Dangerous When Psychotic

Gregory Nield, a jiu-jitsu champion and message therapist being escorted by a sheriff out of the Penticton courthouse Tuesday morning - John Moorhouse/The Canadian Press

"Savagely attacked and left for dead."

"Nurses on the psychiatric unit at Penticton General [Regional] Hospital said the patient calmly walked out of a closed-door session and announced the staff member [doctor] might be dead."
B.C. Nurses Union Monday press release

"A confused and distraught patient pulled a knife on me [at one time in the past]. Fortunately, we were in an emergency ward and police officers were there."
"That level of severity [of an attack] is very uncommon."
Dr. Bill Cavers, Victoria, B.C., president, Doctors of B.C. (medical association)

"They deal with violence on an almost daily basis."
"The (alleged attacker) was left to wander around the locked unit while nurses tended to the unconscious doctor. There certainly was an opportunity for him to injure someone else."
"[In yet another instance of health-care workers endangered] The nurse [on Sunday at Kamloops hospital] was grabbed by the hair, punched several times and thrown against a wall. She was treated in emergency and is recovering at home from pain and bruising."
"I know it is not the government’s intention to see health professionals suffer injuries at work. But I don’t think health authorities seem to be moving forward. Let’s be clear, this was not an isolated incident."
Gayle Duteil, president, British Columbia Nurses Union

At Penticton Regional Hospital, a facility located in the interior of British Columbia, a 30-year-old patient in the psychiatric ward during a routine, closed-door interview with a doctor last week, suddenly went berserk, attacking the staff doctor, beating him thoroughly and breaking his jaw, then left the room with the doctor unconscious. As he did, he announced that the doctor for all he knew, might be dead.

As the psychiatric patient, Gregory Nield, walked away from the nurses' station where he made his casual statement, he ambled nonchalantly over to the psychiatric unit pool table to pick up a cue. Nurses reacting to his statement, and fearing the potential for more attacks, sent patients hurriedly to their rooms. "Yes, I understand it’s the last remaining pool table in a B.C. psych facility. I expect this (act of violence) will expedite its removal", Ms. Duteil remarked wryly.

Evidently, before the attack occurred, nurses had heard loud noises emanating from the patient interview room where the psychiatrist was conducting a closed-door session. But since the room has only a small window on the door so no one could see what was happening until the patient walked out announcing the doctor might be dead. There are times when closed-door sessions, respecting confidentiality, obviously pose a professional hazard.

It took a while before security guards, alerted to the emergency, reached the scene to take charge of the patient who had suddenly become a violent threat. That, because the base station where the guards can be found is located within a different building from the psychiatric unit. Critical response minutes lapse, even during such urgent calls, necessitating speed of action and response, to access the locked unit.

Which would lead anyone with an ounce of preventive-and-response sense to the opinion that the arrangement is rather less than ideal. If the guard station should logically be located anywhere, it should be within swift reach of the psychiatric unit, and for obvious reasons. On the other hand, violence experienced by health-care-givers takes place anywhere in a hospital setting, not necessarily only in a psychiatric unit.

As an example, a nurse with only four years of experience at Vancouver General Hospital was looking after a patient a month ago when that person suddenly punched her violently, dislocating her jaw. That same young nurse reported having been at various times threatened with scissors, slapped, kicked at, and once run into by an patient in a wheelchair who happened to be enraged at the time of the incident.

She has no thought of leaving her profession for a more gentle one; imagine that, the nursing profession most of us might consider the 'gentle' profession, compassionately and professionally caring for those in health need, finding themselves victims of violence at the very hands of those their professionalism is geared toward making comfort and assurances toward.

A spokesman for the B.C. Nurses' Union described a month ago, thirteen workers at Forensic Psychiatric Hospital in Port Coquitlam reporting attacks. "There are many, many more that are never normally reported." The BCNU is once again trying to persuade the powers that be at the provincial government authority to make some needed security alterations to current, insufficient hospital security practises.

The previous union president had similarly raised concerns about security when reports of 25 staff at Maples, a forensic facility for youth, had been assaulted by violent patients. "I would characterize the actions of the employer [Maples] as wilful disregard for the safety of these people, and complicity in the battery of our members", said Debra McPherson, Ms. Duteil's predecessor. "I consider that to be heinous."

There are some obvious and uncomplicated solutions at hand, and the start could be to equip nurses and other health-care workers with individual, personal alarm system to be used if threatening situations arise, to enable them to expeditiously summon help. The installation of more security cameras in obviously strategic locations could also help. And above all, to place security personnel within psychiatric units.

Dr. Cavers, president of Doctors of British Columbia association thinks "panic buttons" can be  useful, but they should be kept discreetly not visible, to ensure that a potentially violent patient not be provoked and an already tense situation escalated. Because he knows that such threats are not uncommon he has one under his office desk at his clinic in Victoria.

As for Gregory Nield the jui-jitsu champion and registered massage therapist, (a western Canadian champion, he competed in the 2013 World Jujitsu Championships, where he captured a bronze medal in the heavyweight class), on Tuesday he appeared in provincial court charged with assault causing bodily harm and aggravated assault. Judge Gale Sinclair ordered that he undergo further psychiatric assessment before his next court appearance on January 7.