Mental health therapists Lori Hays and Brant Johnson supervise patients in Ward 48B at tOregon State Hospital. Johnson recently returned to work after being beaten by a patient.
From the Salem Statesman Journal, June 20 2009
New frustration about patient violence has erupted in Oregon State Hospital’s forensic psychiatric program.
Worker anger and discontent come in the wake of last month’s launch of the hospital’s first maximum-security ward for female patients.
Frustrated staffers on Ward 48B, a maximum-security unit for male patients, said the men’s area has been rocked by patient crowding and violence since half of the unit space was taken to open the women’s ward.
The men’s ward has 17 patients; the women’s ward has four patients.
Cramped conditions on the men’s side have disrupted treatment, triggered patient-caused violence and required massive amounts of mandated employee overtime to deal with unruly patients, several workers said.
“The women’s side really is a success. The men’s side almost seems to get more and more volatile,” said Brant Johnson, a mental health therapist on Ward 48B.
Johnson recently returned to work after being sidelined by injuries suffered when he was beaten by a patient. He now takes medication to ease his anxiety.
“I wouldn’t say I’m afraid; I get nervous,” he said. “I’m on anti-anxiety medication now, and I didn’t used to be.”
By all accounts, Ward 48W, the new women’s maximum-security unit, filled a longstanding need in the violence-plagued forensic program.
It was created to isolate four women who had committed scores of assaults on fellow patients and staff members. Hospital officials said the unit has produced early benefits: peace on the two wards previously wracked by violence and specialized treatment for the four highly assaultive women.
For workers on 48B, positive results are outweighed by powder keg conditions in the men’s unit.
“The thing I worry about is, I don’t want to get hurt, and I don’t want any of my friends getting hurt,” said Kelcey Sugioka, a mental health therapist on 48B. “But every time I turn around, one of my buddies is out because of an assault. I’m sitting here wondering when is it going to be my turn? It’s not cool to go to work every day thinking that way.”
Some workers criticized forensic program managers and hospital leaders for launching the women’s unit without adequate planning or consideration of harmful consequences in the men’s unit.
“We’re the dumping ground, the guinea pigs,” Sugioka said. “That’s the way I feel about it. I don’t feel safe working there anymore.”
Deborah Yager, also a mental health therapist on 48B, blasted hospital administrators for what she called patient abuse.
“I think it’s abusive to the males,” she said. “They basically secluded them in half the space they had before. In my opinion, the whole administration is guilty of patient abuse.”
Hospital officials said they considered various options for creating the women’s maximum-security unit. Ultimately, they had to work around limitations posed by hospital facilities, which are outdated, deteriorating and packed with patients.
The adjoining male and female maximum-security units are located inside the antiquated J Building along Center Street NE. The 126-year-old complex was deemed obsolete and unsafe by state-hired consultants in 2005.
To make two units, a wall was installed, roughly in the middle of 48B. Male patients reportedly resented downsizing of the space they occupied.
“Guys get angry; it’s understandable,” said Matt O’Brien, a mental health therapist on 48B. “Would you like it if me and my family moved into your house and cut a line down the middle and said you have to stay on your half?”
The women’s unit opened May 4.
Since then, mandated employee overtime has soared in the forensic program, especially on 48B.
In May, mandated overtime work in more than a dozen treatment wards and several patient-occupied cottages totaled 1,358 hours, up from 506 hours in April, according to hospital data.
48B and 48W accounted for 522 hours of May’s total — more than any other part of the forensic program.
Prior to the opening of the women’s unit, 48B had dramatically lower levels of mandated overtime: 247 hours in April, 11 hours in March and 95 hours in February.
Further swelling last month’s mandated overtime were extra hours put in by hospital staffers assigned to the Acuity and Security Program.
Mental health therapists making up the ASP team are dispersed to work in patient units with high rates of violence and security issues. ASP mandated overtime hours are separately tracked by the hospital.
In May, ASP employees put in 281 hours of mandated overtime, including 109 hours on 48B.
Hospital officials acknowledged that mandated overtime shot up last month, most notably in 48B, and they outlined steps to reduce it.
“It is something we will diligently try to decrease over time by filling vacancies, reducing acuity, managing census and being able to work through the sort of growing pains of this unit,” said Nancy Frantz-Geddes, hospital director of nursing services.
Frantz-Geddes praised 48B workers for tackling tough change.
“For us, it’s a work in progress,” she said. “For them, they feel like it’s a work in progress on their back, and I understand that. They are doing exceptional work in extraordinarily difficult circumstances.”
Seeking to ease the burden on 48B, managers previously transferred several patients to other parts of the forensic program, reducing the patient census to 17. If possible, more patients may soon leave the max unit, they said.
In addition, seven new employees are assigned to fill staffing vacancies on 48B. The workers have completed training designed to prepare them for the challenges of maximum security and will join the ward this week, officials said.
Veteran staffers cited concerns about new workers stepping into a volatile situation.
“They don’t understand maximum-security mental health,” Sugioka said. “I question whether they’re going to have my back when I’m in trouble.”
The space crunch on 48B, described by staffers as the main source of friction, probably won’t be resolved any time soon, workers said.
“I think what they’re hoping to do is just kind of stay in a holding pattern on any big fixes until the maximum-security part of the new hospital opens,” Johnson said, referring to hospital leaders.
The state is moving forward with plans to build a 620-bed, $280 million hospital on the existing campus in central Salem. Plans call for the maximum-security section to open late next year. The new facility is slated to become fully operational by 2011.
Clinical psychologist Dan Smith doesn’t work on 48B, but he calls for hospital officials to remedy its problems prior to opening of the new hospital.
“That’s a long time to face the level of violence they’re dealing with,” he said. “I’m hoping that a solution can be found, whether it’s relocating the women or creating a new unit for at least some of the men. That would help, even if it’s only temporary until the new hospital is created.”