Pubdate: Wednesday 16 December 1998
Source: Vancouver Sun (Canada)
Copyright: The Vancouver Sun 1998
Author: Pamela Fayerman, Sun Health Issues Reporter


A new ward designed to help emergency room staff segregate unruly
patients who are psychotic, drunk or overdosed on drugs is now in
operation at St. Paul's Hospital.

Patients who used to be physically restrained with stretcher straps
are now being cared for in isolation rooms in the new Comox ward.

Paul Conners, director of the West End Mental Health team, said the
hospital is inundated with such patients because of a lack of detox

Conners said the increase in the prevalence of substance abuse and the
growing numbers of mentally ill people living on the streets or in the
community, are other factors increasing the load on the St. Paul's
emergency department.

More than 800 heroin overdose patients have been treated at St. Paul's
in the last two years.

Addiction consultant Dr. Ray Baker praises the hospital for its
approach during a time of mounting problems among marginalized
populations on the Downtown Eastside.

"They're providing a safe, nonjudgmental environment for some people,
who, because of their disease, may not thank them for saving their
lives," he said.

The Comox ward has its own specialized staff attending to patients in
four private rooms that resemble jail cells -- but without bars, so
they can't injure themselves or others.

There are four additional open area beds, plus another space where
injuries such as those sustained in fights can be treated.

All the rooms have windows and surveillance cameras so nurses can
constantly observe patients.

The $500,000 renovation was on the hospital's wish list for eight
years. That's how long it took the ministry of health to approve it.

"We see about 54,000 patients a year in our emergency department and
many of them [up to 30 per cent] are members of the downtown
community's disadvantaged population -- the drug overdosed,
alcoholics, sex trade workers, street kids, those who may have
psychological disorders, plus serious chronic health problems," said
Dr. Jeremy Etherington, chairman of the emergency department.

While up to 30 per cent of the patients who go to the emergency
department may fit that description, it's also a hospital with another
reputation -- for excellence in cardiac and maternity care, organ
transplants and HIV/AIDS treatment. And the pandemonium that has
prevailed in the emergency department was far from pleasant.

"A lot of people who need treatment in the emergency department come
in times of crisis when they're acting out because they may not have
tremendous coping skills, may be delirious or having a psychotic
break," said Etherington, referring to those who caused the turmoil.

"So, in the past if they've been violent or aggressive and needed
restraint they were taken down or sedated, but that doesn't do much
for their dignity and it made it look to all the other patients like
we're doing football tackles in here and it really added to the level
of stress."

With the isolation rooms, patients won't have to be restrained or need
as much sedation.

But Etherington is hoping the new Comox ward doesn't become a victim
of its success.

"We want to stress we didn't build this to attract business from other
areas," he said, referring to other hospitals and jurisdictions.

Nor will patients be allowed to stay in the Comox ward longer than 48
hours, since the care team, made up of doctors, nurses, social workers
and others, will see to it that they are either admitted to the main
part of the hospital for treatment of health ailments or sent
elsewhere, such as Riverview mental hospital.

Chris Moore, the nurse in charge of patient care in the emergency

department, staff in the segregated area have already noticed there is
less screaming and disorderly conduct.

"With patients like those who will come here, you want to minimize the
stimulation and provide a quiet atmosphere so they can calm down," she

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Checked-by: Rich O'Grady