Anna Brown was 29 years old when she died suddenly last
September.
She left two small children.
Sometimes, the tragic and untimely death of a young mother commands
our attention. Anna’s death in Missouri drew
a little national interest just last week.
She died alone on a concrete jail cell floor. It happened just a few minutes after she was arrested
for trespassing. She refused to leave a
hospital emergency room while she was in agonizing pain.
Anna Brown was
homeless, had mental illness, and was on Medicaid. Hospital officials thought she was a
drug-seeker. They were wrong.
According
to news reports, a morning fog blanketed St. Louis on September 20, 2011 –
the day Anna died. She spent much of her
final day going from emergency room to emergency room begging for care. She started at St. Louis University Hospital
complaining of pain in her leg. She was
evaluated and released with a prescription for painkilling medication.
Unsatisfied with her care, she went next door to Cardinal
Glennon Children’s Medical Center. There
clinicians found tenderness in her leg, but explained that they could not treat
her because she was not a child.
Her pain was so bad that she could not walk. So she was transported by ambulance to a
third hospital, St. Mary’s, where she was diagnosed with a sprained ankle.
But Anna Brown was afraid something more serious was wrong
with her. So when St. Mary’s said she
could go, Anna Brown refused.
That’s when St.
Mary’s had her arrested for trespassing.
A police officer later reported that “they thought that she
was a drug seeker.” The police wheeled
her out of the hospital in handcuffs.
When she arrived at the jail, she was having trouble
breathing. Officers placed her on the
floor of her cell and left her alone. She
died within fifteen minutes of undiagnosed blood clots in her leg that traveled
to her lungs.
What a tragedy.
It was compounded by others in Anna Brown’s life.
She had lost her house a couple of years earlier to a
tornado. She lost her job shortly
thereafter. When she could no longer afford
to pay her heating bills, her service was discontinued and she took to building
fires in her apartment to keep her children warm.
Child protective services found out, and the state removed
her children from her care.
Her mother took in the children, and reported that the
family court gave her a choice – she could care for Anna’s children or Anna,
but not both. She was forced to choose
her grandchildren over her daughter.
So Anna became homeless.
At the time of her death, she was using city shelters and frequenting a
drop-in center for people with mental illness.
Contrary to the assumptions of the clinicians who examined her on her
last day of life, she was not using drugs.
Too much of Anna’s
story isn’t uncommon.
We have all read reports about patients
with mental illness “flooding” hospital emergency rooms because of state
cutbacks to mental health services.
These usually suggest that patients choose emergency rooms
for non-emergency health reasons because they have no place else to go.
In defending its actions just last week – a full six months
after Anna Brown’s death – St. Mary’s Hospital sounded this theme. It issued a statement
that read in part “the sad reality is that
emergency departments across the country are often a place of last resort for
many people in our society who suffer from complex social problems that become
medical issues when they are not addressed.”
That statement may be true.
But Anna Brown wasn’t suffering from “complex social problems” when she
showed up at St. Mary’s.
She was suffering from neglect of her medical
condition. That neglect didn’t begin at
St. Mary’s; it just ended there.
And we are mistaken
if we think this doesn’t happen every day in every state in the nation.
Medicaid emergency room co-pays, cuts to mental health and
substance abuse treatment, inadequate funding to combat homelessness, and
anti-loitering laws are all just symptoms of this neglect.
Anna Brown died from blood clots, but she also died because
too many people looked past her suffering and saw a caricature of a homeless,
mentally ill patient, and jumped to a conclusion about what they think such a
patient represents.
Anna Brown may have visited far too many emergency rooms on
the day she died, but the fault wasn’t hers. And she and her loved ones paid the price.
If you have questions about this column or would like to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.
What a senseless tragedy. If only the medical staff had taken a few additional tests - it would not have transpired. And to die alone on the floor of a jail cell because her symptoms were not heeded - is incomprehensible.
ReplyDelete"But Anna Brown wasn’t suffering from 'complex social problems' when she showed up at St. Mary’s.
ReplyDeleteShe was suffering from neglect of her medical condition. That neglect didn’t begin at St. Mary’s; it just ended there."
Masterfully written.
A couple of things seem to beg for clarification. You wrote that "hospital officials thought she was a drug-seeker" then later that "A police officer later reported that 'they thought that she was a drug seeker.'" Which means the police themselves independently apprised this as well? I read in other news articles that she was discharged with a prescription for pain killers. We know that a prescription is not needed for Tylenol, so the prescription must presumably have been for narcotic pain relievers. If so, why would she be waiting around the hospital to get drugs, if she already had what they believed she had come for? It doesn't add up.
The other thing is when you wrote that "so when St. Mary’s said she could go, Anna Brown refused." Is it a refusal when someone is unable to do something? Is it a refusal if by that point she wasn't able even stand up much less walk? I think more clarification is needed. You wrote that on admission "her pain was so bad that she could not walk." If that was still the case, where was she supposed to go, and how was she to get there? Did anyone ask?
It was the police who reported in a taped conversation that the clinicians at the third hospital - St Mary's - thought she was a drug seeker. She had been given the pain prescription at the first hospital. I imagine that they concluded she was drug-seeking possibly because they were aware that she already had one prescription with her but more likely because they knew she had come directly from another hospital via ambulance complaining of pain, and then they (St Mary's) didn't find the clot or anything else wrong with her. In the video image accompanying at least one article, she is clearly sitting on the floor. It is possible that the hospital thought she was faking her inability to walk and conveyed this to the police, because the police didn't seem to handle her very gently and because the same officer reported that the attending physician was clear in saying that she was ready for discharge. As to where anyone thought she was supposed to go in her condition,or how she was supposed to get there, your guess is as good as mine.
DeleteMy understanding is she had come to St. Mary's by ambulance from the children's hospital, where she had only a cursory assessment at because it was a children's hospital which she had gone to by mistake (or perhaps because she couldn't walk any further?). How much her appearance there figured into assessing her mental state, I don't know. I'm not familiar with St. Louis, but I'm assuming not all children's hospitals have "Children's" printed in giant letters across their entrances.
ReplyDeleteI had a similar reaction as Jayar Jackson, who stated, speaking of the police: "They drag her from the wheelchair on the floor of the hospital, drag her from there to the car, drag her from the car to the jail, and drag her to the prison cell, and leave her on the ground groaning. How much more faking can you possibly do?! Damn, these drugs must be really important to her!" You seem to suggest that St. Mary's--aware of her previous prescription--thought she wasn't at that point seeking medication as an addict in need of an immediate 'fix' would, but that she was rather seeking to stockpile it. Which makes it all the more difficult to believe for a layperson that such a patient would engage in so persistent of a feat of acting, spanning many hours. Is there anything in the literature you've seen of something like that ever happening before? If so, could you kindly share any reference(s)?
I've never seen anything suggesting this. But I don't want to lose the point that in this case she clearly wasn't just drug-seeking. And while many clinicians are not trained to recognize symptoms of mental illness, her mental illness should not have been the issue here - she had a physical problem. I am aware of instances where physical problems were missed because the person's mental illness wasn't diagnosed, and where physical problems masked mental illness - but from the reports neither seemed to be the case here.
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