Aiming to alter hospital policy

Rachel Klein said she waited in the emergency department of a Boston hospital for hours before a doctor talked to her about treating a severe headache.

But when she told him she was taking prescription medicine for posttraumatic stress disorder, she was forced into the separate psychiatric section of the emergency room, she said yesterday at the State House. Klein, a 39-year-old Watertown resident, said she was stripped naked, given four shots of a tranquilizer and antipsychotic drug and restrained for 14 hours.

"I was completely helpless," said Klein, vice president of M-Power, a grass-roots organization that advocates for the rights of the mentally ill. "No one should have to suffer this way."

Klein and other advocates for the mentally ill spoke in favor of legislation that would set new state requirements for how psychiatric patients are treated in emergency rooms.

Representative Ruth Balser, a Newton Democrat who is chairwoman of the Committee on Mental Health and Substance Abuse, has filed a bill that would require the Department of Public Health and the Department of Mental Health to adopt regulations for protecting the mentally ill, such as making sure front-line staff are properly trained and that they work with family to calm a patient, rather than using restraints.

Representative Peter Koutoujian, a Waltham Democrat who is chairman of the Joint Committee on Public Health, has filed a bill that would give licensing authority for psychiatric beds in hospital emergency rooms to the Department of Mental Health, rather than the Department of Public Health, where the authority currently resides. Some opponents of the bills would like to see a more collaborative approach.

In written testimony, the commissioners of the two departments reject the legislation. An industry spokesman said that further regulating the two agencies will add another layer of bureaucracy to an already tense system.

Already, state Medicaid patients covered by the MassHealth insurance plan have to be evaluated by four different entities before being admitted to a freestanding psychiatric hospital, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems. Matteodo and the two state departments suggested that the mental health advocates, the departments, and other stakeholders try to find a common solution.

"What is needed is less, not more, administrative oversight in this area," Matteodo said. "We do not believe hospital emergency rooms discriminate against the mentally ill or try to treat them in a negative manner."

In July, the Globe reported that the state investigated at least 21 complaints that emergency departments mistreated psychiatric patients since 2006. Officials cited hospitals in half those cases for problems including unnecessarily forcing patients to undress, punching or hitting them, and restraining some for hours without proper monitoring.

According to Klein and the advocates, her story is one of hundreds across the state of mentally ill patients receiving poor treatment in the emergency rooms of hospitals. They said advocates are sometimes afraid to talk about abuses because they will have to return to the hospital for treatment.

April Simpson can be reached at asimpson@globe.com.