Some psych patients wait days in hospital ERs
Thu, 03 Jul 2008 21:09:02 GMTBy DAVID B. CARUSO, Associated Press Writer
NEW YORK - When staffers at a Brooklyn hospital spotted a middle-aged woman lying face-down on a waiting room floor last month, it hardly seemed like cause for alarm.
The sight, after all, was common in the psychiatric emergency room at Kings County Hospital Center. The unit is so routinely backed up with people waiting hours, or even days, for services that patients often spend the night nodding in chairs or sprawled in a corner.
It took an hour before a nurse realized the prone woman was in trouble. By then, she was dead.
Security camera footage of the woman drew outrage when it became public this week. Experts say it is also an extreme symptom of a crisis occurring in hospitals nationwide.
Emergency rooms, they say, have become all-purpose dumping grounds for the mentally ill, with patients routinely marooned a day or more while health care workers try to find someone to care for them.
A survey of hundreds of U.S. hospitals released last month by the American College of Emergency Physicians found that 79 percent reported that they routinely "boarded" psychiatric patients in their waiting rooms for at least some period of time because of the unavailability of immediate services.
One-third reported that those stays averaged at least eight hours, and 6 percent said they had average waits of more than 24 hours for the next step in a patient's care.
"We try to find a place to put them," said Dr. David Mendelson, an emergency physician in Dallas who wrote the ACEP report. Ideally, he said, that place would be a quiet spot with one-on-one nursing care, but that doesn't always happen.
"Unfortunately, sometimes the only thing we can do is restrain them, or medicate them," he said.
There are many reasons for the delays, which vary from city to city, but doctors said they usually boil down to one thing: a lack of available mental health services.
In some communities, there are shortages of clinicians and few open beds at psychiatric hospitals. Sometimes, insurance companies refuse to approve treatment and patients must wait while doctors appeal. Other times, patients aren't sick enough to need inpatient care, but would be lost if discharged to the street. Finding a program to look after them can take days, doctors said.
In the meantime, the patients sit — and wait.
"There's no place to put them in the community, so we literally hold onto them," said Dr. Michael Cohen, director of the emergency psychiatric unit at Stony Brook University Medical Center on Long Island.
Esmin Green, a poor immigrant from Jamaica, had been in the waiting room at King's County Hospital Center for almost 24 hours when she toppled from her chair the morning of June 19.
Security camera tapes show that, for an hour, no one who saw the 49-year-old sprawled on the floor bothered to check her condition, including the unit's attending psychiatrist and two security guards.
Doctors are still trying to determine a cause of death.
Six hospital employees were fired in the days after she died, and the city agreed to reduce overcrowding and trim the time patients spend in the unit. Hospital administrators also promised to improve conditions in the unit, which had been deplored in a recent lawsuit.
The suit, which is still pending, claimed the long waits for care at King's County could be cruel. Patients had limited access to linens, gowns or soap. The showers were filthy and there were few places to sleep.
One patient lucky enough to get a bed complained that someone stole her spot when she got up in the night to use the bathroom. Another patient said he was robbed of his wallet after falling asleep in a busy hallway.
A 54-year-old man only days removed from an open heart surgery said he had to curl up on the floor of a reception area, where he was kept awake by fighting between patients and security guards.
Emergency physicians at other hospitals describe conditions far less grim, but they uniformly agreed that a hospital waiting room is rarely a comfortable place for someone in a psychological crisis.
"Optimally, you don't want a patient sitting in the emergency room for any length of time," said Dr. Bruce Schwartz, the director of clinical psychiatry at Montefiore Medical Center, in the Bronx.
Still, those types of waits can be routine.
In Austin, Texas, hospital officials have complained that a county decision to reduce the number of patients sent to a state psychiatric hospital has clogged their emergency rooms with mentally ill people with no place else to go.
In Massachusetts, some parents have complained about days-long waits in the emergency room for children who need placement in a pediatric psychiatric service.
California health officials have struggled for years with complaints about overcrowding in psychiatric emergency rooms.
Not every long emergency room wait is pointless, said Joyce Wale, senior assistant vice president of behavioral health at the New York City Health and Hospitals Corporation, which runs the city's public hospitals.
Doctors need time to see how patients react to medications. Patients arrive intoxicated, and need to sober up before they can be properly evaluated.
There is also reluctance, in many cases, to simply commit patients to a mental hospital, when their illness may not be that severe.
"Everybody really tries very hard not to admit someone into a psychiatric inpatient unit unless it really needs to happen," Wale said.
And every hospital emergency room in the city, she said, feels the pressure of being used as a dumping for the city's mentally ill.
"It's the police. It's the schools. It's health clinics, all sending people to the emergency room, when these people don't really need to be there," agreed Stony Brook's Cohen.
Scientists Watermelon yields Viagralike effects
Thu, 03 Jul 2008 21:48:53 GMTBy BETSY BLANEY, Associated Press Writer
LUBBOCK, Texas - A slice of cool, fresh watermelon is a juicy way to top off a Fourth of July cookout and one that researchers say has effects similar to Viagra — but don't necessarily expect it to keep the fireworks going all night long.
Watermelons contain an ingredient called citrulline that can trigger production of a compound that helps relax the body's blood vessels, similar to what happens when a man takes Viagra, said scientists in Texas, one of the nation's top producers of the seedless variety.
Found in the flesh and rind of watermelons, citrulline reacts with the body's enzymes when consumed in large quantities and is changed into arginine, an amino acid that benefits the heart and the circulatory and immune systems.
"Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it," said Bhimu Patil, a researcher and director of Texas A&M's Fruit and Vegetable Improvement Center. "Watermelon may not be as organ-specific as Viagra, but it's a great way to relax blood vessels without any drug side effects."
Todd Wehner, who studies watermelon breeding at North Carolina State University, said anyone taking Viagra shouldn't expect the same result from watermelon.
"It sounds like it would be an effect that would be interesting but not a substitute for any medical treatment," Wehner said.
The nitric oxide can also help with angina, high blood pressure and other cardiovascular problems, according to the study, which was paid for by the U.S. Department of Agriculture.
More citrulline — about 60 percent — is found in watermelon rind than in the flesh, Patil said, but that can vary. But scientists may be able to find ways to boost the concentrations in the flesh, he said.
Citrulline is found in all colors of watermelon and is highest in the yellow-fleshed types, said Penelope Perkins-Veazie, a USDA researcher in Lane, Okla.
She said Patil's research is valid, but with a caveat: One would need to eat about six cups of watermelon to get enough citrulline to boost the body's arginine level.
"The problem you have when you eat a lot of watermelon is you tend to run to the bathroom more," Perkins-Veazie said.
Watermelon is a diuretic and was a homeopathic treatment for kidney patients before dialysis became widespread.
Another issue is the amount of sugar that much watermelon would spill into the bloodstream — a jolt that could cause cramping, Perkins-Veazie said.
Patil said he would like to do future studies on how to reduce the sugar content in watermelon.
The relationship between citrulline and arginine might also prove helpful to those who are obese or suffer from type-2 diabetes. The beneficial effects — among them the ability to relax blood vessels, much like Viagra does — are beginning to be revealed in research.
Citrulline is present in other curcubits, like cucumbers and cantaloupe, at very low levels, and in the milk protein casein. The highest concentrations of citrulline are found in walnut seedlings, Perkins-Veazie said.
"But they're bitter and most people don't want to eat them," she said.
