said David LaRose, past president of the health care security association. “How much has your system thought about safety and security? In some places that’s a 2 or 3; in some places it’s a 10.”

After Mr. Pean’s shooting, St. Joseph’s chief executive, Mark Bernard, said the officers were “justified.” The hospital said it was reviewing its practices but declined to respond to questions. The Houston Police Department, citing an internal investigation, declined to comment or to make the officers available for interviews, and released only a heavily redacted version of its report on the shooting. This account is drawn from a review by federal health investigators, medical records, criminal complaints and interviews with medical personnel and family members.

Mr. Pean had expected an apology after the shooting. Instead, during four days in intensive care,prosecutors charged him with two counts of felony assault on a police officer. They accused him of attacking with four “deadly weapons” — an unspecified piece of furniture, a wall fixture, a tray table and his hands.

James Kennedy, a lawyer representing Mr. Pean, says his client disputes that he was the aggressor and other allegations by the police, but cannot discuss specifics until the charges are resolved. His family has filed complaints with the Justice Department and health care regulators, including the Centers for Medicare and Medicaid Services, which provides funding to most American hospitals.

After an emergency investigation, the Medicare agency faulted St. Joseph for the shooting, saying it had created “immediate jeopardy to the health and safety of its patients.” Threatening to withdraw federal money, the agency demanded restrictions on the use of weapons.

A family with Haitian and Mexican roots who settled in McAllen, Tex., the Peans were shocked that Mr. Pean’s effort to get medical aid ended so badly. Though his father, Harold Pean, and a half-dozen other relatives are physicians, they said they had no idea that guns could be used against patients. After watching the nation roiled by the shootings of unarmed black men by police officers over the last year or so, the family now wonders whether race contributed to Alan’s near-fatal encounter.

“We never thought that would happen to us,” Dr. Pean said.

‘I’m Manic!’

In his family of high-achievers, Alan Pean (pronounced PAY-on) is the soft-spoken and mellow middle sibling, into yoga, video games and pickup football. Christian, 28, now a medical student at Mount Sinai in New York, is the Type A leader; Dominique, 24, is following his path, applying to medical school while pursuing a master’s degree. Alan, who had never been in any sort of trouble, is “probably the nicest of us three,” Dominique said.

Like many people with mental health issues, he did not get a clear-cut diagnosis. After a brief delusional episode in 2008, he was hospitalized for a more severe recurrence the next year, at the end of his second year at the University of Texas. He was kept for a week and told that he had possible bipolar disorder, though his symptoms did not reappear for years even after he tapered off medication.

He was prone to bouts of sadness and anxiety, he recalled in an interview, but had attended college, taking breaks from time to time, and worked for a while as a medical assistant back home in McAllen, near the Mexican border. Though he had smoked marijuana regularly to help tame his symptoms, he said in an interview, he quit last summer when he enrolled at the University of Houston to complete his bachelor’s degree.

Just days into the semester, though, he barely slept and found himself increasingly agitated and delusional.

On Aug. 26, he talked repeatedly on the phone with his parents and brothers, who tried to calm him but worried that he sounded disoriented. Christian had been concerned enough that he called the Houston police to do a “welfare check” on his brother at his apartment, though no one answered the door when officers arrived.

When Mr. Pean sounded worse in the evening, his family summoned a fraternity brother in Houston to take him to an emergency room; his parents would fly in the next morning. But Mr. Pean did not wait. His mind vacillating between the knowledge that he needed psychiatric medication and encroaching delusions that he was a Barack Obama impersonator or a “Cyborg robot agent” who was being pursued by assassins, he said, he got into his white Lexus and drove at high speed to St. Joseph Medical Center, the only major hospital in downtown Houston.

Turning into the parking lot just before midnight, he crashed, nearly totaling his vehicle. As Mr. Pean was helped into the emergency room and onto a stretcher by paramedics and nurses, he recalled, he yelled: “I’m manic! I’m manic!”

Alan Pean’s white Lexus. He struck several cars after driving himself to St. Joseph Medical Center for treatment of possible bipolar disorder. Prosecutors later charged him with reckless driving.

He was seen immediately by a doctor from the trauma team to assess his injuries (scans and exams showed none). The physician’s initial note, minutes after arrival, lists the young man’s history of bipolar disorder. His father and brother, in separate phone calls to the emergency room, and a family friend who came to the hospital, alerted the staff about his psychiatric issues, they recalled.

Nonetheless, Mr. Pean was admitted for observation to Room 834 on a surgical floor. The diagnoses: hand abrasion, substance abuse, motor vehicle accident. His toxicology tests were negative for alcohol, opiates, PCP or cocaine, records show. (They did disclose some THC, the active ingredient of marijuana, but the chemical remains in the body for many weeks.)

While St. Joseph does have a psychiatric ward, Mr. Pean was never seen by a psychiatrist or prescribed any psychiatric medicines before the shooting. Because he had complained of back pain, he was given Flexeril, a muscle relaxant, which can exacerbate psychoticsymptoms.

In interviews with the Medicare investigators and notations in medical records, the nurses who cared for Mr. Pean describe a man who had flashes of lucidity, but was increasingly restless and bizarre.

He pulled out the IV in his arm. He thought it was 1989. He could not remember the car crash or why he was in a hospital. But even in the throes of his illness, he was polite. When a nurse told him to return to his room after he repeatedly emerged naked into the hall, he complied, she told investigators, with a “Yes ma’am, righty-o, O.K. ma’am.”

‘No Clear Guidance’

Though the trauma team had planned to discharge Mr. Pean that morning, his parents were so alarmed when they arrived about 10 a.m. that they insisted a psychiatrist see him. As they waited for doctors to discuss their concerns, the Peans went to their nearby hotel to try to rent a car and drive their son to a psychiatric facility. In their 30-minute absence, a nurse made the call to security.

At St. Joseph Medical Center, the security force included armed off-duty police officers as well as unarmed civilian officers. Who responded to a call depended only on availability, according to the investigators’ interview with the chief nursing officer.

The two men who arrived were Houston police officers. Roggie V. Law, 53, who is white, and Oscar Ortega, 44, who is Latino, each had decades on the force. They supplemented their base salaries of about $64,000 by moonlighting at the hospital. Their records were unremarkable. Both had some commendations, and Officer Ortega had one distant four-day suspension for failing to submit an accident report.

Houston police officers get 40 hours of crisis intervention training, according to the department. The N.A.A.C.P. and the Greater Houston Coalition for Justice, a civil rights group, have complained that local officers too often use their weapons, and repeatedly requested the appointment of an independent police review board. From 2008 to 2012, there were 121 police shootings, in which a quarter of the victims were unarmed, according to an investigation by The Houston Chronicle.

At right, Room 834 at St Joseph Medical Center, where Alan Pean was shot in an encounter with armed security personnel, two off-duty Houston police officers. Credit Michael Stravato for The New York Times

The two off-duty officers had signed on with Criterion Healthcare Security, a four-year-old staffing agency based in Tennessee whose executives had previously managed prisons and owned gyms. Their training at St. Joseph consisted of an orientation and online instruction, which investigators found inadequate. “The facility had no clear guidance for the role, duties and responsibilities of the police officers they employ to provide security services,” the Medicare investigators’ report said.

Like many other security firms, Criterion encourages applications from those with law enforcement or military backgrounds, who are trained to use weapons and to deal with volatile situations. But working in health care settings requires a different mind-set, security experts emphasize.

“If they come from law enforcement or the military, I ask them directly, ‘How would you respond differently here than if you encountered a criminal on a street in L.A. or when you are kicking down a door in Iraq?’” said Scott Martin, the security director at the University of California, Irvine, Medical Center. “You have to send the message that these are patients, they’re sick, the mental health population has rights — and you need to be sensitive to that.”

Many mental health professionals strongly object to weapons in hospitals, saying they have numerous other means — from talk therapy to cloth restraints and seclusion rooms to quick-acting shots of sedatives — to subdue patients if they pose a danger. State mental health facilities typically do not allow guns or Tasers on their premises; even police officers are asked to check weapons at the door. (Twenty-three percent of shootings in emergency rooms involved someone grabbing a gun from a security officer, according to a studyby Dr. Gabor Kelen, director of emergency medicine at Johns Hopkins Medical School.)

Uniforms and weapons may, in fact, exacerbate delusions, since many psychotic patients are paranoid and, like Alan Pean, believe they are being pursued. Anthony O’Brien, a researcher at the University of Auckland, in New Zealand, said, “That’s not a good thing, pointing something that looks like a gun at a patient with mental health issues.”

When the two Houston officers arrived on St. Joseph’s eighth floor, they headed for Room 834. Unannounced, and unaccompanied by doctors, nurses or social workers, they went in, the door closing behind them.

Anxious Patient to Felony Suspect

Racing upstairs to a Code Blue in Room 834, Dr. Arango found a cluster of about 20 Houston police officers in the hall, according to his interview with investigators.

When he pulled back the sheet covering Mr. Pean, he saw that the patient was in handcuffs, his torso dotted with Taser probes and a bloody wound on his upper chest. It was only after the doctor noted the blood pooling around the young man, who began shouting that he was Superman as the physician tried to examine the wound, that someone mentioned he had not only been hit with the Taser, but also shot.

“Take the damn handcuffs off!” Dr. Arango yelled, according to an employee.

Mr. Pean’s X-ray, taken several days after he was shot, showing bruised lungs and bullet fragments scattered through his chest.

Initially combative and flailing, Mr. Pean allowed a staff member to start an IV as she told him: “It’s O.K., Alan, I’m a nurse. We’re here to help.” Within minutes, doctors placed him on a ventilator, inserted a tube into his chest and whisked him away for a scan, which showed that the bullet had fractured his fifth and sixth ribs, scattering metal fragments and causing extensive bleeding as it ripped through his chest.

According to a statement on the Police Department’s website, Alan struck one officer in the head, causing a laceration, when they arrived in the room. Officer Law shocked the patient with a Taser, to no apparent effect, and then Officer Ortega, fearing for their safety, shot Mr. Pean.

After the shooting, his father said officers asked over and over if Alan had a criminal record. The next day, Christian Pean asked Sgt. Steve Murdock, a Houston police investigator, why the officers had to shoot his brother. In a phone conversation, Christian recalled, the sergeant replied, “Let’s just say the term ‘Tasmanian devil’ comes to mind.”

“It was like a big whirlwind,” he went on. “Everything was fair game. Objects, chairs, eating trays, everything was being thrown.”

An ambiguity in Medicare rules allowed Alan Pean’s conversion from delusional patient to felony suspect. If a patient throws a tray at a nurse and the staff responds with restraints, it can be considered a health care incident. If the same patient throws the same tray at a police officer, even one off-duty, who shoots in response, the encounter is subject to a criminal investigation.

While Mr. Pean was in the intensive care unit, he was handcuffed to his bed, even though he was heavily sedated, with a Houston police officer standing guard. His family had to post $60,000 bail days later so he could be discharged from the hospital.

Mr. Pean’s felony case is likely to go before a grand jury in the coming months. Under the care of a psychiatrist and on medication, Mr. Pean left Texas behind. Living with his brother in New York, he is finishing his degree at Hunter College and planning to go to graduate school in public health.

But the day before Christmas, Mr. Pean learned that prosecutors had brought a new charge — reckless driving — against him, referring to his race to the hospital.

Christian Pean, left, and his brother Alan. Alan is now living with Christian in New York, and finishing his degree at Hunter College. Credit Chad Batka for The New York Times

Accompanied by his father, he flew to Houston. In five hours of processing at the Harris County Detention Center, Mr. Pean was interviewed by a detention officer, photographed for a mug shot and fingerprinted. “Being paraded around was really stressful,” he said. “Did they not understand what I’d gone through? I’d been shot in a hospital room by an officer.”

This article was originally published in The New York Times on 2/14/16






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