Hennepin Healthcare: Transform Culture of Oppression and Assess Overuse of Medical Force

Jennifer DeCubellis CEO, Hennepin Healthcare Board of Directors, Hennepin County Commissioners

OVERVIEW

Who? Concerned Employees is a multiracial and multidisciplinary group of Hennepin Healthcare workers who came together after George Floyd's murder. With demonstrations spreading, we asked: What can we do as workers to address systemic racism in our corner of the world, at Hennepin Healthcare?

What? Given known disparities in usage of medical force in a wide range of settings across the country, we decided to start there. Medical force involves physical restraint, seclusion, and the coercive use of powerful sedatives.

Demands? After researching the issue, we came up with a few simple demands. When HCMC trains the Minneapolis Police Department, which they have done in the past, we want that training to utilize a trauma-informed care, antiracist, anti-ableist framework - we want them to train the police just like they'd train us. Second, we want transparent data with demographic information on how medical force is used across the healthcare system. Third, we want a public review of that data with the aim of safely preventing and reducing the use of medical force such as restraint and seclusion.  

You can be part of the solution.

We have a lot of racial justice work to do in this country. This petition gives us, both inside and outside of the organization, an opportunity to be part of the solution, bringing the demonstrations we witnessed and participated in last summer into our workplaces and institutions where we can affect change. We have strength in numbers – every signature counts. We won’t get there without you. If you are not employed by HH but you support this work, please sign this petition in solidarity.


HENNEPIN HEALTHCARE:

We are Concerned Employees of Hennepin Healthcare who demand that our healthcare system address its role in perpetuating systemic racism that marginalizes and harms people in our community. We recognize that the same institutional biases that led to the murder of George Floyd pervade our healthcare system. Acknowledging that Hennepin Healthcare has been party to violence against oppressed members of our community - even while we propose to serve that community – is important. To those who have been harmed by these practices, we are deeply sorry and we strive to do better.

Noting the profound impact of Mr. Floyd’s death, and the ways in which that injustice has demonstrated widespread problems of institutionalized racism and ableism, we believe our healthcare system can do much better. Building a just relationship between Hennepin Healthcare and our Twin Cities communities extends from crisis encounters of our Emergency Medical Services in streets and homes, to Hennepin Healthcare clinic and hospital settings, where vital services are provided.

Hennepin Healthcare made this promise: “Our commitment to the community is to move forward in a more visible and action-packed way. We promise to look at racism in our own department and work to dismantle it so our patients receive care that is uniquely tailored to their physical, mental, and emotional health needs. We resolve to fight against systemic racism in this country.”

We challenge Hennepin Healthcare to live up to these words. Now is the time for transformative leadership to prevent coercion and violence from occurring as part of medical care and, to the degree it is possible, at the hands of police. Our frontline staff need real, sophisticated education and resources to deliver sensitive patient care attentive to the influence of historical trauma, mental illness, and addiction that make members of our community vulnerable to violence in their homes, on the streets, and in the hospital.

In crisis, when confronted by authorities issuing commands or directives, people in historically oppressed and traumatized communities often experience fear and threat, which causes fight-or-flight response. Too often, the actions of people under stress are labeled pejoratively as “uncooperative” or “agitated,” which serves to “justify” aggressive responses from authorities, law enforcement and medical personnel, alike. While there are times when behavioral disturbance is a sign of serious illness that demands rapid action, a humane and measured response to persons in crisis greatly reduces use of medical force and prevents additional trauma.

Though Hennepin Healthcare has many compassionate workers, as well as its own expert clinicians and important relationships with community members who emphasize trauma-informed care, cultural humility, and attention to implicit bias in medicine, the institution has not championed those principles in practice.

Instead, Hennepin Healthcare’s past training to the police about managing “uncooperative” or “agitated” individuals, with an emphasis on Excited Delirium Syndrome (ExDS), has misplaced the focus of our expertise and neglected our duty to first do no harm. Providing this ExDS training to the Minneapolis Police Department (MPD) - a police department with a national reputation for racist practices - without a supportive foundation of mental health awareness and skills, has provided medical justification to oppression on the streets of our city. We believe that the misuse of the ExDS label in the prehospital setting has led to unnecessary, involuntary restraint and sedation of community members with the practice disproportionately affecting poor and working class, Black, Native American, Non-Black People of Color, Disabled, and other persons that are systemically oppressed.

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We demand that Hennepin Healthcare redefine its relationships with police and the community with swift, pervasive reforms. We hope these actions will be a step toward creating a hospital system where everyone’s lives are given the value and dignity they deserve.

Whereas Hennepin Healthcare has failed in its role to provide person-centered care due to the influence of systemic racism and implicit bias within its own institutional structures;

Whereas a rare condition known as Excited Delirium Syndrome (ExDS) is associated with violent encounters between police, medics, and community members, including forced treatment of citizens with physical restraints and sedatives which may result in real physical and psychological harm to both citizens and first responders;

Whereas Hennepin Healthcare has trained the MPD on the condition of ExDS, and identifying the features of the syndrome are subjective, increasing the incidence of implicit racial bias;

Whereas, Hennepin Healthcare did not support MPD with training about more common mental health crises outside of ExDS;

Whereas current Hennepin Healthcare usage of medical force reproduces systemic racism and classism in our communities and the harm caused is antithetical to an organizational commitment to health equity.

Therefore be it resolved:

  • MPD TRAINING: Hennepin Healthcare must adopt an anti-racist, anti-ableist, and trauma-informed care framework for potential future trainings of the Minneapolis Police Department. We demand the narrow emphasis on Excited Delirium Syndrome be replaced with a broad-based curriculum that addresses directly how police culture runs counter to the therapeutic approaches necessary for persons in crisis to be treated with dignity, respect, and cultural humility.

  • TRANSPARENT DATA: Hennepin Healthcare must examine whether our practice meets our goals of anti-racist, and trauma-informed care through transparent reporting on the prevalence of restraint and seclusion in the prehospital, emergency, and inpatient settings across the healthcare system

    • We demand the following data with demographic information be shared with this coalition and the restraint committee 15 days prior to a formal meeting with members of the Hennepin Healthcare Board of Directors, and specifically, Jennifer DeCubellis CEO. Total hours of seclusion and restraints for the entire organization on an annual basis, since 2017, by race, gender, age, primary language, housing status, mental health and addiction diagnoses, cognitive impairment diagnosis

      • Discrete incidents of restraint and seclusion, both violent and non-violent, for each department, starting with inpatient psychiatry, acute psychiatric services, and the emergency department with above demographic information

        • Duration of discrete incidents of restraints and seclusion by above demographic information

      • Discrete incidents of chemical sedation and physical restraint in the prehospital setting by the above demographic information

      • Forced medications given based on a medical emergency justification

  • HEALTH EQUITY ACTION PLAN: We demand that Hennepin Healthcare must meet with representatives of this coalition and stakeholders within 45 days of receiving this petition to review the provided data and evaluate disparities in seclusion and restraint. This analysis will be used to identify what resources are needed to safely reduce and prevent the use of seclusion and restraint.

  • COMMUNITY VOICE: Hennepin Healthcare must actively seek direct feedback from members of the Twin Cities community to guide reform, particularly patients who have experienced seclusion and restraint.


Petition by
Tressa Casey
Minneapolis, Minnesota

To: Jennifer DeCubellis CEO, Hennepin Healthcare Board of Directors, Hennepin County Commissioners
From: [Your Name]

HENNEPIN HEALTHCARE:
Transform Culture of Oppression and Assess Overuse of Medical Force

We are Concerned Employees of Hennepin Healthcare who demand that our healthcare system address its role in perpetuating systemic racism that marginalizes and harms people in our community. We recognize that the same institutional biases that led to the murder of George Floyd pervade our healthcare system. Acknowledging that Hennepin Healthcare has been party to violence against oppressed members of our community - even while we propose to serve that community – is important. To those who have been harmed by these practices, we are deeply sorry and we strive to do better.

Noting the profound impact of Mr. Floyd’s death, and the ways in which that injustice has demonstrated widespread problems of institutionalized racism and ableism, we believe our healthcare system can do much better. Building a just relationship between Hennepin Healthcare and our Twin Cities communities extends from crisis encounters of our Emergency Medical Services in streets and homes, to Hennepin Healthcare clinic and hospital settings, where vital services are provided.

Hennepin Healthcare made this promise: “Our commitment to the community is to move forward in a more visible and action-packed way. We promise to look at racism in our own department and work to dismantle it so our patients receive care that is uniquely tailored to their physical, mental, and emotional health needs. We resolve to fight against systemic racism in this country.”

We challenge Hennepin Healthcare to live up to these words. Now is the time for transformative leadership to prevent coercion and violence from occurring as part of medical care and, to the degree it is possible, at the hands of police. Our frontline staff need real, sophisticated education and resources to deliver sensitive patient care attentive to the influence of historical trauma, mental illness, and addiction that make members of our community vulnerable to violence in their homes, on the streets, and in the hospital.

In crisis, when confronted by authorities issuing commands or directives, people in historically oppressed and traumatized communities often experience fear and threat, which causes fight-or-flight response. Too often, the actions of people under stress are labeled pejoratively as “uncooperative” or “agitated,” which serves to “justify” aggressive responses from authorities, law enforcement and medical personnel, alike. While there are times when behavioral disturbance is a sign of serious illness that demands rapid action, a humane and measured response to persons in crisis greatly reduces use of medical force and prevents additional trauma.

Though Hennepin Healthcare has many compassionate workers, as well as its own expert clinicians and important relationships with community members who emphasize trauma-informed care, cultural humility, and attention to implicit bias in medicine, the institution has not championed those principles in practice.

Instead, Hennepin Healthcare’s past training to the police about managing “uncooperative” or “agitated” individuals, with an emphasis on Excited Delirium Syndrome (ExDS), has misplaced the focus of our expertise and neglected our duty to first do no harm. Providing this ExDS training to the Minneapolis Police Department (MPD) - a police department with a national reputation for racist practices - without a supportive foundation of mental health awareness and skills, has provided medical justification to oppression on the streets of our city. We believe that the misuse of the ExDS label in the prehospital setting has led to unnecessary, involuntary restraint and sedation of community members with the practice disproportionately affecting poor and working class, Black, Native American, Non-Black People of Color, Disabled, and other persons that are systemically oppressed.

We demand that Hennepin Healthcare redefine its relationships with police and the community with swift, pervasive reforms. We hope these actions will be a step toward creating a hospital system where everyone’s lives are given the value and dignity they deserve.

Whereas Hennepin Healthcare has failed in its role to provide person-centered care due to the influence of systemic racism and implicit bias within its own institutional structures;

Whereas a rare condition known as Excited Delirium Syndrome (ExDS) is associated with violent encounters between police, medics, and community members, including forced treatment of citizens with physical restraints and sedatives which may result in real physical and psychological harm to both citizens and first responders;

Whereas Hennepin Healthcare has trained the MPD on the condition of ExDS, and identifying the features of the syndrome are subjective, increasing the incidence of implicit racial bias;

Whereas, Hennepin Healthcare did not support MPD with training about more common mental health crises outside of ExDS;

Whereas current Hennepin Healthcare usage of medical force reproduces systemic racism and classism in our communities and the harm caused is antithetical to an organizational commitment to health equity.

Therefore be it resolved:

MPD TRAINING: Hennepin Healthcare must adopt an anti-racist, anti-ableist, and trauma-informed care framework for potential future trainings of the Minneapolis Police Department. We demand the narrow emphasis on Excited Delirium Syndrome be replaced with a broad-based curriculum that addresses directly how police culture runs counter to the therapeutic approaches necessary for persons in crisis to be treated with dignity, respect, and cultural humility.

TRANSPARENT DATA: Hennepin Healthcare must examine whether our practice meets our goals of anti-racist, and trauma-informed care through transparent reporting on the prevalence of restraint and seclusion in the prehospital, emergency, and inpatient settings across the healthcare system

We demand the following data with demographic information be shared with this coalition and the restraint committee 15 days prior to a formal meeting with members of the Hennepin Healthcare Board of Directors, and specifically, Jennifer DeCubellis CEO. Total hours of seclusion and restraints for the entire organization on an annual basis, since 2017, by race, gender, age, primary language, housing status, mental health and addiction diagnoses, cognitive impairment diagnosis

Discrete incidents of restraint and seclusion, both violent and non-violent, for each department, starting with inpatient psychiatry, acute psychiatric services, and the emergency department with above demographic information

Duration of discrete incidents of restraints and seclusion by above demographic information

Discrete incidents of chemical sedation and physical restraint in the prehospital setting by the above demographic information

Forced medications given based on a medical emergency justification

HEALTH EQUITY ACTION PLAN: We demand that Hennepin Healthcare must meet with representatives of this coalition and stakeholders within 45 days of receiving this petition to review the provided data and evaluate disparities in seclusion and restraint. This analysis will be used to identify what resources are needed to safely reduce and prevent the use of seclusion and restraint.

COMMUNITY VOICE: Hennepin Healthcare must actively seek direct feedback from members of the Twin Cities community to guide reform, particularly patients who have experienced seclusion and restraint.