BDNH Storytelling Project: Restorative Justice as an Alternative to Firing a Patient
A Zine and Audio Story
Storyteller: Community Health Center Physician, Massachusetts
Zine Art and Design: Kruttika
In this story — offered in both zine and audio formats — a physician in Massachusetts prevents a patient from being dismissed from his practice by implementing a restorative justice process.
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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Restorative Justice as an Alternative to Firing a Patient
[00:00:00] I began my career as a primary care physician at a community health center in Boston with a focus on taking care of people living with HIV. Over time, I embraced a harm reduction strategy for people who use drugs.
[00:00:20] I first met T when she was 14 and would accompany her mom to medical visits with me. Her mom had AIDS. This was 1995, when AIDS was still considered a death sentence.
[00:00:32] T's father died of cirrhosis from Hepatitis C a few years after we met. Her mom died of an overdose when T was in her early twenties, and I then became her PCP. Other than a rocky relationship with her aunt, she had no stable adult in her life other than me.
[00:00:51] Over the years, T had repeated bad relationships with men, and had a son when she was 27. She revealed to me that she had been sexually assaulted by her father's best friend when she was 14.
[00:01:04] T struggled with her mental health, navigating anxiety, depression, and PTSD. She began drinking in her teenage years, eventually moving on to stimulants and heroin. In her early thirties, she was in a motor vehicle accident, which resulted in a severe ankle fracture, leaving her in chronic pain.
[00:01:24] T had poor impulse control and was quite demanding at times, though always polite to me. She had clashes with her front desk and nurses around getting refills for her prescriptions or having to wait to be seen for an appointment.
[00:01:38] One morning, she called into the office three times, demanding that her prescriptions be refilled by the end of the day. On her third telephone call, she threatened to punch out the secretary who answered the phone if her prescriptions weren't ready by 5:00 PM. This threat was reported to hospital security.
[00:01:58] Because she had previously received verbal warnings, this resulted in a written warning stating that behavior like this would not be tolerated. One week later, she arrived at our office at closing time, demanding to be seen. I was not there, and we had no available appointment, so she was turned away. She was caught on camera, defacing a sign with a permanent magic marker in her parking lot, which was reported to security.
[00:02:25] I was informed the following day that she was to be dismissed from the practice and would have 60 days to find another doctor. I was devastated.
[00:02:35] At that point, our office was her entire medical home. I was providing her primary care and addiction care, and she was receiving counseling through our mental health services.
[00:02:47] Her life had been full of violence and loss. Our office provided some level of stability. Sometimes, our practices are the only places people receive care of any kind. The only soft place for them to land in the world. She likely would not have been able to find a new PCP willing to prescribe the array of controlled medications I was prescribing.
[00:03:13] I intervened with our medical director to see whether there would be some alternative to dismissing her from our medical practice. He agreed to allow a restorative justice process for her. With the help of an experienced facilitator, we formed a healing circle that included the secretary she had threatened, a nurse from our practice, security, our medical director, and her therapist.
[00:03:38] We offered her the opportunity to bring a support person, but she declined. I believe she viewed me as her support person.
[00:03:47] Prior to the meeting, T had written a letter taking responsibility for her actions and acknowledging the harm she had caused.
[00:04:00] In the restorative justice circle, we considered for a moment the reality that experiencing so much violence in one's life could also reproduce violence as a way of exercising some power and meeting one's needs. T also heard from the secretary she had threatened, and was surprised to learn that the secretary was actually frightened that she would hit her. T relayed that that was just how she talked, and she would never in her wildest dreams hit someone.
[00:04:29] Together, we came up with concrete steps to repair the harm she caused, including community service. This enabled T to stay in our practice and get the care she needed.
[00:04:40] Despite some rocky times, T is thriving and extremely grateful that she has remained a patient in our practice.
[00:04:46] This policy has now been adopted as one way to address disruptive behavior in a way that meets the needs of the patients and the staff. I'm hoping that other healthcare systems will adopt restorative justice processes, so as not to reproduce the systems of violence and punishment so widespread in other spaces in our patients' lives.
[00:05:07] Our healthcare systems are not well-equipped to address these kinds of conflicts. In fact, the way our healthcare systems are structured creates the conditions that enable these very situations, which, more often than not, result in no one getting the care they need.
[00:05:25] If we hadn't tried the restorative justice circle, T may have gotten fired from our practice, and the secretary who was threatened may have gone home feeling hurt and traumatized.
[00:05:37] But if the story ended there, would anyone have gotten the care they needed? Transforming the conditions that lead to these conflicts is key, as is continuing to explore strategies that repair harm, and that facilitate healing and care.
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Kruttika is an illustrator and cartoonist working with community-engaged organizations in the Global South and the U.S. to create books, zines, and toolkits.
