When the hospital fires the bullet

In an undated handout photo, Alan Pean, with his mother and father, after he was shot in August inside St. Joseph Medical Center in Houston where he entered the hospital seeking treatment of possible bipolar disorder. More and more hospital guards acro...

When doctors and nurses arrived at Room 834 just after 11 a.m., a college student admitted to the hospital hours earlier lay motionless on the floor, breathing shallowly, a sheet draped over his body. A Houston police officer with a cut on his head was being helped onto a stretcher, while another hovered over the student.

Blood smeared the floor and walls. “What happened?” asked Dr. Daniel Arango, a surgical resident at the hospital, St. Joseph Medical Center.

The student, 26-year-old Alan Pean, had come to the hospital for treatment of possible bipolar disorder, accidentally striking several cars while pulling into the parking lot. Kept overnight for monitoring of minor injuries, he never saw a psychiatrist and became increasingly delusional. He sang and danced naked in his room, occasionally drifting into the hall. When two nurses coaxed him into a gown, he refused to have it fastened. Following protocol, a nurse summoned security, even though he was not aggressive or threatening.

Soon, from inside the room, there was shouting, sounds of a scuffle and a loud pop. During an altercation, two off-duty Houston police officers, moonlighting as security guards, had shocked Pean with a Taser, fired a bullet into his chest, then handcuffed him.

“I thought of the hospital as a beacon, a safe haven,” said Pean, who survived the wound just millimeters from his heart last Aug. 27. “I can’t quite believe that I ended up shot.”

Like Pean, patients seeking help at hospitals across the country have instead been injured or killed by those guarding the institutions. Medical centers are not required to report such encounters, so little data is available and health experts suspect that some cases go unnoticed. Police blotters, court documents and government health reports have identified more than a dozen in recent years.

They have occurred as more and more U.S. hospitals are arming guards with guns and Tasers, setting off a fierce debate among health care officials about whether such steps — along with greater reliance on law enforcement or military veterans — improve safety or endanger patients.

The same day Pean was shot, a patient with mental health problems was shot by an off-duty police officer working security at a hospital in Garfield Heights, Ohio. Last month, a hospital security officer shot a patient with bipolar illness in Lynchburg, Virginia. Two psychiatric patients died, one in Utah, another in Cincinnati, after guards repeatedly shocked them with Tasers. In Pennsylvania and Indiana, hospitals have been disciplined by government health officials or opened inquiries after guards used stun guns against patients, including a woman bound with restraints in bed.

Hospitals can be dangerous places. From 2012 to 2014, health care institutions reported a 40 percent increase in violent crime, with more than 10,000 incidents mostly directed at employees, according to a survey by the International Association for Healthcare Security and Safety. Assaults linked to gangs, drug dealing and homelessness spill in from the streets, domestic disputes involving hospital personnel play out at work, and disruptive patients lash out. In recent years, dissatisfied relatives even shot two prominent surgeons in Baltimore and near Boston.

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey, more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with the mentally ill.

Massachusetts General Hospital in Boston, for example, sends some of its security officers through the state police academy, but the strongest weapon they carry is pepper spray, which has been used only 11 times in 10 years. In New York City’s public hospital system, which runs several of the 20 busiest emergency rooms in the country, security personnel carry nothing more than plastic wrist restraints. (Like many other hospitals, the system coordinates with the local police for crises its staff cannot handle.)

After Pean’s shooting, St. Joseph’s chief executive, Mark Bernard, said the officers were “justified.” The hospital said it was reviewing its practices but declined to respond to questions. The Houston Police Department, citing an internal investigation, declined to comment and released only a heavily redacted version of its report on the shooting. This account is drawn from a review by federal health investigators, medical records, criminal complaints and interviews with medical personnel and family members.

Pean had expected an apology after the shooting. Instead, during four days in intensive care, prosecutors charged him with two counts of felony assault on a police officer. They accused him of attacking with four “deadly weapons” — an unspecified piece of furniture, a wall fixture, a tray table and his hands.

An ambiguity in Medicare rules allowed Alan Pean’s conversion from delusional patient to felony suspect. If a patient throws a tray at a nurse and the staff responds with restraints, it can be considered a health care incident. If the same patient throws the same tray at a police officer, even one off-duty, who shoots in response, the encounter is subject to a criminal investigation.

While Pean was in the intensive care unit, he was handcuffed to his bed, even though he was heavily sedated, with a Houston police officer standing guard. His family had to post $60,000 bail days later so he could be discharged from the hospital.

Pean’s felony case is likely to go before a grand jury in the coming months. Under the care of a psychiatrist and on medication, Pean left Texas behind. Living with his brother in New York, he is finishing his degree at Hunter College and planning to go to graduate school in public health.

But the day before Christmas, Pean learned that prosecutors had brought a new charge — reckless driving — against him, referring to his race to the hospital.

Accompanied by his father, he flew to Houston. In five hours of processing at the Harris County Detention Center, Pean was interviewed by a detention officer, photographed for a mug shot and fingerprinted.

“Being paraded around was really stressful,” he said. “Did they not understand what I’d gone through? I’d been shot in a hospital room by an officer.”