Michael Mozdzierz lives just ten minutes away from Northeastern Vermont Regional Hospital, but he tries to avoid going there when he needs help. But in June of 2018, Mozdzierz was “having a real hard time” after his dog died and he skipped some of his medications. To keep himself safe, he drove to Northeastern’s emergency room.
After arriving at the hospital and getting a checkup, Mozdzierz said he’d decided to leave after arguing with a staffer. As he was leaving the ER, he made both suicidal and threatening statements to hospital staff, his medical records and a police report show, and was forcibly taken back inside—by a county police officer. According to a police report and a report filed later with regulators, a sheriff kneed Mozdzierz twice in the leg, tackled him to the ground with an “arm-bar takedown”—a commonly-taught law enforcement move meant to subdue suspects—and handcuffed him.
For Mozdzierz, it was a scarring experience. “They have a real bad reputation,” he said. “If you go in with mental health problems they just treat you like shit.”
“They could've treated me better and tried to talk to me, convince me to go back in,” he said. “The way they did it was totally uncalled for.”
State regulators who later investigated the incident agreed. “There was no evidence of additional hospital staff being alerted to respond and assist with the management and redirection of [Mozdzierz],” the regulators wrote in their report. “...Patient was not in custody of law enforcement, but remained a patient in need of psychiatric services and hospitalization.”
Cops are not trained in best practices to talk to or help someone suffering with mental health issues, let alone in an emergency room, and often arrest or hurt people they perceive as threatening—or worse. One study found that people with mental illnesses are 16 times more likely to be shot by police, despite a robust body of research showing that the mentally ill are no more dangerous than the average person.
Vermont is a surprising case study in how things can quickly go wrong when hospitals invite police inside. At least nine of Vermont’s 14 emergency rooms, including six of its eight hospitals serving rural populations, have been cited by national regulators over the past five years for improperly calling police to help with mental health patients.
As Vermont’s Department of Mental Health noted in a report from April of this year, federal requirements mandate only hospital staff are permitted to handle patients in psychiatric care. Outside contractors, like private security officers, need to be trained and “under the supervision” of hospital staff when handling patients. And police officers “cannot lay hands on an individual who is committing (or has committed) a crime in the emergency department unless they are going to arrest and remove the individual,” the report said.
But those standards have been ignored in Vermont hospitals in recent years.
One 2016 hospital report describes how a patient seeking treatment for anxiety, depression and suicidal thoughts was tackled by police with an arm-bar takedown; the officers then handcuffed the patient’s arm to a bed. Five officers were called in 2018 to intimidate a patient who was refusing to accept medication for their bipolar disorder. And in two different hospitals last fall, county sheriffs called by staff Tasered two separate patients seeking treatment for mental health issues, neither of whom were in police custody at the time. Only five hospitals nationally were cited in 2018 for the improper use of Tasers; the two in Vermont were the only ones outside major urban areas.
Doctors and nurses in hospitals are allowed to use physical force to calm down a patient who is seeking treatment for mental health issues and is getting agitated or violent. But these medical techniques for restraint, like soft straps to keep a patient in a bed or wheelchair and injectable sedatives, have strict regulations for use. Most techniques police officers use to restrain suspects—like handcuffs, Tasers, and tackling moves—are not considered medically appropriate for a person suffering from mental health problems.
Restraining a mental health patient “is a medical intervention in a hospital,” said Suzanne Leavitt, the state survey director at Vermont’s Division of Licensing and Protection, which licenses and certifies health care organizations in the state.
“If you have the police come in and handcuff somebody, that is not a medical intervention,” Leavitt said.
Vermont and national regulations say that while hospitals may call police for patients committing crimes in ERs, police must arrest the patient and take them into custody after treatment—not act as a security force.
“The hospital cannot call the police and say, we need your help restraining this guy, hold him down please, so we can give him a shot,” Leavitt said.
When hospitals don’t set clear boundaries with police, hospitals can get in trouble with national regulators. Hospitals with multiple bad reports risk losing funding and certification from national and state governments—-a potentially devastating blow to rural populations where medical access, and especially mental health access is already thin on the ground.
Vermont’s problems with police started when floodwaters from Hurricane Irene forced the sudden closure of the Vermont State Hospital, the state’s only hospital with a psychiatric facility, in 2011. Hospitals across the state were suddenly inundated with patients seeking mental health services in emergency rooms not equipped to handle their needs.
Rural healthcare is going through a crisis across the country, with increasing numbers of patients—especially those with mental health issues—competing for dwindling resources at cash-strapped hospitals. In Vermont, rural hospitals “have come to rely on...law enforcement means because they don't have the capacity to manage someone,” said Mourning Fox, deputy commissioner at Vermont’s Department of Mental Health.
Crunched for resources, the Department of Mental Health decided to recruit the police. DMH began footing the bill for sheriff supervision of mental health patients who were involuntarily committed to emergency rooms, including assigning sheriffs to wait with patients in ERs and provide transportation to hospitals with space.
More than eight years after Irene, law enforcement presence is still strong in Vermont’s hospitals. While sheriffs under contract with the DMH receive some training in how to handle mental health crises, the DMH has no say in how emergency rooms communicate patient treatment guidelines with police. And while the state encourages county and town police forces across Vermont to send officers to a training program on how to handle people experiencing mental health crises, DMH can’t mandate participation in the program.
Police techniques used on suspects also “do not fit in from a mental health perspective of treating people with dignity and respect,” Fox said. “Over the last year or so, [regulators have] taken note that, ‘Hey, wait a minute, what's going on here? What do you mean a law enforcement person used a Taser in an ER? What do you mean a sheriff tackled some guy just trying to leave the ER?’ And this is getting the hospitals in trouble.”
Rural hospitals are leaning hard on police help in Vermont. Eight hospitals are designated critical access hospitals, which maintain 25 or fewer beds and serve mainly rural communities. The top seven most expensive payments last year from the state program to provide sheriffs in emergency rooms were to critical access hospitals, of which all but one had been the subject of at least one citation involving police conduct.
It’s not just police sent to hospitals by the state that are an issue. Many of Vermont’s citations have to do with local police called by hospital staff. Several of the incidents over the past five years involved patients who had voluntarily admitted themselves to hospitals for mental health problems—iincluding at least one patient who was Tasered.
One Vermont hospital has turned directly to local police for its security. Northeastern Vermont Regional Hospital, where Mozdzierz went, contracts with its county sheriff’s office to have police double as the hospital’s security force. While under this contract, the hospital has been cited three times for sheriffs using excessive force and unapproved tactics on patients over the past five years, with two incidents in 2018 alone. Northeastern was the site of one of the tasing incidents last fall, where a county officer tased a patient twice after he went “into a boxing stance,” according to a police report.
Seleem Choudhury, who until May was Northeastern’s Chief Nursing Officer, insisted that the incidents were outliers and that the hospital has corrected its practices. “When a patient becomes incredibly violent, we do defer to using the police,” he said. “If a nurse or doctor enters the room and gets beat up, then it becomes a law enforcement issue.” The issue is also not restricted to Vermont: In January, regulators wrote up a hospital in Maryland that had contracted with local police, noting in the report that the hospital had failed to train police in appropriate restraints and provide guidance on the use of weapons.
Hospitals can be dangerous places for employees: the US Department of Labor ranks hospitals as one of the most hazardous places to work. In 2014, hospitals worked with legislators in Indiana to create a bill that allows the state’s medical centers to form their own police forces to help with security.
Both Choudhury and Sheriff Dean Shatney of Caledonia County, whose officers are dispatched to Northeastern, said the officers on duty mostly patrol the hospital’s parking lot and do not get involved with patient care. Shatney added that all officers under his supervision had taken all training on responding to people mental health crises offered by the state, including one voluntary program he described as an “advanced course.” When a crisis arises, he said, his officers’ first goal is “to keep everyone safe.”
But there is no evidence that Northeastern is communicating any better with the police it has hired about how to navigate mental health crises in a hospital setting since last year’s complaints. A copy of the 2019 security contract between the county and the hospital provides no details or specifics on how officers should support hospital staff in dealing with psychiatric patients (and the contract for 2020, Shatney confirmed, has no changes with regards to training).
The hospital would not confirm if it had provided any supplemental rules or training around the treatment of mental health patients to the police it employs in recent months. A follow-up report made by regulators in November 2018 noted that the hospital still “lacked clarification defining Security's/law enforcement's role during behavioral interventions.” (The hospital told regulators it would outlaw use of law enforcement weapons, like Tasers and batons, as part of its corrective actions to respond to the violation. A training model for staff included by the hospital makes no mention of police presence.)
In May, Vermont’s legislature voted to give funds to the DMH to help the state’s hospitals get more staffing and support for patients with mental health issues. Fox said that the promise of this new funding has made hospitals lean on police less in recent months. Plus, he said, “word got out that they’re getting in trouble” for using the cops.
Mozdzierz said he’s staying cautious.
“When I’m up at [Northeastern], I’m DTA—don’t trust anybody,” he said. “I think about what happened last May, and my rights were definitely violated.”