Lawsuit Leads Hospital to End Patient Strip Searches

Boston's Beth Israel Deaconess Medical Center agreed as part of a settlement of a lawsuit brought by a former patient to change its policy of requiring some psychiatric patients in the hospital's emergency department to remove all their clothing to permit a search for weapons before they can receive treatment.

The case arose in March 2005, after Cassandra Sampson went to Beth Israel's emergency department complaining of severe migraines. The staff learned that she was under psychiatric care and had expressed thoughts of self-harm. Hospital staff asked her to remove all her clothes. She took off most of her clothing but told the staff that having been sexually abused made her fearful of removing her pants. She agreed to be patted down by a doctor to ensure that she was concealing no “unsafe objects.”

Following that, however, she was forcibly stripped by five male security guards. According to her complaint, Sampson was searched, not because of any suspicion that she was carrying a weapon, but because she fit into one of several blanket mandatory search categories requiring clothing removal and search, by restraint if the patient refused, without any room for staff discretion or accommodation of individual patient circumstances, explained Susan Stefan, J.D., M.Phil., director of the National Emergency Department Project of the Center for Public Representation in Newton, Mass., and one of Sampson's attorneys. Sampson was also represented by the Bazelon Center for Mental Health Law in Washington, D.C., and the private Boston law firm of Campbell, Campbell, Edwards, and Conroy.

“A large percentage of female psychiatric patients have a history of sexual abuse, so they are more sensitive to removing their clothes,” said Stefan, in an interview. “I commend the courage of Cassandra Sampson for being willing to come forward and of Beth Israel for [ultimately] doing the right thing.”

Hospital policies for strip searching psychiatric patients vary from state to state and even from city to city within states, said Stefan, author of Emergency Department Treatment of the Psychiatric Patient (Oxford University Press, 2006).

“It's more common than we'd like,” she said. “But there are plenty of hospitals serving similar populations that do not require patients to strip.”

Usually, hospitals claim they apply such policies for safety reasons, but there is no research to suggest that psychiatric patients are especially likely to bring weapons to the emergency department, she said. “There is some indication that overworked [emergency department] doctors want all patients to strip down and wear hospital gowns because it permits them to examine patients more quickly.”

The case raises the question of where the boundary lies between the maximum levels of intrusiveness and the minimum level of safety, said Alec Buchanan, M.D., Ph.D., an associate professor of psychiatry at Yale and chair of APA's Task Force on the Assessment of Violence Risk. Hospitals also have a responsibility for the safety of patients and staff.

“If psychiatric units are to provide safe and therapeutic environments for patients, they must be able to exclude weapons or drugs,” said Buchanan in an interview. “Not every intervention is intrusive.”

At the New Haven hospital where he works, it is not unusual to search—but not strip search—a patient before evaluation, said Buchanan in an interview. The hospital also has a metal detector that patients can be asked to walk through.

Beth Israel Deaconess limited its response to a request for comment to a written statement provided to Psychiatric News by Jerry Berger, director of media relations for the hospital.

“We regret Cassandra Sampson had a difficult experience in our emergency department,” read the statement. “While we are constrained from making a comment about this specific case, it is important to point out that Beth Israel Deaconess Medical Center [and] its nurses and physicians treat every patient as an individual with unique needs.... We believe it is important to continually educate staff and to regularly review our procedures and policies. We are confident our policies and procedures are clear, addressing the interests of patients and protecting the safety of patients and staff.”

Any financial part of the settlement is subject to a confidentiality agreement, said Stefan.

Coincidentally, the February 2008 issue of the newsletter of the American Association for Emergency Psychiatry published a column by Jon Berlin, M.D., of Milwaukee. Berlin called the practice of requiring all psychiatric patients to disrobe in the emergency department “clinically unsound and legally dubious.”

If such a policy were applied to all patients, explained to patients, and handled respectfully, with allowance for exceptions, it might work, he wrote.

“Unfortunately, it is hard to meet all of those conditions uniformly, and the risks are great of retraumatizing a person with sexual abuse issues or escalating individuals that are already agitated and paranoid.... A consultation can help a service to examine what it is in its own institutional culture that perpetuates such a self-defeating practice.”

Spurred by the Sampson case, Massachusetts mental health consumer groups spurred lawmakers to introduce bills in the state legislature to require state regulatory agencies to develop standards for clothing removal. In response, the Department of Mental Health adopted rules saying that patients would be individually evaluated for likely harm, but unless there was “compelling clinical evidence of imminent harm to self or others,” removal of clothing would not be required.

The complaint filed by Cassandra Sampson against Beth Israel Deaconess Medical Center in the U.S. District Court, District of Massachusetts is posted at<www.bazelon.org/pdf/sampson-israel.pdf>.▪