Hospital Struggle Results In Homicide

Coroner's report calls psychiatric patient's death a 'homicide,' but police do not suspect foul play.

From The Sacramento Bee by Ryan Lillis, August 24, 2006

A 51-year-old woman who died after being restrained in an area psychiatric care facility was the victim of a homicide, according to a Sacramento County coroner's report.

Ramona Knapp died Dec. 5, one day after struggling with medical staff at Sierra Vista Hospital, 8001 Bruceville Road, "during an apparent excited delirium state," the report states.

Her death was ruled a homicide "due to the direct involvement by medical staff," according to the report, which was released Friday.

Knapp died after "a large person forcefully compressed (her) back down against the floor," the report states.

The homicide finding means the coroner believes the death resulted from the action of another person or persons. In this case, police do not suspect foul play.

Sierra Vista spokesman Mark Grip said he could not comment about the case -- or say if Knapp was a patient -- because of patient confidentiality regulations.

Eric Emanuels, an attorney representing Knapp's two children, said he is looking into the case.

Restraining patients is a hot-button issue nationally -- with mental health advocates decrying the use of restraint techniques and a state report describing the technique as "crude and ancient."

After an investigation earlier this year determined criminal activity was not involved in Knapp's death, Sacramento police referred the case to the state medical board, said spokesman Sgt. Terrell Marshall. The medical board could not be reached for comment Wednesday.

The California Department of Health Services, which licenses health care facilities in the state, will look into whether the hospital followed its own policies and procedures, said spokeswoman Lea Brooks. If not, the department would prescribe a "plan of correction."

She said in cases of repeat problems, the state takes the hospital's Medicare and Medi-Cal reimbursements.

Knapp was admitted to Sierra Vista on Dec. 4 for "acute psychosis," according to the coroner's report.

Later that night, she called her mother and said she wanted to go home, said her sister, Andula Young.

The coroner's report said Knapp was "restless, disruptive, uncooperative and combative" during her hospital stay.

Hospital staff found Knapp sitting on the floor of her room and she stood up and fell "two to three times" as hospital staff tried to calm her, the report states. Then, while lying on her side, Knapp "became combative to one of the workers who attempted to restrain her by holding down her right arm and lying across her back," according to the report.

The worker who held Knapp down was "reportedly heavy," according to the report. That worker was joined by another worker who held Knapp's legs.

Knapp was restrained for five minutes before a nurse arrived to inject her with medication, the report states. Knapp "became still" just before the nurse arrived.

The nurse did not evaluate Knapp before injecting the medication, according to the report.

"During the next few minutes it became apparent that (Knapp) was unresponsive," the report states. Hospital staff soon began cardiopulmonary resuscitation and Knapp was taken to Kaiser Hospital South, where she died 20 hours later, according to the report.

The coroner's office issued its report eight months after Knapp's death, about twice as long as most similar investigations take, said Kim Burson, an assistant coroner.

"This was a very complicated case with a lot of complicated factors involved," said Burson, adding the office's case load contributed to the delay.

Knapp, a Sacramento native, "was a very well-liked person," Young said. She had taken medication to battle depression for 20 years and "had it well under control," her sister said.

A 2002 California Senate Office of Research report addressed the matter of restraining patients.

"The crude and ancient practices of secluding and restraining mental health patients are antiquated, traumatizing and potentially dangerous," it says.

Sally Zinman, executive director of the California Network of Mental Health Clients, said mental health staffs should learn alternative modes of calming and de-escalating a combative patient.

"Other modes are less traumatic for staff and safer for people being restrained," she said.

A 2003 state law mandated that the state Department of Mental Health and the state Department of Developmental Services develop training to reduce the use of restraints.

It allows the use of restraints only when "a person's behavior presents an imminent danger of serious harm to the person or others." The law also requires hospitals and facilities to report all deaths related to restraints.

Source: The Sacramento Bee

Link: http://www.sacbee.com/content/news/story/14306169p-15189729c.html