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On May 14, 2012, Brandy Bell was committed to Rusk State Hospital in Texas for a long history of psychiatric illnesses. After 16 days in the hospital, Brandy, 33, died. The mental illness that deprived her of her life, compelling her to lose 9 pounds in 9 days, was tragically ignored by hospital staff. Brandy died a preventable death.

Although the initial autopsy reported that Bell died from blood clots in her lungs, a subsequent examination of her case by a federal Medicare investigator discovered the hospital made crucial mistakes by neglecting Bell’s self-starvation and providing substandard nursing care.

Carrie Williams, spokeswoman for the Department of State Health Services, reported that there are currently 85 patients with diagnosed eating disorders at the state psychiatric hospitals (this number does not include people without such diagnoses who temporarily refuse food for other reasons, such as paranoia). If this is the case, why haven’t state psychiatric hospitals developed a protocol for treating patients with eating disorders? How many individuals are slipping through the cracks by undertrained hospital staff?

The APA (American Psychiatric Association) guidelines do not recommend psychiatric hospitals as a level of care. Individuals with a primary diagnosis of an eating disorder should not, based on the APA guidelines for care, be admitted to state psychiatric hospitals. Those who are admitted to state psychiatric hospitals with a co-morbid diagnosis eating disorder require treatment by specialists who have sufficient knowledge of the illnesses. Though it is helpful to pay “extra attention to a patient’s physical condition, food intake and hydration”, it is not enough treatment.

“In the early days of her admission, Bell was monitored closely to ensure she didn’t hurt herself, the documents show. After she showed no signs of obvious self-abuse, she was placed on routine supervision.” Bell proved that there was no threat of self- harm, and staff showed little concern or action for her dangerous behaviors that left her dehydrated, refusing meals, unresponsive, refusing activities and speech, and dependent on a wheelchair. More than a dozen entries in Bell’s records document her self-starvation.

On May 30, Bell became unresponsive while waiting to have labs drawn. She was revived and taken to East Texas Medical Center, where she was diagnosed with dehydration, low potassium and low blood pressure. Bell was declared dead in the emergency room at 10:52 a.m. The official cause of death was bilateral pulmonary emboli – blood clots – which can be caused by prolonged immobilization or bed rest. Additionally, the autopsy also found that Bell had starvation ketosis – a condition in which the body burns fat instead of carbohydrates. This can lead to coma, seizures, and in Brandy’s case, death.

Rusk’s quality director responded to this tragedy by saying that the hospital’s “focus was on the psychiatric issues and not the possibility of medical issues.” She said, “the patient’s weight was slightly over the weight range for her age and height and that there were no visible signs that the patient was not eating or drinking.” This unfortunate weight bias that Brandy experienced led staff members to ignore clear signs of destructive eating disorder behaviors. The quality director’s response of “there were no visible signs that the patient was not eating or drinking” is certainly a contradiction to Bell’s medical records of refused meals. The dangers of not eating should be evident to all medical professionals. Why was this ignored? Was it because of her “normal appearance”? Was it because of under-trained staff?

Medical staff would greatly benefit from education on eating disorders. Clinicians who are properly trained on eating disorders will be able to identify an eating disorder, understand the life threatening severity, and recognize that eating disorders do not discriminate, meaning: eating disorders occur in every body type, they affect every race, culture, all genders, and all ages. It’s time that we give our medical community the tools for prevention and intervention.

Finally, it is important that we have properly trained physicians in eating disorders just as we do in obesity. This is especially important because eating disorders are on the rise! “The incidence of eating disorders in children under the age of 12 is two times higher than diabetes.” (Dr. Debra Katzman, Professor of Pediatrics in the Divison of Adolescent Medicine, Department of Pediatrics and the University of Toronto). We must train physicians, physician’s assistants, nurses, etc. on how to detect and treat eating disorders. This is especially important because we know that early detection can save lives – the life of someone like Brandy.