Anti-social behaviour in A&E adds insult to injury
A tougher policy is needed to protect hospital staff, and our health system, writes Eamon Delaney
Published 15/05/2011 | 05:00
THERE are a lot of good things to be said about our health service. And they should be said because it is almost a given to just criticise our health system, and its funding and service. Yes, the HSE is an unwieldy bureaucracy but that's an entirely different matter. The service itself is generally excellent, and is something of which I have had much experience of late, with personal and family medical matters: all of it was done smoothly with great support, and at little cost -- something which, unlike others, I don't take for granted and for which I'm very grateful.
The line is that 'once you get into the system, you're fine'. But it's getting in which is the problem. Hence people languish on waiting lists or, in the case of A&Es, try to get up the queue. But on the way there, you see the problems that could be rectified. And given that the A&E is one of our main routes into the health system, it is worth focusing on what we experience there. For it is quickly revealed just the sort of pressure the system is under, and not necessarily medical pressure. Instead, it is the fact that A&Es have become the repository for all sorts of social issues, dysfunction, misbehaviour and unnecessary visits.
For a start, think of the pressure that could be taken off our emergency staff if we could remove all the drunks and drug addicts. And I don't just mean the young drunks we see in those television documentaries being carried into hospital waiting rooms. I mean the adult drinkers and drug abusers, who constantly disrupt the waiting rooms and berate the staff. I've had a few all-night experience of A&Es recently -- not just three or four hours, but the full 12 hours or more -- and it's just amazing the stuff they have to put up with.
I wasn't surprised therefore to hear that last week a man was jailed for four years for attacking staff and disrupting patients in the A&E of the Mater hospital. The man, Raymond Neeson, 34, was brought to the Mater Hospital in an aggressive and intoxicated state. He chased after the staff nurse, verbally abused a security guard and took hold of another patient's drip pole before he spat blood at two gardai and threatened to infect them with HIV. Subsequent tests showed he was not infected with the virus, but no one was to know that at the time.
Four years is a surprisingly tough sentence, but the judge, Pat McCartan, is one who has shown a refreshing regard for the real world in his deliberations. He was presumably mindful that Neeson had a staggering 80 previous convictions, including violent disorder in a garda station and two convictions for impeding a person providing a medical service in 2009. So, in terms of preventing people from trying to help others who need help, he has form, so to speak.
Let's hope this sends a message to other A&E offenders. Neeson's case is an extreme example but a variation of this anti-social disruption is a running feature of our A&Es and absorbs a great amount of medical time and attention, as does the treating of people coming in with injuries sustained from self-abuse. And the amazing thing is how patiently they are treated, with nurses quizzing them about their medical history -- "and do you have any allergies?" -- while they sit there, drunk and bloodied. Quite simply, there should be a tougher policy, with 'drunk tanks' and drug abusers screened off like they are in other countries.
There is also the fact that casualty departments, by their very nature, 24-hour and full of drama and crisis, attract many of the dysfunctional souls wandering the city. This is especially so somewhere like the Mater hospital. They go there just so they can hang about and annoy the staff, patients and security guards. And interact with those colourful patients, who are regularly carried in. I saw one woman, with a bloodied scalp, sitting on a man's knee, laughing and clearly off her head while she half-answered the dutiful questions of the overworked Middle Eastern doctor. Unbelievable. But they all count, we're told, they're all citizens and patients, and so they have to be looked after in the same way.
On the floor, meanwhile, a large man was lying on an ambulance stretcher and sleeping off his inebriation, thereby apparently blocking the use of an ambulance for the rest of the night. "He does that regularly," the paramedic told me. Apparently the man can't be disrupted for fear of subsequent legal action. It was one of a few ambulances working on the north side of Dublin city that night. Crazy wastage.
Our medical staff are excellent and often overworked, but we're not helping things if we don't protect them, and the health system, from this sort of destructive behaviour.