Jim,

I’m an attorney practicing VA law. I’ve read the updated “38 CFR Part 17 Responding to Disruptive Patients” and it looks like Big Brother is alive and well.

Your take?

Reply:

That document is here.

I do not like the use of force by any "enforcement" agency. I always want the police to be on a very short leash and I want much more accountability than we have today.

On the other hand, in my long health care career, I've worked the streets doing ambulance work and I've worked in county hospitals taking care of the casualties left by the Friday Night Knife and Gun Club.

Whether in the VA setting or at the local mall, there are some very dangerous people out there. If they aren't overtly dangerous they are obnoxious and they like making the rest of us uncomfortable by their actions.

When that fringe element acts out, whether in the VA hospital or at Baskin Robbins, I want a trained and well equipped authority figure to deal with them on my behalf. I no longer have the strength or agility to deal with a rowdy myself. I used to...but I realize that at age 62, I'm kidding myself to think I can handle situations like that.

I feel for anyone who may have a mental health issue and is accosted by officers as they get chilled out. I would hate for that to happen.

I think that's rare that law enforcement intentionally abuses an individual who has a mental health problem. Most of the people that this is directed at aren't survivors of MST and they aren't heroic combat veterans, they're jerks.

These jerks write to me often and whine that they have a restriction now that says to get their care at a VA facility they must be escorted by a police officer. That usually happens because they have been unhappy with some 26 year old clerical worker and gone into their screaming and yelling mode in the halls of a VA hospital...often more than once.

As veterans we sometimes scare people. We all have been trained to take human life. For most of us, during active duty our underlying goal in all we did was to blow stuff up and kill human beings. We weren’t teachers or peacekeepers or gardeners, we were warriors. The American military killing machine is the best ever on the planet because of the individuals who are well schooled in the art of maiming others and dedicated to totally defeating any perceived enemy.

We of the Vietnam era are sometimes the scariest of all. We are bikers and we may be homeless and we have long hair and scruffy beards and prominent tattoos and we know that by being loud and aggressive we can get our way. That's how we were trained.

As a group we sometimes have long standing drug and alcohol issues on top of our PTSD problems and when angered, we can get ugly on you, in your face up close and personal in a heartbeat.

The new VA directive is far from perfect. Handling disruptive patients is an old problem. I faced it for years in my civilian health care career. The Joint Commission insisted that hospitals have strict protocols regarding the use of restraints to keep disruptive patients from hurting themselves or others. When a patient could be restrained, how they could be restrained and the length of the time of that restraint has been debated by health care leaders for decades.

http://www.theveteransvoice.com/75_FR_69881_Final_Rule_Responding_to_Disruptive_Patients_20.pdf

Find a knowledgeable health care provider and say the words "Posey Belt" or "Chemical Restraint" and watch their expression. A Posey is a popular restraint system designed to progressively restrain a patient's hands, then legs, then torso in a stepwise fashion as needed.

http://www.handcuffwarehouse.com/posey.html

Chemical restraint is every bit as draconian as it sounds. The aggressive patient is sedated using large doses of powerful drugs that usually also depress the heart rate, breathing and other life supporting functions of the body.

http://medical-dictionary.thefreedictionary.com/chemical+restraint

The VA directive isn't something invented by a harsh bureaucracy in some far away gulag to be used to punish veterans who reasonably express displeasure with VA services. It is meant to offer solutions to a challenging problem that plagues all health care providers...how to protect and serve all customers and providers who may be endangered by an individual who is disruptive or abusive.

If you aren’t one of those who must face the disruptive veteran patient and deal with the consequences of their actions, it’s going to be easy to point a finger and say that the methods noted here are too harsh. I would disagree and invite you to participate in an intervention yourself sometime soon.

I commend those who put the directive forth. It appears reasonable to me.