Nursing home resident dead after confrontation with police

[ffemt8978]

http://usnews.nbcnews.com/_news/201...ent-dead-after-confrontation-with-police?lite

A 95-year-old resident of an Illinois nursing home died early Saturday, hours after being shocked with a Taser and bean bag rounds in a confrontation with police.

Authorities said John Warna was a resident at Victory Centre of Park Forest, on the 100 block of South Main Street in the south suburb. He was threatening paramedics and staff with a cane and a metal shoehorn when police arrived at the complex, they said.

Police said they struck him with a Taser and bean bag rounds after he threatened officers with a 12-inch butcher knife.

Are we so afraid for our safety that we let a shoe horn and a cane stop us? This should have been stopped BEFORE it got to the point of the butcher knife getting involved.

 

[Handsome Robb]

That's crap and you know it.

I don't care how old you are or what mental illness/reduced mental capacity you have you don't threaten myself or my partner's safety. We have every right to go home at the end of the day. I'm sure if he held up a McDonald's and the same result occurred nothing would have been said about it. He pulled a knife on PD as well as brandished an object which could wasily be ised as a weapon, in a threatening manner, at EMS personnel and he faced the consequences just like anyone else. Really doesn't take long for him to drop the cane reach over and grab a knife.

If they'd have tackled him and hurt him there's be a huge article about how the big bad paramedics jumped some old geezer for no reason.



What happened to professional respect for our co-responders and not judging their actions without knowing the full situation? How do you know he wasn't a larger, still capable 95 year old? I've met plenty of 90-100 year old patients who're sharp as a tack and still very physically capable. That article has zero information in it. As a community leader you're supposed to help guide and teach right? But instead you're Monday morning quarterbacking our fellow EMS brothers and sisters. You weren't there, do you know what they did to try and de-escalate the situation prior to the arrival of law enforcement?

How do we expect to not be messed with if we continually allow people to threaten and/or mess with us without facing the consequences? We need to enforce an "off-limits" approach if we expect things like this to stop.

No wonder we don't get any respect as a profession...we don't even get it from people who are part of our profession.

 

[JPINFV]

"The resident of the faculty was being "involuntarily" committed for medical treatment by staff at the Victory Centre, the release said."

http://articles.chicagotribune.com/...t-20130727_1_park-forest-taser-health-centers

Since nothing has been said justifying the "involuntary commitment" (i.e. someone simply didn't want to go to the hospital, and the SNF staff and ambulance crew thought they could force him to go because... shut up, that's why), wouldn't this be just the poor man standing his ground? Doesn't he have the right to protect himself from being kidnapped?

So, Robb, don't kidnap patients and they won't threaten you with a knife.

 

[ffemt8978]

That's crap and you know it.

I don't care how old you are you don't threaten myself or my partner's safety. He pulled a knife on PD and faced the consequences just like anyone else. Really doesn't take long for him to drop the cane reach over and grab a knife.

If they'd have tackled him and hurt him there's be a huge article about how the big bad paramedics jumped some old geezer for no reason.



What happened to professional respect for our co-responders and not judging their actions without knowing the full situation?

How do we expect to not be messed with if we continually allow people to threaten and/or mess with us without facing the consequences? We need to enforce an "off-limits" approach if we expect things like this to stop.

I am not questioning the police actions once the knife came into play. I am questioning how it was allowed to get to that point in the first place. Two crew members from the ambulance plus staff from the nursing home were either a) unable to or b) unwilling to disarm the patient or prevent him from getting to the knife in the first place.

What does it say for our profession and colleagues when we let a patient armed with a cane and shoe horn hold us at bay, thereby allowing him to arm him self with a lethal weapon?

 

[Highlander]

I know he's an older gentlemen, but he pulled a weapon out so I'm going to assume the officers feared for their life, as well as the ems workers. The age is going to be the biggest issue here however this being stated is just my opinion. Also don't they check for weapons at nursing homes? It should of been safe before we walk in.

 

[ffemt8978]

I know he's an older gentlemen, but he pulled a weapon out so I'm going to assume the officers feared for their life, as well as the ems workers. The age is going to be the biggest issue here however this being stated is just my opinion. Also don't they check for weapons at nursing homes? It should of been safe before we walk in.

Like I said, for the most part I have no issues with what happened once the knife came into play. I am just questioning how it got to that point instead of being stopped beforehand.

 

[JPINFV]

I know he's an older gentlemen, but he pulled a weapon out so I'm going to assume the officers feared for their life, as well as the ems workers. The age is going to be the biggest issue here however this being stated is just my opinion. Also don't they check for weapons at nursing homes? It should of been safe before we walk in.

1. Why can't the old guy stand his ground against kidnappers? If Zimmerman can stand his ground against some kid buying skittles and an Arizona Ice Tea, than certainly this qualifies.

2. Looking up the facility, it looks more like an assisted living apartments than a SNF. Knives are generally found in kitchens.

 

[JPINFV]

Like I said, for the most part I have no issues with what happened once the knife came into play. I am just questioning how it got to that point instead of being stopped beforehand.

Probably somewhere after the old guy wanted to sign out AMA and the crew and facility wouldn't let him.

 

[WolfmanHarris]

I was recently involved in a 3 hour Police standoff with an elderly dementia patient threatening himself and anyone who approached with scissors, extremely agitated. I cannot say enough about how well the scenario was handled.

Once facility staff were removed to safety, initially arriving PD secured the perimeter and began attempting to talk down the patient. We stoodby in the hallway.

PD brought in the Emergency Response team, a negotiator and their Shift Commander and took an approach of watch, wait and talk and stoodby until and unless their was an imminent threat to the patient.

From our side we had a Superintendent on scene and brought in ACP for possible sedation if required.

The patient was brought food and given time to deescalate.

Finally after a few hours when things got quiet and the patient was no longer answering the negotiator. (They could only get a visual from behind.) PD forced entry as gently as they could from the balcony and found the patient asleep. We transported him without incident.

From the beginning there was team effort and good communication. PD was clear from the beginning that they were hoping to avoid any use of force and we were all on the same page that at its core this was a medical call.

 

[mycrofft]

Headlines as Rorschach test

I'd want to see the police report before I started quarterbacking this. The account doesn't parse readily. I wouldn't be calling it or anybody anything based on such a sketchy story.

MM, I understood you at once.

Many facilities like that don't secure their kitchens at all times, so a resident could mosey in and out. Or a family member could bring it in "for self protection" or something like that (weird stuff happens).
------------------------------------------
Reminds me of the Rodney King arrest. We were sitting at lunch at the jail I worked in watching the video, thinking "Don't those officers know how to take an apparently unarmed guy down??".

 

[Handsome Robb]

1. Why can't the old guy stand his ground against kidnappers? If Zimmerman can stand his ground against some kid buying skittles and an Arizona Ice Tea, than certainly this qualifies.

2. Looking up the facility, it looks more like an assisted living apartments than a SNF. Knives are generally found in kitchens.

Is there an article with more information as to what was going on?

I agree he has every right to refuse to be transported provided he has the capacity to do so.

Was he an Alzheimer's/dementia patient who was not competent to make decisions regarding his healthcare and the POA agreed that he be transported? Was his sensorium acutely altered?

No one is arguing that he can't refuse and apparently we all agree that once the knife came into play the actions by PD were appropriate.

As to FFEMT's question about why someone didn't take the cane and shoehorn away from him before he picked up the knife, I don't know, I wasn't there. At 95 years old I wouldn't be super excited to attempt to take a weapon from this agitated gentleman from a CYA standpoint. It is not my job to disarm people (yes I understand its a cane and metal shoehorn...he's brandishing it in a threatening manner making it a weapon. Side thought, I've seen some very decorative shoe horns with sharp points and what not on them...did the one this gentleman was holding have anything like this? Definitely would make me nervous approaching someone with something that had the potential to become impaled in myself or my partner), that's the police department's job. I can absolutely see the EMS crew being hung out to dry in court because they attempted to take the cane and shoehorn away and ended up injuring the patient (yes, I understand he died but at that point the situation is completely different).

I'd imagine the EMS crew attempted to talk him down and failed. At some point PD was requested and while waiting for them to respond the knife came into play. Again this is just speculation. Remember "when seconds count the police department is usually minutes away". Same goes for the FD and EMS.

 

[JPINFV]

Is there an article with more information as to what was going on?

Not anything more than the staff was somehow involuntarily committing him for "medical" treatment. If he had some sort of neurodegenerative or anything that would cause him to be altered, I'm sure it would have been mentioned.

I agree he has every right to refuse to be transported provided he has the capacity to do so.

Was he an Alzheimer's/dementia patient who was not competent to make decisions regarding his healthcare and the POA agreed that he be transported? Was his sensorium acutely altered?

No article I've seen suggests that he was not competent to make decisions. However, I have seen, both as a medical student and as an EMT, hospital staff and nursing home staff believe that any healthcare decision they make is a their way or the highway decision. Just because the assisted living staff says that he has to go doesn't mean that he has to go. Just because the police said he has to go doesn't mean he has to go. Just because the EMTs and paramedics said he has to go doesn't mean he has to go. Being altered is not "just because."

The nursing staff at my hospital was going crazy last week because a patient who had a recent NSTEMI decided that the tele equipment was annoying, so he didn't want to wear it, and because he wanted to go outside to smoke. In my opinion, if he wants to go outside and smoke, fine. If he didn't want to be continuously monitored, fine. Sign the AMA (because the obvious advice is to wear the tele monitor and not to smoke) and move on. He ended up signing AMA and leaving anyways because he wouldn't get an immediate bypass surgery (ignoring that we would have had to transfer him anyways as my hospital doesn't do cardiothoracic surgery). However the paternalism seen in the healthcare community (especially, from what I've seen, in EMS and nursing. Physicians tend to shrug and move on more often than not with these things) is astonishing.

No one is arguing that he can't refuse and apparently we all agree that once the knife came into play the actions by PD were appropriate.

If he is being forced against his will and he has capacity, I have no issue with him drawing the knife. Kidnappers are kidnappers, regardless of whether they are police, EMS, or some stranger on the street. Until he was shown to have some issue that precluded his ability to refuse transport, I'm forced to believe that he had the capacity to refuse.

 

[Aidey]

If he is being forced against his will and he has capacity, I have no issue with him drawing the knife. Kidnappers are kidnappers, regardless of whether they are police, EMS, or some stranger on the street. Until he was shown to have some issue that precluded his ability to refuse transport, I'm forced to believe that he had the capacity to refuse.

Its not that simple and you know it. Someone with capacity can still be forced to do something they don't want to do if there is a legal order in place. We take fully alert and oriented people to the hospital against their will all the time because their LRA was revoked, or an order for a 72 hour hold has been issued. You can be competent and still be considered a threat to yourself.

We very obviously aren't getting all the details. The story says he was alert and talking with EMS when they transported him, and that he died after being transported to a second hospital several hours later. He didn't get hit with the taser and fall over dead like the article title implies.

 

[JPINFV]

Its not that simple and you know it. Someone with capacity can still be forced to do something they don't want to do if there is a legal order in place. We take fully alert and oriented people to the hospital against their will all the time because their LRA was revoked, or an order for a 72 hour hold has been issued. You can be competent and still be considered a threat to yourself.

I don't hold that someone who is on a 72 hour hold for being a danger to themselves, danger to others, or gravely disabled due to a psychiatric order to be someone who has capacity. Capacity isn't A/Ox4.

Also LRA?

 

[Aidey]

LRA is "least restrictive alternative". It is basically parole for people who are on an extended involuntary hold, or who have a history of frequent holds. They figure out the least restrictive environment for you where you can still get the support you need, and they outline conditions you must meet, like going to therapy or taking your meds, or not using drugs or whatever. If you don't meet the outlined conditions your LRA will get revoked, and you will be placed back on an involuntary hold.

 

[Handsome Robb]

Not anything more than the staff was somehow involuntarily committing him for "medical" treatment. If he had some sort of neurodegenerative or anything that would cause him to be altered, I'm sure it would have been mentioned.


No article I've seen suggests that he was not competent to make decisions. However, I have seen, both as a medical student and as an EMT, hospital staff and nursing home staff believe that any healthcare decision they make is a their way or the highway decision. Just because the assisted living staff says that he has to go doesn't mean that he has to go. Just because the police said he has to go doesn't mean he has to go. Just because the EMTs and paramedics said he has to go doesn't mean he has to go. Being altered is not "just because."

The nursing staff at my hospital was going crazy last week because a patient who had a recent NSTEMI decided that the tele equipment was annoying, so he didn't want to wear it, and because he wanted to go outside to smoke. In my opinion, if he wants to go outside and smoke, fine. If he didn't want to be continuously monitored, fine. Sign the AMA (because the obvious advice is to wear the tele monitor and not to smoke) and move on. He ended up signing AMA and leaving anyways because he wouldn't get an immediate bypass surgery (ignoring that we would have had to transfer him anyways as my hospital doesn't do cardiothoracic surgery). However the paternalism seen in the healthcare community (especially, from what I've seen, in EMS and nursing. Physicians tend to shrug and move on more often than not with these things) is astonishing.



If he is being forced against his will and he has capacity, I have no issue with him drawing the knife. Kidnappers are kidnappers, regardless of whether they are police, EMS, or some stranger on the street. Until he was shown to have some issue that precluded his ability to refuse transport, I'm forced to believe that he had the capacity to refuse.

Alright, we've established hepotentially has the right to refuse. Without more information about the situation we can't determine if he had the capacity to refuse or not. You can be "forced" to believe whatever you want. Pick another point to argue because we're beating a dead horse. I will point out that I have my once disagreed with you about patients at these facilities being able to refuse if they are competent.

How do we know he wasn't being placed on a legal hold for danger to himself, (legal 2000, 5150, whatever your state calls it). Just because he is elderly doesn't mean he can't be suicidal. In fact per the CDC patients 85 years and older have the second highest suicide rate when categorized by age. Also males have a higher suicide rate than females. I'm not going to get into an ethical debate about suicide, I'm not saying he was suicidal just presenting a scenario.

http://www.afsp.org/understanding-suicide/facts-and-figures

The fact that he pulled a knife leads me to believe there's more to this story. Yes, kidnapping is wrong I'm not arguing that fact either but look at the situation. We have staff calling for an ambulance transport, an EMS crew that seemed to think it was a necessary one (I'm giving them the benefit of the doubt, I agree that there are a lot of EMS folks out there that fit your description) and finally you have the police department that showed up. The question is did the knife come out before or after they arrived. Before and it doesn't really have any relevance to whether it was appropriate or not but if it came out after they arrived I tend to believe there was a reason this gentleman was going to the hospital and there wasn't an AMA option.

EMS education bashes "everyone needs to go" and "if they don't go they could die" into students' heads over and over again. That's why many have trouble with AMAs.

It's sad that he died, I'm not trying to disregard that, I apologize if that's how I came off. My thoughts go out to his family.

 

[Clipper1]

If his behavior was out of character for him, he needs to go someplace. If this is the first time he has acted irrational, you don't just take "no" for an answer and walk away. It could be as simple as a medication reaction between a new med or something he might have inadvertently taken in combo, including OTC, or too much. Labs can be drawn to see if it is an easily fixed situation and there are psych facilities which specialize in diagnosing and treating geriatric patients for both short and long term.

Unfortunately it seems no one at this scene had enough information or experience with geriatrics to understand their potential. Anyone who has ever worked in a LTC facility or hospital know their ability to become violent for many reasons. They will use anything for a weapon including knives. But, usually they do not need to be killed to be stopped. Most of the time they can be diverted from the objects which can be used as a weapon. Had this occurred in a SNF, nursing home or hospital the outcome would probably have been very different. Chances are in this situation, there were probably several men wearing uniforms and very intimidating to an old man in his space. We also don't know how many memories came back to him maybe even from a concentration camp just like the Vietnam vets and their experiences.

 

[DrParasite]

Are we so afraid for our safety that we let a shoe horn and a cane stop us? This should have been stopped BEFORE it got to the point of the butcher knife getting involved.

If he takes the cane and gives one person a concussion (lucky shot), and another a broken arm or leg (another lucky shot), is that enough to warrant a response?

he was armed with a knife. should the police have waited for him to stab someone to shoot him, in order to justify their actions?

even if you are crazy or demented, you can still cause harm and death to another person, and I am not blaming the officers for their actions in the slightest

 

[Aidey]

They will use anything for a weapon including knives. But, usually they do not need to be killed to be stopped.

They didn't kill him to stop him. He didn't die on scene. He was awake and talking on scene, and died hours later after being transferred to a second hospital.

 

[ffemt8978]

Like I said, for the most part I have no issues with what happened once the knife came into play. I am just questioning how it got to that point instead of being stopped beforehand.

If he takes the cane and gives one person a concussion (lucky shot), and another a broken arm or leg (another lucky shot), is that enough to warrant a response?

he was armed with a knife. should the police have waited for him to stab someone to shoot him, in order to justify their actions?

even if you are crazy or demented, you can still cause harm and death to another person, and I am not blaming the officers for their actions in the slightest

Do I have to say it again?