Monday, June 23, 2014


Assembly Bill 1340 (Achadjian) deserves favorable consideration: here's why.

Today, in my day-to-day role as a physician specializing in neurological injuries and diseases, I examined a nurse who in the course of trying to take care of a mentally unstable patient, got so badly beaten up that her head and neck injuries preclude her from returning to work in almost any capacity. Could her injury have been prevented?

Sadly, the answer is yes. Luckily, the same answer portends better for others in a similar position in the future.

About 4 years ago at Napa State Hospital (NSH) Psychiatric Technician Diana Gross was killed. Further less dire incidents have happened since then at NSH and other mental health facilities. At Atascadero State Hospital (ASH) one mentally unstable patient killed another. All this despite increased guard patrols and police attention.

Psychiatric technicians, nurses, and doctors are now calling for preventive measures in the form of AB 1340 (Achadjian) which would mandate intensive treatment for high risk patients. The bill would require that Enhanced Treatment Programs (ETPs) be set up in California by State Hospitals and would enable state hospital psychiatrists and psychologists to refer patients to ETPs as needed, i.e., when it is determined that a patient is potentially dangerous to himself or others because of impaired mental status when there is evidence of proclivity to violence. The bill would require professional forensic medical evaluations.  Patients could then be assigned to an ETP for up to a year but with provision for re-evaluation within one year.

Psychiatric technician Linda Monahan was quoted in BUSINESS WIRE as having said "Legislators need to understand that we struggle to provide the best patient care possible under extraordinarily dangerous conditions. Some of our patients' mental illnesses make them predatory or sociopathic. Those few are responsible for the majority of the violence we endure. We need specialized programs to provide those patients with more effective treatment while also making hospitals safer for other patients and staff."

It is probably true that the civil rights of these violent patients may be obliged to play second fiddle to their mental health needs until such time as they're enough better to accept treatment in traditional and less supervised environments. Managers of these programs will be obliged to ensure that a proper balance is struck.

My patient today, a devoted nurse who'll probably not work again because of her injuries, is among the lucky ones. She's still alive.

We owe it to her and her colleagues to give them more protection in the form of safer working environments where their skills as doctors and nurses won't depend upon the ability to duck a punch, a kick, or a weapon.


Napa, CA., BUSINESS WIRE, 6/09/14

CAPT (California Association of Psychiatric Technicians), 6/06/14

AB 1340 is sponsored by the Union of American Physicians and Dentists (UAPD) and is co-sponsored by the American Federation of State, County and Municipal Employees (AFSCME)


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