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| - Sunday, 4/15, I brought my daughter to the PHX Children ER. She's a person with mod- severe autism without a prior history of violence. Without provocation, she assaulted me & family members leaving marks and was unresponsive to communication to calm.When I was standing in line at the ER to be admitted, she began to attack me. I explained my daughter's unprecedented ,violent behavior & showed my wounds to staff. She was given a UTI test, which I was told showed signs of UTI, but they would need to be confirmed by the lab. They started her on Keflex anyway. Later, Staff sent in a social worker who set my daughter up with a psychiatrist for Tuesday 4/17 and the prescription for antibiotics to treat a UTI. The social worker said that we would be discharged as there was nothing else to do now. She stated that my daughter didn't qualify for overnight help at the hospital per policy. Very upset, I escalated this to the Er doctor and clinical supervisor explaining that I was in fear for my safety, my family's safety and her safety. While the staff stepped away to discuss , my daughter and I were left with a behavioral tech. During this time, my daughter for the 3rd time assaulted me in front of hospital staff. The staff then agreed to keep her overnight for observation and gave her two types of medication that didn't work. During this time, she attacked me again and other staff members. It took 2 large men and 3 women to safely hold my extra tall 11.5 year old so that she was safe and they were safe. This happened 2x more times.Staff prescribed a stronger medication.Had I not advocated , we would have been discharged moment s prior to this.She was given a 3rd psychiatric medication . 4/16 AM: we met with a psychiatric nurse practitioner, Barbara Browder who said she would give my daughter some Rx & discharge at noon. I asked her what medication & she exclaimed in an impatient tone ,"Ma'm , I don't know yet! I haven't even seen her chart."( yes, she came into my room to speak as a qualified professional, but yet had not reviewed her patient's chart!!!!) I then asked her if she was aware that my daughter attacked me while under hospital care. Very loudly, "She attacked you?" A nearby behavioral tech replied, "Yes, it's in the notes; she attacked her and some staff." Barbara finally reviewed the notes before she spoke to me again. She stated that she would prescribe something to help with impulsivity, anger, and anxiety & keep her until noon to ensure this med worked. I explained that I was still concerned that it might happen again if we don't know cause. Barbara said that it was likely the UTI and her hormones creating, " the perfect storm." So since the hospital was treating her for UTI and she had follow up scheduled with a psych for next day, I was initially reassured by Barbara. Later I received a text from the hospital lab that UTI was negative. This meant that I still had no explanation & it might recur. So I decided to speak the RN on duty, Sanjay, who was professional. Suddenly Barbara just appeared & essentially dismissed him from the conversation.I tried to state my concerns & asked for overnight ob or at least a short delay in discharge. Barb's tone and demeanor were that of impatience and annoyance. I explained that my daughter's UTI results came in and they were negative for UTI, and pointed out that Barbara had said this was a big part of the reason for the behavior change and that my daughter had NOT been given a psych eval. It seemed as though Barbara thought her authority was being questioned . She then in a sarcastic tone said to me, "I believe YOUR word was that the UTI was the "antecedent." I said yes, I used that word AFTER you said that hormones and UTI likely were the cause. I used to word "antecedent" to summarize what you said to me, but I don't think getting caught up in exact words is really the issue. My concern is her safety." I asked to speak to the clinical supervisor. I witnessed a clinical supervisor Casey, talk with Barbara at length.I was completely looped of the meeting with the clinical supervisor and the psychiatric nurse, Barbara Bowden as they discussed my daughter's case. Mr. Fortenberry , a Director of Social Services, appeared approx 10 minutes after the meeting with Barbara and Casey ended. He was polite & professional and relayed the hospital party line; clearly all decisions had been made with prejudice before speaking to me to get my perspective and thoughts. I let him know in great detail my concerns for my daughter , myself, my family and anyone else my daughter encounters before her psychiatric eval takes place. I let him know that I felt unsafe driving with her. Hospital policy needs to change. The psychiatric nurse practitioner, Barbara Browden needs a refresher course on compassion and communication skills when dealing with families during trauma. Additionally, she might consider reviewing patient files BEFORE meeting with the patient.
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