Family members with schizophrenia, one of the more frustrating mental illnesses to treat, often face a bumpy treatment road filled with potholes and setbacks. Many people with schizophrenia believe there’s nothing wrong with them. Or the medications they take often have significant, negative side effects.
So even though schizophrenia can often be treated fairly effectively with medications and psychotherapy, it often is not because medication compliance becomes a significant ongoing issue.
This results in many people with schizophrenia going in and out of inpatient care. Because inpatient psychiatric care is virtually non-existent in most states any longer, this means a primary treatment point for people with chronic, serious mental illness defaults to the local hospital emergency room (ER).
While most ERs are setup to handle people with a serious mental illness fairly well, ERs aren’t exactly known for their warm-fuzzy, emotionally-supportive environments. So people slip through the cracks.
In this case, the woman with schizophrenia who slipped through one hospital ER’s cracks was Cindy Ciarafoni, a mother of two, who died when she apparently wandered out of the ER and tried crossing a busy highway. She was struck by a car and later died from her injuries. Now her family wants to know what happened, but the hospital is being tight-lipped.
Cindy’s story is that she had a history in the past three years of deteriorating behavior. In the past 6 months alone, she had been hospitalized about once a month, according to her family.
On New Year’s Day, she was acting strangely in a local Toronto coffee house. Police were called, who then called paramedics to take her to the hospital when it was apparent Cindy was suffering from a mental illness and needed treatment.
She was dropped off at the hospital just before 5:00 pm, and signed in by the triage nurse to the emergency room at Humber River Regional Hospital’s Church St. campus.
Her family was notified by the police of her hospital admission, but since it had become a commonplace occurrence, her family was not concerned for her safety or well-being. They knew she’d be kept under observation for at least 72 hours.
A day later, they got another phone call from the police. This was not as good a call, because Cindy had been hit by a car 10 kilometers north of the hospital.
Here’s the kicker. The hospital has refused to answer questions about the incident, citing “patient confidentiality.” But when the family has tried to get answers, all they’ve gotten is a stone wall:
Danny said he never received a call to tell him his wife had left the emergency department without being assessed or admitted. The family said the hospital has been uncooperative about telling them what happened that night.
“They’re not even calling us back, so it’s frustrating,” Ciarafoni-McGrath said.
Why is the Humber River Regional Hospital stonewalling? What have they got to hide, except for the fact that a patient was dropped off in their ER, and they didn’t notice when she left on her own long before being seen by a doctor.
But the hospital emergency record obtained by the family shows that when a physician attempted to begin a preliminary assessment six hours later, at 11:36 p.m., there was no answer — indicated by a slashed zero and the word “answer.”
This is the problem when hospital ERs become dumping grounds for people with serious mental illness who need special attention and care. Some hospitals are just ill-equipped and their staff aren’t properly trained to help such people.
This tragedy could’ve been prevented had the hospital had a procedure in place to ensure that people with special mental health needs are properly taken care of once signed in. Not left in the waiting room like someone with a broken arm. Staff training is also a must, because they need to be alerted about the needs of people with a mental health issue.
Hopefully answers will be forthcoming. In the meantime, hospitals should take this opportunity to review their own ER procedures to ensure they take into account the needs of people who have a mental health concern.
Read the full story: Family seeks answers after woman with schizophrenia dies on road
Photo: Renee Ciarafoni-McGrath with her mother, Cindy, at Renee’s wedding supplied by the family.
7 comments
Perhaps an emergency mental health intake program initiated by Alberta Health Services at the Royal Alexdria Hospital in Edmonton should be carefully looked at. The program has only been in existence for a short time but the results and outcomes are really encouraging!!
There are many issues;1) ER staff not properly trainned,a peer support program will work better in crisis ; 2) after 25 years suffering from schizophrenia, her family knows how the system works, actually how it doesn’t work, therefore when she wasn’t taking her med regularly, should get a Judge’s form to admit her. That didn’t happen but at least they shouldn’t leave her alone when was taken to hospital by police, they’d be supporting her and making sure that she was admitted;3)medical staff cannot give information about patients unless they are certified but they have the obligation to listen to what family or friends can say about the patient. There’s no doubt, the Mental Health Act needs some reforms.
Peer support? Are you kidding me? Schizophrenia is a NEUROLOGICAL disorder. This is a very real medical condition.
With all due respect to ‘loving mother’. This was my sister and all the details/facts about the case have not been made public. My sister’s husband was notified when the police found his wife and he spoke to them about her condition, in fact many of the EMS workers/drivers, police in that jurisdiction and the hospital all had some previous experience with my sister and her illness. The EMS attendants spoke with my sister’s husband before taking her to the hospital and reassured him that she would be admitted to the hospital. (Something that had become routine for her and her husband.) The ambulance drivers stayed with my sister as per protocol until the hospital staff on duty that evening released them of their responsibility for her and had been given her info. This included her husbands name and phone number. My sister was brought into the hospital with some personal belongings which included a purse that contained a couple hundred dollars. She left the hospital, at what time we do not know for sure, and wandered the streets in below freezing weather for around 24hrs before being hit and killed by a car. Her purse was missing, she was wearing someone elses boots and coat and had her husband,daughter and son’s phone numbers on her. Why did the hospital not call her husband when they realized she was not in the waiting room? Why was she left there with no security, with the general population and not in a separate room? It was obvious she was in crisis! She had a mental health issue and obviously was unable to make safe and good decisions! And how was the family to get a Judge to ‘form her’ on New Years Day in the middle of this crisis in which she refused to go home with her family? The only viable option given all the issues (some of which included having stopped taking her meds a week prior after just having changed doctors and meds) was for her to go to the hospital. The hospital has even stated themselves that they have a certain protocol they follow for these situations, some of which includes isolating the patient or having mental health staff sit with the person. Finally, why was there not even a police investigation into the loss of her personal belongings ie’ money and clothes given she was alone at night in a fairly high crime area? For all we know she was likely robbed and maybe even raped in those many hours she wandered the streets so vulnerable! My heart aches when I think of her being all alone on that cold, dark night before being hit. Unfortunately she didn’t die instantly but still had to suffer more while being taken to Sunnybrook Hospital where she died on the operating table. I know to many it is just another story and to the staff at the hospital just another ‘nut case’ but to me and the rest of my beautiful sister’s family she was a kind, funny, gentle soul who suffered so much in her short time here! 🙁
This doctor and author paints the rosy picture that meds are a panacea were it not for the side effects. Truth is many meds simply don’t take away all symptoms. Furthermore, deep psychosis is quite different than standing schizophrenia and I can say that from a lived experience. Truth is most practitioners as well as the public ignore that this is a cognitive disorder on par with Alzheimer’s in favor of the more popular view that mental illnesses are all emotionally based. Psychotic people don’t need a “warm fuzzy” in the ER to get better, they need the medical doctors and nurses to have a real and true understanding of the underlying structures of this disease.
I just long for the day when mental illness will be a thing of the past.
I think it is possible even if I don’t live to see it.
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