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November 04. 2013 9:57PM

Governor steps in on emergency room violence, sets up team to review recent incidents

MANCHESTER — Gov. Maggie Hassan said Monday she set up a team to review "the crisis in our emergency rooms" most recently demonstrated during two violent incidents involving mentally ill patients being held at Elliot Hospital's emergency department while waiting for a bed to open at the state's psychiatric facility.

"The recent incidents involving patients at the Elliot Health Systems raise serious concerns and questions about how we are using our existing mental health resources," the governor wrote state Health and Human Services Commissioner Nicholas Toumpas, informing him of the review."We can all agree that our mental health system is deeply strained," she added.

Former state Supreme Court Justice Joseph Nadeau, who now heads the state's Board of Mental Health Practice, will lead the Sentinel Event Review team. Dr. Alexander P. de Nesnera of the Geisel School of Medicine and New Hampshire Hospital associate medical director, and Senior Assistant Attorney General Michael Brown, are also on the team.

The review will focus on the two incidents that occurred at Elliot since July 8, but also will explore "broader questions" these incidents raise. They include examining how psychiatric emergencies are prioritized in hospitals, how local hospital emergency room staff are trained to treat acute psychiatric episodes and what steps are necessary to minimize the risk of harm to patients and staff.The team will report its findings to Hassan and Commissioner Toumpas. They have not been given a deadline to complete their work, but have been asked to proceed "as expeditiously as possible," the governor's spokesman said.

"This is wonderful news and a critical step in the right direction to alleviating the issue," Elliot Hospital spokeswoman Susanna Whitcher said in a statement.

"We are confident that Gov. Hassan understands the serious safety issues presented to the public and health care staff when people in need of mental health care at the New Hampshire State Hospital wait for days in an emergency department for transfer," she added.

Two violent incidents

Elliot's emergency department has been the scene of two violent incidents involving mentally ill patients waiting for a bed to open at New Hampshire Hospital.

The patients were not identified by name by the governor. However, their names and the incidents have been detailed in public court records and law enforcement charging documents. In one case, family and friend have spoken publicly.
The most recent involves Manchester resident Fern Ornelas, 54, whose family and friends said was brought to the Elliot emergency department Oct. 15 for a mental health episode triggered when he went off his medications.
Ornelas allegedly attacked a hospital security officer the following night and the two exchanged blows to the head until the guard — using pepper spray and with the help of at least two other security guards and a Manchester police officer — subdued him. Ornelas and the security guard were treated for significant facial wounds. Ornelas went to Manchester police headquarters where he was booked and charged with simple assault, then transferred to Hillsborough County House of Corrections about midnight Oct. 17.

County jail medical staff returned Ornelas to Elliot Hospital by ambulance about 9:30 that morning in serious condition. Friends and family said Ornelas had a broken neck and was paralyzed from the neck down.

Ornelas was transferred to Massachusetts General Hospital in Boston that day, where he remains in the intensive care unit. Family members said he initially was unable to talk and was on a breathing tube.

"I'm very happy it's going to be done. I think it's long-needed," one of Ornelas' close friends, Thomas North, said of the review. North said the incident would not have occurred if there was a bed available at New Hampshire Hospital for Ornelas."The state of New Hampshire prides itself on not providing services, but they don't like the outcome of not providing services," North added.

North said Ornelas' twin sister and guardian, Anna, visited with her brother Sunday and reported his condition improved.

"Fern is able to breathe without the breathing tube and, when the tube is out, he can talk," North recounted.

"She said he has a lot of questions," North added.

Criminal investigation

The Hillsborough County Attorney's Office and state Attorney General's office is conducting a criminal investigation of how and when Ornelas sustained the injuries. Authorities are examining events from the time Ornelas arrived at Elliot Oct. 15, to the brief time spent in police custody, to when he was in the custody of the county House of Corrections.
The lack of available beds at New Hampshire Hospital has emerged as one of the most critical issues facing the mental health system in New Hampshire as mentally ill people suffering dangerous episodes can wait for days in local emergency rooms until a bed opens.

The severity of the issue and dangers it poses to hospital staff gained widespread attention July 8 when Angel Kinglocke, 34, of Manchester allegedly attacked Elliot Hospital licensed nursing assistants Donald Wyman and Melissa Clermont while waiting to be involuntarily committed to the state-run hospital.

Kinglocke had been held three days in the hospital's emergency department for a bed to open at the state hospital when he allegedly attacked Wyman, stole his employee key card and tried to escape. Wyman suffered critical head injuries.

Hassan asked the review team to explore a series of issues that pertain not only to the Manchester incidents, but to patients awaiting care in other emergency rooms in the state to determine if existing mental health beds and resources are being used.

The state is moving ahead with implementing its 10-year mental health plan, including opening 12 beds at the state hospital in June, Hassan said. The state is working to expand community treatment teams statewide, expanding community mental health services and increasing the number of emergency beds available.

kmarchocki@unionleader.com


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