BDNH Storytelling Project: On the Consequences of Policing Patient Behavior in the Hospital
A Zine and Audio Story
Storyteller: Community Health Center Physician, Massachusetts
Zine Art and Design: Rommy Torrico
In this story — offered in both zine and audio formats — a physician at a community health center challenges the policing of his patients by offering a harm reduction-based approach to care.
This story is part of the Beyond Do No Harm Network’s Storytelling Media Project, which seeks to highlight and amplify the actions individual medical providers are already taking to interrupt criminalization in the context of care, in the hopes of increasing awareness of the harmful impacts of criminalization within the medical system and inspiring others to take action at multiple levels.
Check out the zine, audio, and audio transcript below!
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On the Consequences of Policing Patient Behavior in the Hospital
[00:00:00] As a primary care physician who works in both outpatient and inpatient settings, I've become more and more bothered about how we recreate the carceral systems in our hospitals by policing patients' behaviors. Let me tell you a few stories.
[00:00:22] The first involves a frantic phone call I got last year from a patient advocate. This patient had been admitted to the cardiac stepdown unit at my hospital for unstable angina. This gentleman had spent 40 years in prison and had just been paroled six months earlier.
[00:00:39] At 11:00 PM on the night of his admission, his nurse entered his room to encounter him masturbating under the sheets, behind his closed curtain. Instead of merely walking out and saying she'll come back later, she instead called the hospital police and security, who ran a background check, saw that he was on parole, and called his parole officer. His parole was revoked, and he was handcuffed to the bed, accompanied by two corrections officers.
[00:01:08] The following morning I came to his bedside and found him handcuffed to the bed with two officers at his side, despite the fact that he was admitted with heart disease. The revocation of his parole meant, at discharge, he was going to be returned to prison.
[00:01:24] Whenever security is called on one of my patients, I file a safety report to document the harms that ensue, whether it results in a patient leaving the hospital prematurely, or in the patient being handcuffed to the bedrails. Along with my colleagues who are seeking alternatives to policing in hospital settings, we document every time calling security has led to an adverse outcome, to keep a record and to indicate that this behavior does not go unnoticed.
[00:01:54] While this may not have an immediate impact, I know that at some point I can go to the hospital and say, look, I submitted 10 safety reports about 10 patients who either left prematurely or had worse outcomes when security was called, so what are the alternatives?
[00:02:12] In this particular instance, after submitting the safety report, I met with the hospital security staff, and then I expressed my concern with the cardiology attending on this service, pointing out that calling security had resulted in this man with heart trouble being handcuffed to his bed.
[00:02:28] Although I'm reluctant to claim credit, the following day, the handcuffs were removed, and the officers left his bedside. I'm sad to report that this patient, after undergoing cardiac bypass surgery, had post-surgical complications and died in the hospital.
[00:02:45] 2. Several months after this, I was the attending doctor on the addiction service, supervising an addiction fellow. We shared an extremely complex patient, admitted with multiple complications over injection drug use. She was on intravenous antibiotics and required total parenteral nutrition, also known as TPN, through an intravenous line due to a previous colon resection. Because of some behavioral disinhibition, she had a sitter outside her room to monitor her impulsive behavior.
[00:03:19] Three weeks into her hospitalization, her boyfriend visited her in her single room. Her sitter peered through the window of her closed door to discover that the patient was performing oral sex on her boyfriend. Rather than turning away, the sitter called the nurse, who in turn called security, who then escorted the boyfriend off the premises and banned him from further visitation.
[00:03:42] Due to the violation of her privacy and the banning of her partner, and despite her extremely precarious medical condition, she gathered her belongings with the intent to leave the hospital before her infections were fully treated, and without continued access to the life-saving nutritional support she required.
[00:04:02] Fortunately, my fellow developed an excellent rapport with the patient, and after much discussion, she agreed to stay.
[00:04:09] 3. My most recent patient was a gentleman I saw while on the inpatient addiction consult service. He was a 35 year old man with a longstanding necrotic ulcer on his forearm, a result of a xylazine-related wound from injection drug use.
[00:04:25] This wound had been festering for over a year and was now down to his bone. He had tried several times to get care, but left the emergency room each time because of inadequate pain and withdrawal control, as well as stigmatizing attitudes from the medical staff. Finally, after 13 months of wound progression, he decided to come into the hospital for definitive treatment.
[00:04:50] He was admitted to the plastic surgery service for a planned four to six week hospitalization involving IV antibiotics and multiple surgical procedures. I was consulted on admission to help manage his pain and withdrawal.
[00:05:04] Despite nicotine replacement, he was antsy to smoke a cigarette. On the night of admission, he used a nicotine vape in his bathroom and was reprimanded. After a second episode of suspected nicotine vaping, he lost all off-floor privileges.
[00:05:21] The following evening, under the stress of his hospitalization, the confinement to his room, his PTSD from previous incarceration, and the challenges with his withdrawal and pain, he left the hospital for six hours and was officially discharged per protocol.
[00:05:38] He returned with his mother and stepfather the following morning. I was paged to the room by his primary nurse. Upon entering his room, I saw the patient, his mother, and stepfather in an antagonistic conversation with a plastic surgeon who was refusing to admit him to a service.
[00:05:55] He wanted the patient to pursue outpatient treatment and prove that he could be compliant with care. If he were to keep several appointments over the next several weeks, the plastic surgeon would consider at that point readmitting him to continue the planned multi-step procedure.
[00:06:11] Fortunately, I was able to arrange for the patient to be admitted to the medical service with plastic surgery consulting. He continued to receive his IV antibiotics, had appropriate management of his pain and withdrawal, and was allowed to leave the floor to smoke a cigarette each shift. He successfully completed his hospitalization.
[00:06:30] These are but a few of the many examples of the unnecessary policing of patient behaviors in the hospital. It's been a struggle over the years to allow my patients off-floor privileges to smoke cigarettes because of concern that they're somehow more likely to use drugs while walking down the street than in the privacy of their room.
[00:06:52] We know that approximately 40% of patients who use drugs will do so while hospitalized. That's not only due to poor management of their pain and addiction, but because they're in a stressful environment and will use the coping mechanisms that they know will be effective. Whether it's nicotine, caffeine, fresh air, or intimate contact with a loved one, these are things that bring folks comfort and ease.
[00:07:19] In hospitals that can sometimes replicate prison-like conditions that strip people of their agency, will, and self-determination, why deny access to the things that make them feel human?
[00:07:31] Why not have safe consumption rooms within hospitals, supervised by nurses or peers, where patients can safely use the drugs that will keep them comfortable?
[00:07:40] Why not have an alternative to calling security when patients are dysregulated, or thought to be using drugs in the hospital?
[00:07:48] Calling in large men in blue suits is triggering for anyone. Especially patients who have previously experienced negative encounters with the police or have a history of incarceration. Why not have a psychiatrically trained behavioral response team respond at that point, instead of the police?
[00:08:08] When I hear the argument that police and security keep people safe, I counter with, "Keeps who safe?" Certainly not the patients who end up leaving the hospital prematurely, without their underlying medical problems being taken care of.
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What is one action the physician in this story took to protect his patients?
What could it have looked like if agency and self-determination were central to these patients' care?
Imagine a time you encountered police in your workplace — what support or information would have been helpful at the time? How might you respond differently now?
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Rommy Torrico is a formerly undocumented, queer, trans nonbinary visual artist born in Iquique, Chile and raised in Florida. They have been involved in social movement spaces encompassing (im)migrant, queer and trans rights struggles for over a decade and infuse much of their work with personal experience and the stories their communities share. Over the years, Rommy’s work has been included in several publications and exhibited at the Getty Museum, the Smithsonian Museum, the Library of Congress and the Museo Nacional Centro de Arte Reina Sofía as well as many galleries and museums throughout the Americas and internationally. Learn more about Rommy here.
