‘Bad apples’ hinder reform efforts at Oregon State Hospital

From the Salem Statesman Journal, May 9, 2011

Psychiatric facility attempts to improve employee accountability

The sun sets in February on the Oregon State Hospital's restored cupola and the last crumbling wall of the J Building. As the psychiatric facility undergoes a reform transformation, attempts are being made to address problem employees who are perceived to buck the system.

A failure to root out bad employees has posed recurring problems at Oregon State Hospital in Salem, consulting reports and interviews reveal.

It’s a festering sore point for many OSH managers and front-line staffers who are working hard to turn around the long-troubled psychiatric facility. They resent “bad apples” who linger on the payroll, undercutting reform-minded efforts and morale.

Some point to the checkered hospital employment of Richard Gonzalez as a case in point.

Two separate investigations last year substantiated allegations of patient abuse against the hospital security worker. But Gonzalez wasn’t fired. In fact, a letter of reprimand was the only disciplinary action taken against him in connection with the two abuse findings.

Gonzalez kept working at the psychiatric facility until last month, when he resigned in the wake of being arrested by Salem police on criminal charges unrelated to his job.

His recent arrest and ensuing resignation came as a relief to some hospital workers. Even so, some have questioned why the hospital did not fire him earlier.

“There should be no tolerance for patient abuse. Yet, here we have two (confirmed allegations),” said Richard Dean, a security employee who has worked at the hospital since 1985. “How’d he get past the first one? And furthermore, how’d he get past the second one? Wow, some people are like Teflon, you know.”

Gonzalez’s exit from OSH had nothing to do with his abusive treatment of patients. It came after he ran afoul of police.

On April 4, Gonzalez allegedly pushed a woman out of a parked car during a domestic dispute, leading to a police chase of his vehicle that began in north Salem and continued into Keizer.

Police caught up with him on Cummings Lane N.

Gonzalez was arrested on charges of recklessly endangering another person, reckless driving, criminal mischief and eluding police.

He resigned April 15 — the same day the hospital planned to place him on unpaid leave because of his arrest.
Patient abuse confirmed

Gonzalez was hired at OSH on Oct. 20, 2008. Like all new employees, he participated in a safety training program called Pro-Act, short for Professional Assault Crisis Training and Certification.

Part self-defense, part conflict resolution, it’s used when patients become aggressive or violent.

Developed in the late 1960s and widely used throughout the country, Pro-Act bills itself as “a risk management, safety enhancement tool” for any organization “seeking to establish a zero-restraint environment.”

Core principles of the program “focus on maintaining the safety and dignity of the client while keeping everyone safe,” according to Pro-Act literature.

Hired as a mental-health security technician, Gonzalez joined the hospital’s acuity and security program, which was created to help defuse patient crises and conflicts that occur on psychiatric units.

Hospital policies call for security employees to take a backseat to nursing supervisors in dealing with patients on the wards. Simply put, nurses are supposed to call the shots, not security workers.

Gonzalez ran roughshod over the policy, according to Statesman Journal interviews with employees and investigative reports obtained by the newspaper through Oregon’s public records law.

The first case of substantiated patient abuse against him stemmed from an incident in April 2010, in which Gonzalez and two other security techs were called to move a patient from one room to another.

An investigation by the state Office of Investigations and Training determined that Gonzalez used unnecessary or excessive physical force while moving the patient. Abuse allegations against the two other security employees were deemed “not substantiated.”

Gonzalez and his two security co-workers “put hands” on the patient to escort him out of his room, even though the patient “presented no threat” to himself or others, the OIT report says.

When the patient put up resistance, the three security workers reportedly “pushed or dragged” him down the hallway, where he was placed against a wall. That’s where Gonzalez grabbed the patient’s arm, yanking it up and behind his back.

The patient said the arm twisting “hurt like hell” and alleged that Gonzalez was trying to “dish out punishment,” the OIT report says.

In finding Gonzalez guilty of abusing the patient, the investigation concluded that he “used pain to force (the patient) to comply with a directive.”

No sanction was taken against Gonzalez for the abuse. He was ordered to participate in Pro-Act refresher training.

In August 2010, Gonzalez abused another hospital patient, according to a separate OIT investigation.

At the time, the patient was receiving one-on-one staff monitoring on a hospital ward. Staffers on the ward commonly directed patients to shut doors to their rooms while they were on “constant” monitoring, incorrectly thinking that conformed with hospital policy, reports show.

In this case, security was called to the ward because the patient balked at closing his door and became upset.

Taking the lead, Gonzalez confronted the patient and began steering him to a side room, assisted by another employee. A struggle ensued, leading to the patient being taken down to the floor by the two staffers.

The OIT investigation determined that Gonzalez committed physical abuse by “unnecessarily restraining” the patient. It also found that he exceeded his authority by taking the reins.

The hospital decided Gonzalez should receive a pay cut in connection with the second act of patient abuse. But he was already at the bottom rung of the pay scale. As a result, he was issued a letter of reprimand, in lieu of a pay reduction.

The reprimand letter, dated March 28, told Gonzalez that he had demonstrated poor judgment and “failed to meet performance expectations.”

About a week later, Gonzalez was arrested by Salem police — leading to his April 15 resignation.

Hospital Superintendent Greg Roberts told the Statesman Journal on Thursday that recent steps have been taken to speed up investigations into allegations of patient abuse. He also said hospital managers have been given additional training designed, in part, to help them document the actions of troublesome employees.

“I would say we have a much-better process in place today than you would deduce from this case,” he said, referring to what occurred with Gonzalez.

Roberts, who assumed leadership of the hospital in September, said he was not totally familiar with the April 2010 abuse incident.

“Honestly, I’d have to look at the report again,” he said. “I’m not trying to get off the hook by saying it was before my time, but it’s partly why I’m less familiar with the details of that incident. But I would think if the outcome was to recommend him for retraining, they must have thought he was not willfully, deliberately, trying to hurt the patient. But he certainly wasn’t following the procedures that Pro-Act teaches.”

In general, Roberts said, there are various categories of patient abuse, and not all types warrant firing of the perpetrator. He said case-by-case determinations are needed to set appropriate sanctions, such as retraining, a pay reduction or termination.

Asked what type of patient abuse warrants firing, Roberts said: “Certainly physical abuse of a patient, a deliberate action by a staff member — that will result in termination.”

‘Enabler’ for problem employees

Since September, two reports issued by outside consultants have tried to dissect the tangled hospital operations and flaws that stall or stymie removal of “problem” employees.

In a report issued in January, Kaufman Global, an Indiana firm hired to examine the hospital’s culture, described “lack of accountability at all levels of OSH” as “an enabler for problematic employees.”

As part of its study, the consultants conducted interviews with hospital managers and surveyed rank-and-file employees.

Survey results showed fewer than 33 percent of staffers said they received performance evaluations from their supervisors “often” or “very often.”

“Interestingly enough,” the consultants reported, “front-line staff consistently expressed that they seek to be held accountable and expect it of their colleagues, as well. They noted that people typically do a ‘subpar job when they are not held accountable’… One staff member made it very clear saying, ‘I used to work in a restaurant and was held more accountable as a waitress.'”

Many hospital managers reportedly blamed the OSH Human Resources department for not taking strong disciplinary action against poorly performing or troublesome employees, a charge denied by HR officials.

“There seems to be a disconnect between what OSH managers expect in the way of HR support and that for which Human Resources actually feels responsible,” Kaufman Global reported. “This topic resulted in substantial commentary, particularly among OSH managers. One manager noted, ‘HR is a barrier, not a help. I’m not abdicating my responsibility to train and supervise, but, HR isn’t helping to get rid of the bad apples, not taking a stand.'”

Several other hospital managers reportedly cited incidents “where they had done everything that they were supposed to do to profile poor performance; still the underperforming employee was never dismissed,” the consultants reported.

Kaufman Global’s report expanded on conclusions drawn in a prior report issued in September by Liberty Healthcare, an Indiana-based consulting firm.

Conflicts and finger-pointing between hospital managers and HR officials also surfaced in Liberty’s report.

“There is a prevalent thinking that managers can do little to discipline or remove problem employees,” reported the Liberty consulting team. “Clinical managers have looked to HR to handle personnel issues, while HR declines such responsibility because it is a management issue.”

Amid vague accountability and blurred responsibility, paralysis lets problem employees off the hook, concluded the Liberty consultants.

“Reluctant to act, managers retreat into helplessness and tolerate continued poor performance from problem employees whose behavior hurts team cohesion and morale,” states their report.
Superintendent sees progress

Roberts said the hospital is making progress when it comes to fixing flaws identified by the consultants, including the stark conclusion that “a lack of accountability” exists at all levels of OSH.

Actions cited by the hospital chief:

-Stepped-up employee performance evaluations. “We set aside a week in January, a meeting-free week, so that performance evaluations could be completed,” Roberts said.

The HR department now is tracking the rate of completed performance evaluations on a monthly basis “so we don’t slip back,” he said.

Speeded up OIT investigations into allegations of patient abuse or neglect.

Investigations that formerly dragged out for many months now, for the most part, are being completed within 30 days, Roberts said.

Quick dismissals of new employees who fail to meet expectations during their probationary periods.

“We’ve been dismissing people fairly regularly, early on in their employment, if they’re not looking like they can do the job we want them to do,” Roberts said.

Additional training for managers, designed to help them work in concert with HR to take appropriate action in dealing with problem employees.

“I’m not going to claim that’s now a perfect system, but I think many more managers, especially in the nursing department, are aware of options available to them and what they need to do to document things related to employee performance,” Roberts said. “We certainly still have lots to do there, but many more managers know it’s not a hopeless situation.”