Many mental health professionals strongly object to weapons in hospitals, saying they have numerous other means — from talk therapy to cloth restraints and seclusion rooms to quick-acting shots of sedatives — to subdue patients if they pose a danger. State mental health facilities typically do not allow guns or Tasers on their premises; even police officers are asked to check weapons at the door. (Twenty-three percent of shootings in emergency rooms involved someone grabbing a gun from a security officer, according to a study by Dr. Gabor Kelen, director of emergency medicine at Johns Hopkins Medical School.) Uniforms and weapons may, in fact, tam trang an toan o tp hcm exacerbate delusions, since dia chi nang nguc tin cay dia chi nang nguc tin cay many psychotic patients are paranoid and, like Alan Pean, Anxious Patient to Felony Suspect Racing upstairs to a Code Blue in Room 834, Dr. Arango found a cluster of about 20 Houston police officers in the hall, according to his interview with investigators. When he pulled back dia chi nang nguc o tphcm the sheet covering Mr. Pean, he tam trang an toan o sai gon saw that the patient was in handcuffs, his torso dotted with Taser probes and a bloody wound on his upper chest. It was only after the doctor noted the blood pooling around the young man, who began shouting that he was Superman as the physician tried to examine the wound, that someone mentioned he had not only been hit with the Taser, but also shot. Advertisement Continue reading the main story “Take the damn handcuffs off!” Dr. Arango yelled, according tam trang an toan spa to an employee believe they are being pursued. Anthony O’Brien, a researcher at the University of Auckland, in New Zealand, said, “That’s not a good thing, pointing something that looks like a gun at a patient with mental health issues.” When the two Houston officers arrived on St. Joseph’s eighth floor, they phau thuat nang nguc o dau dep headed for Room 834. Unannounced, and unaccompanied by doctors, nurses or social workers, they went in, the door closing behind them.

‘No Clear Guidance’ While St. Joseph does have a psychiatric ward, Mr. Pean was never seen by a psychiatrist or prescribed any psychiatric medicines before the shooting. Because he had complained of back pain, he was given Flexeril, a muscle relaxant, which can exacerbate psychotic symptoms. In interviews with the Medicare investigators phau thuat nang nguc o dau an toan and notations in medical records, the nurses who cared for Mr. Pean describe a man who had flashes of lucidity, but was increasingly restless and bizarre. Like many other security firms, Criterion encourages applications from those with law enforcement or military backgrounds, who are trained to use weapons and to deal with volatile situations. But working in health care settings requires a different mind-set, security experts emphasize. “If they come from law enforcement or the military, I ask them directly, ‘How would you respond differently here than if you encountered a criminal on a street in L.A. or when you are kicking down a door in Iraq?’” said Scott Martin, the security director at the University of California, Irvine, Medical Center. “You have to send the message that these are patients, they’re sick, the mental health population has rights — and you need to be sensitive to that.” He pulled out the IV in his arm. He thought it was 1989. He could not phau thuat nang nguc an toan nhat remember the car crash or why he was in a hospital. But even in the throes of his illness, he was polite. When a nurse told him to return to his room after he repeatedly heir son to a psychiatric facility. In their 30-minute absence, a nurse made the call to security. At St. Joseph Medical Center, the tam trang an toan uy tin security force included armed off-duty police officers as well as unarmed civilian phau thuat nang nguc o dau uy tin officers. Who responded to a call depended only on availability, according to the investigators’ interview with the chief nursing officer. The two men who arrived were Houston police officers. Roggie V. Law, 53, who is white, and Oscar Ortega, 44, who is Latino, each had decades on the force. They supplemented their base salaries of about $64,000 by moonlighting at the hospital. Their records were unremarkable. Both had some commendations, and Officer Ortega had one distant four-day suspension for failing to submit an accident report. Houston police officers get 40 hours of crisis intervention training, according to the department. The N.A.A.C.P. and the Greater Houston Coalition for Justice, a civil rights group, have complained that local officers too often use their weapons, and repeatedly requested the appointment of an independent police review board. From 2008 to 2012, there were 121 police shootings, in which a quarter of the victims were unarmed, according to an investigation by The Houston Chronicle. emerged naked into the hall, he complied, she told investigators, with a “Yes ma’am, righty-o, O.K. ma’am.” Though the trauma team had planned to discharge Mr. Pean that morning, his parents were so alarmed when they arrived about 10 a.m. that they tam trang o dau re ma an toan insisted a psychiatrist see him. As they waited for doctors to discuss their concerns, the Peans went to their nearby hotel to try to rent a car and drive their son to a psychiatric facility. In their 30-minute absence, a nurse made the call to security.

He was prone to bouts of sadness tam trang an toan gia re and anxiety, he recalled in an interview, but had attended college, taking breaks from time to time, and worked for a while as a medical assistant back home in McAllen, near the Mexican border. Though he had smoked marijuana regularly to help tame his symptoms, he said in an interview, he quit last summer when he enrolled at the University of Houston to complete his bachelor’s degree. Just days Turning into the parking lot just before midnight, he crashed, nearly totaling his vehicle. As Mr. Pean was helped into the emergency room and onto a stretcher by paramedics and nurses, he recalled, he yelled: “I’m manic! I’m manic!” Photo Alan Pean’s white Lexus. He struck tam trang o dau an toan gia re several cars after driving himself to St. Joseph Medical Center for treatment of possible bipolar disorder. Prosecutors later charged him with reckless driving. He was seen immediately nang nguc noi soi o dau uy tin by a doctor from the trauma team to assess his injuries (scans and exams showed none). The physician’s initial note, minutes after arrival, lists the young man’s history of bipolar disorder. His father and brother, in separate phone calls to the emergency room, and a family friend who came to the hospital, alerted the staff about his psychiatric issues, they recalled. Nonetheless, Mr. Pean was admitted for observation to Room 834 on a surgical floor. The diagnoses: hand abrasion, substance abuse, motor vehicle accident. His toxicology tests were negative for alcohol, opiates, PCP or cocaine, records show. (They did disclose some THC, the active ingredient of marijuana, but the chemical remains in the body for many weeks.) into the semester, though, he barely slept and found himself increasingly agitated and delusional. On Aug. 26, he talked repeatedly phau thuat nang nguc chay xe gia bao nhieu on the phone tam trang re ma an toan with his parents and brothers, who tried to calm him but worried that he sounded disoriented. Christian had been concerned enough that he called the Houston police to do a “welfare check” on his brother at his apartment, though no one answered the door when officers arrived. When Mr. Pean sounded worse in the evening, his family nang nguc chay xe o dau an toan summoned a fraternity brother in Houston to take him to an emergency room; his parents would fly in the next morning. But Mr. Pean did not wait. His mind vacillating between the knowledge that he needed psychiatric medication and encroaching delusions that he was a Barack Obama impersonator or a “Cyborg robot agent” who was being pursued by assassins, he said, he got into his white Lexus and drove at high speed to St. Joseph Medical Center, the only major hospital in downtown Houston.

like emergency rooms and parking nang nguc uy tin o dau areas — and supervision, weapons save lives and defuse threatening situations. The Cleveland Clinic, which has placed metal detectors in its emergency room, has its own fully armed police force and hires off-duty officers as well. The University of California medical centers at Irvine and San Diego and small community hospitals are among the more than 200 facilities that use stun guns produced by Taser International, which has courted hospitals as a lucrative new market. “I’ve worked in systems where everyone r. Pean had expected an apology after tam trang an toan ma hieu qua 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. Advertisement Continue reading the main story James Kennedy, a lawyer representing Mr. Pean, says nang nguc an toan nhat his client disputes that he was the aggressor and other allegations by the police, but cannot discuss specifics until the charges are resolved. His family has filed complaints with the Justice Department and health care regulators, including the Centers for Medicare and Medicaid Services, which provides funding to most American hospitals. After an emergency investigation, the Medicare agency faulted St. Joseph for the shooting, saying it had created “immediate jeopardy to the health and safety of its patients.” Threatening to withdraw federal money, the agency demanded restrictions on the use of weapons. A family with Haitian and nang nguc chay xe o dau Mexican roots who settled in McAllen, Tex., the Peans were shocked that Mr. Pean’s effort to get medical aid ended so badly. Though his father, Harold Pean, and a half-dozen other relatives are physicians, they said they had no idea that guns could be used against patients. After watching the nation roiled by the shootings of unarmed black “We never thought that would happen to us,” Dr. Pean said. ‘I’m Manic!’ In his family of high-achievers, Alan Pean tắm trắng an toàn hiệu quả tphcm (pronounced PAY-on) is the soft-spoken and mellow middle sibling, into yoga, video games and pickup football. Christian, 28, now a medical student at Mount Sinai in New York, is the Type A leader; Dominique, 24, is following his path, applying to medical school while pursuing a master’s degree. Alan, who had never been in any sort of trouble, is “probably the nicest of us three,” Dominique said. Like many people with mental health issues, he did not get a clear-cut diagnosis. After a brief delusional episode in 2008, he was hospitalized for a more severe recurrence the next year, at the end of his second year at the University of Texas. He was kept for a week and told that he had possible bipolar disorder, though his symptoms did not reappear for years even after he tapered off medication men by police officers over the last year or so, the family now wonders whether race contributed to Alan’s near-fatal encounter. has a firearm and an intermediate weapon, and I’ve worked in systems where a call to security meant the plumber and every able-bodied man would respond,” said David LaRose, past president of the health care security association. “How much has your system thought about safety and security? In some places that’s a 2 or 3; in some places it’s a 10.” After Mr. Pean’s tam trang an toan hieu qua nhanh nhat 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 or to make the officers available for interviews, 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.

Mr. Pean, patients seeking help at tắm trắng an toàn hiệu quả ở đâu 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 American 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. Continue reading the main story RELATED COVERAGE ospitals can be dangerous places. From tắm trắng ở đâu an toàn tphcm 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 nâng ngực tự nhiên 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. That was 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 people who have a mental illness. 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 nâng ngực có an toàn không 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.) “Tasers and guns send a bad message in a tắm trắng ở đâu thì an toàn health care facility,” said Antonio D. Martin, the system’s executive vice president for security. “I have some concerns about even having uniforms because I think that could agitate some patients.” One Patient’s Story: ‘That’s a Kill Shot’FEB. 12, 2016 The same day Mr. 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, Va. Two psychiatric patients died, one in Utah, another in Ohio, after guards repeatedly shocked nang nguc uy tin them with Tasers. In Pennsylvania and Indiana, hospitals

like the two-million member Service Employees nang mui uy tin chat luong International Union, are not part of the federation.) Exit and entrance polls from the Iowa and Nevada caucuses showed voters from union households favoring Mrs. Clinton over Mrs. Sanders by a roughly 10-point margin — greater than the margin by which Mrs. Clinton won those contests overall. Still, that 10-point margin — assuming it is correct, which is not necessarily assured — may reflect a narrowing of the gap between the two candidates among union members since last fall. In the three polls that Afscme conducted between last May and October, more than 60 percent of its Democratic members consistently backed Mrs. Clinton, versus no more than 20 percent who backed Mr. Sanders. It is impossible to know nang mui o dau dep an toan the margins by which members of specific unions voted for Mrs. Clinton in this year’s early primary contests, but other evidence suggests significant pockets of support for Mr. Sanders. The Afscme council in Washington State endorsed him in January, and a prominent service employees union local in New Hampshire endorsed him in November. mp said he wanted to punch a protester, who had been ejected from the event, in the face. On the eve of what could be Mr. Trump’s third nâng mũi cho nam giới consecutive victory among a fractured Republican presidential field, the protester — the third one to interrupt him at the event and who Mr. Trump said had d his supporters about the importance of “voting” — he said he hated the word “caucusing” — and told them that they should go into Tuesday night expecting a tie, to help energize them. But he also issued a warning to them: “Don’t make me have a miserable evening.” Mr. Trump, leading in the number of delegates tắm trắng an toàn tại cần thơ and states won in the nominating contest, also turned his attention to the general election, saying he would be aggressive against Hillary Clinton and repeatedly raising the specter of her email scandal. thrown punches at security guards — really drew the candidate’s ire. As the man was being escorted away, Mr. Trump repeatedly told the crowd that he wished for the “old days,” adding, “You know what they used to do to guys like that when they were in a place like this? They’d be carried out on a stretcher.” “I’d like to punch him in the face, I’ll tell ya,” Mr. Trump added. Mr. Trump has faced criticism over his response tam trang an toan o can tho to protesters before. After a Black Lives Matter demonstrator was pushed to the ground at one of his events in November, Mr. Trump said in an interview after the episode that “maybe he should have been roughed up,” before later pulling back from his comments. But on Monday night, he held nothing back, and the crowd of thousands met every one of his lines with whooping cheers. Addressing another protester, a man holding a sign that read, “Veterans to Trump: End Hate Speech Against Muslims,” Mr. Trump repeatedly said, “Get him the hell out,” as the crowd booed the man’s exit. But Mr. Trump didn’t limit his rough talk to the protesters. Referring to the Iranians who took 10 Navy sailors hostage in January, Mr. Trump said the leader of the Iranians was a “rough Ms. Weingarten suggested that some of the tam trang an toan khong bat nang blame for confusion about the level of labor support for Mrs. Clinton resided with the A.F.L.-C.I.O., which she said had given the impression that a Clinton endorsement might be imminent in the run-up to this week’s meeting, and to a similar meeting last summer. She pointed out that many unions were increasingly forming ad hoc alliances outside the federation to work on key issues, like pensions and the ability of unions to collect fees from nonmembers. “The traditional role the A.F.L. is supposed to have is marshaling all this energy, and they’re not doing it, we’re doing it ourselves,” she said. “This in some ways is just more of that. Frankly I’m surprised the A.F.L. put itself in position, both in July and now, where they were creating an expectation

ddress, in observance of his birthday. In it, he ecause there’s now a story where there should not have been one — certain people in the Bernie camp wanted to take advantage of it — the unions that tắm trắng da ở đâu tốt endorsed Hillary want to make really clear to people that we are incredibly supportive of her.” The A.F.L.-C.I.O. endorsed Vice President Al Gore in October 1999, shortly before he competed against former Senator Bill Bradley in the 2000 Democratic primaries. It endorsed Senator John Kerry in February 2004, after Mr. Kerry had piled up victories in more than a dozen contests, including the Iowa caucuses and the New Hampshire primary, and appeared on his way to the nomination though he still faced a challenge from Senator John Edwards. (Mr. Edwards finished unexpectedly close to Mr. Kerry in the Wisconsin primary shortly before the federation’s endorsement that year.) In 2008, the A.F.L.-C.I.O. did not endorse a Democratic candidate out of fear that pushing forward with a vote could be divisive. Others worried that a vote could divide the labor movement more broadly. “I do believe it would not be beneficial to push the issue,” said Lee Saunders, president of the 1.6-million member American Federation of State, County, and Municipal Employees, or Afscme, which has also endorsed Mrs. Clinton and was part of the joint statement. “Everyone will have to come together when there’s a Democratic candidate.” In truth, both nâng mũi an toàn sides have evidence to back up their claims about the state of the race among union voters. Mrs. Clinton has the endorsement of 23 unions, versus three for Mr. Sanders, and the unions that tam trang an toan cho da have endorsed her represent more members than all the unions in the A.F.L.-C.I.O. (S — Barack Obama — until June, by which point Mr. Obama had already effectively laments the rise of factions and political parties as a threat to the new government’s ability to get things done. “All obstructions to the execution of the laws, all combinations and associations, under whatever plausible character, with the real design to direct, control, counteract or awe the regular deliberation and action of the constituted authorities, are destructive of this ecretary Clinton has proven herself as the fighter and champion working people and their families need in the White House,” says the statement, which was embraced by several large unions, including the American Federation of State, County, and Municipal Employees, the American Federation of Teachers, and the Service Employees International Union. “That is why, of all unions endorsing a candidate in the Democratic primary, the vast majority of the membership in these unions has endorsed her.” The statement is partly a reaction to the aftermath of the announcement by the A.F.L.-C.I.O., a federation of unions, that it would not vote during its executive council meeting this week on whether to endorse a candidate in the Democratic presidential primaries, essentially postponing an endorsement until the primaries are no longer competitive. “I have concluded that there is nang mui an toan o dau broad consensus for the A.F.L.-C.I.O. to remain neutral in the presidential primaries for the time being,” Richard L. Trumka, the A.F.L.-C.I.O. president, said in an tam trang an toan chat luong email to union officials last week. Supporters of Mr. Sanders argued that the decision not to hold an endorsement vote reflected substantial enthusiasm for him among rank and file union voters, even within unions that had already endorsed Mrs. Clinton. “I would say over all that union nâng mũi uy tín members are divided,” said Larry Cohen, a senior adviser to Mr. Sanders and past president of the Communications Workers of America. “It’s significant given where we were fundamental principle, and of fatal tendency,” Washington wrote. “They serve to organize

inton, depending on how delegates are allocated in Clark County, will end up with more pledged delegates from the caucuses than Senator Bernie Sanders. That would give her a lead not just in pledged delegates, which are won in states, but in superdelegates as well. A lead in both categories eluded her in the 2008 race against Barack Obama, and, if it holds through Super Tuesday and beyond, it would render moot some of the complaints against her from progressive groups. And the results in Nevada, just as the final numbers in Iowa did, vindicated for many in the Clinton orbit the approach and style of Robby Mook and awe of a New York real estate developer-turned-reality television star’s winning the South Carolina Republican primary on Saturday night blotted out As for the Republicans, it is their turn to head to Nevada, where Donald J. Trump owns a hotel and has a commanding lead. Caucuses did not favor Mr. Trump in Iowa, where organization mattered a great deal and where his campaign was not well prepared. Nevada, as well as the Super Tuesday states, will be another big test of his ability to organize. But despite some signs of weakness that nâng mũi s line 3d showed in South Carolina in his base of support, Republicans who oppose Mr. Trump are increasingly fearful that, with a divided field of candidates and Democrats were trying to work together to pass bipartisan legislation on criminal justice, energy policy and an escalating drug crisis. Now the bitter dispute over whether Senate Republicans are nâng mũi bọc sụn willing to even take up the nomination is likely to spill over into the other items on the Senate agenda, as both sides eye each other warily. While they tắm trắng da ở đâu cannot force the nomination tắm trắng da có hại không through, given their minority status, Democrats believe they have the upper hand politically, with Republicans forced to defend their position not to act even though Mr. Obama has almost 11 months remaining in his term. But Republicans believe they would face a backlash from their conservative base if they gave Mr. Obama a final-year chance to reshape the court. One of the first orders of business will be the annual nâng mũi sửa tướng reading of George Washington’s farewe heading into the Super Tuesday states, he is strong enough to emerge successful. The only person who might be able to stop Mr. Trump is Mr. Trump, by virtue of an eruption or provocation so far unforeseen. Mr. Trump seemed to try hard, almost inadvertently, to tam trang da ngam den damage himself, particularly in the final week before South Carolina voted. None of it stopped him. the other major, parallel story of Hillary Clinton’s victory in the Nevada caucuses., her campaign manager, who faced a barrage of questions heading into those contests.

“So I’ll be a little bit more careful, but I’ll continue to operate, you know, on a high wire without a net,” he said, “and frankly I’d like to see everybody who’s running for president tam trang da sieu toc get out of the scripted role and start to be real and take questions.” Indian-American, and Senator Tim Scott, who is black, were like t he would be able to work with Donald J. Trump as the party’s presidential nominee, the latest signal of acceptance from national figures of the billionaire real estate developer. “I think I’ll work with Donald Trump,” Mr. McCarthy dia chi nang mui dep an toan said on MSNBC’s “Morning Joe” program, adding, “I think I can work with anyone that comes out to be the nominee.” That includes Senator Ted Cruz of Texas, who helped egg on a government shutdown over efforts to defund President Obama’s signature health care law, according to Mr. McCarthy. While Mr. McCarthy’s comments were hardly a ringing endorsement of Mr. Trump, they were not an expression of concern about the impact that the first-time candidate could have on the tam trang da loai nao tot party’s chances at taking back the White House or holding its majority in the Senate a Republican Benetton ad, as Ms. Haley joked at every event. But in Nevada, where Mr. Rubio is competing in the state’s caucuses on Tuesday, that diversity is noticeably absent. As he boarded his campaign plane for a day o ut the biggest fish in the race, the state’s Hispanic Republican governor, Brian Sandoval, is so far uncommitted. In a religious sense, however, his Nevada team is somewhat less conventional than dia chi nang mui an toan the usual Republican lot. Mr. Heller, Mr. Hutchison and Mr. Chaffetz are all Mormon, as was Mr. Rubio for a brief time when his parents moved his family to Las Vegas for six years before returning to Miami. Find out what you need to know about the 2016 presidential race today, and get politics phẫu thuật cuốn cánh mũi news updates via Facebook, Twitter and the First Draft newsletter.f rallying voters in the northern reaches of the state, his entourage was nearly all white and male. There was Dean Heller, the state’s Republican senator, and the lieutenant governor, Mark Hutchison. Representative Jason Chaffetz of neighboring Utah was along for the ride too. tam trang da vinh vien Representative Mark Amodei, who represents a district in this northern Nevada region, was scheduled to link up with them later in the day. The dearth of brown or black faces might seem surprising for a state that has Find out what you need to know about the 2016 presidential race today, and get politics news updates via Facebook, Twitter and the First Draft newsletter.

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