OSH: Violence Breeds New Ward

Christina Hogenson

Christina Hogenson

From the Salem Statesman Journal, March 28 2009

Christina Hogenson grew up traumatized by child abuse.

It sowed the seeds of her rage and repetitive violence.

Concerns about Hogenson’s outbursts first surfaced when she was in kindergarten. She spent most of her childhood in specialized schools, detention centers and treatment facilities that tried but failed to tame her combative behavior.

Now 26, Hogenson is known as one of the most violent patients in Oregon State Hospital’s packed and volatile forensic psychiatric program.

Her case speaks volumes about the vexing factors that fuel violence at Oregon’s largest mental hospital, and it underscores why hospital officials intend to launch the facility’s first maximum-security unit for female forensic patients.

Next month’s planned opening of the new unit follows a well-publicized surge last year in patient attacks on staff members. Hospital leaders linked a large part of the problem to recurring violence waged by about a dozen female patients.

Officials hope the new unit, scheduled to open with five patients, will help make hospital wards safer for patients and staff.

“We’re certainly hoping this is going to make a difference,” said Sue Zakes, acting program director in the hospital’s forensic section. “By removing these particular women from their wards, it will help the milieu on the wards they’re leaving because they add quite a bit of commotion.”

Whether Hogenson will be housed on the new unit remains to be seen. “I can’t say that for sure,” Zakes said. “I think she’s probably on our list that we’ll do the evaluation on.”

A Statesman Journal review of Hogenson’s confidential medical records, authorized by her consent, found that therapists have described her as intelligent, articulate, eager to work and hopeful about fashioning a stable life.

Time after time, however, she has lashed out at fellow patients and employees, undermining her ambitions and shattering treatment goals.

Between 2004 and August 2008, Hogenson reportedly was responsible for 154 acts of aggression, 75 percent of which resulted in staff members placing her in restraints, hospital records show.

The long list of violence includes Hogenson’s biting, kicking and spitting on staffers, choking fellow patients, cutting herself, destroying property and throwing objects such as urine, juice, chairs, food trays, a computer, ornaments and a phone.

In a recent interview, Hogenson rated herself as having a 50 percent chance of being assigned to the new maximum-security unit. It’s a prospect she dreads.

“It’ll set me back in my treatment,” she said. “I want the heck out of here. Something needs to be done about getting people like me out of the hospital.”

Multiple diagnostic labels have been attached to Hogenson’s condition, including intermittent explosive disorder, post-traumatic stress disorder, personality disorder and bipolar disorder.

As Hogenson tells it, state hospital treatment wards are crowded and seethe with tension, inflaming her stress-related problems.

“There’s lots of violence and yelling,” she said. “My PTSD is triggered quite often by being here.

“Anger is not my issue, it’s what is underneath it. The thing is, it all really started when I was just a little kid and being in institutions for so long. I never graduated from one. I’ve always been sent from place to place. And what does that give me but the thought that I’m incurable?”

Nightmarish inner world

As a child, Hogenson reportedly was physically abused by two of her three stepfathers. She was sexually victimized by two babysitters before she was 6.

Mental-health treatment for the troubled girl began when she was 8. Later, her intensive care continued for more than three years at the Christie School, a residential treatment program for severely emotionally disturbed children.

Grim reports written by mental-health professionals and school officials documented her inner turmoil.

“In terms of her internal life, Christina appears to live in a rather frightening and nightmarish inner world where violence and aggression are commonplace and can easily turn ghoulish and bizarre,” stated a June 30, 1995, evaluation of the 12-year-old girl.

Hogenson was charged with several criminal assaults on staff members during her residency at the school.

Eventually, the teenager was moved to a juvenile detention facility, followed by placement in a foster home in Eastern Oregon.

Her eight-day stay in foster care ended in chaos in May 1997. The 14-year-old Hogenson reportedly defied rules, refused to take her medication and caused more than $2,000 worth of damage to the home.

Pulled from the foster home, Hogenson was admitted to Oregon State Hospital for the first time. She entered a now-shuttered treatment program for emotionally disturbed adolescents.

After three years at the state hospital, her planned discharge in 2000 “was complicated by her difficulty controlling her behaviors and mood swings,” records show.

Numerous community mental-health facilities and providers refused to accept Hogenson into their programs. With no other options, officials transferred her to Hillcrest Youth Correctional Facility in Salem.

At the juvenile lock up, Hogenson completed her GED. She also put in productive work time with Marion County Humane Society and Oregon Parks and Recreation Department.

But there was no end to Hogenson’s violence. At Hillcrest, Hogenson was convicted of five counts of assault, resulting in a sentence of 25 additional months in state supervision.

Path to isolation

Paroled to a residential program in Corvallis, Hogenson turned violent again one day in March 2003 after she missed an opportunity to participate in a shopping trip with other residents and staff.

Crying hysterically, she stabbed her forearm with a stick, struck two employees with chairs and destroyed more than $1,000 worth of property.

When police arrived, Hogenson barricaded herself behind a door. Officers forced their way inside the room and subdued her with pepper spray.

This time, Hogenson was found guilty of two counts of assault and one count of criminal mischief. She got sent to the Coffee Creek Correctional Facility, Oregon’s women’s prison, in Wilsonville.

For about a year, Hogenson was isolated in a special housing unit reserved for inmates with the most extreme behavioral or mental health problems.

Hogenson later described her time in the prison unit as unbearable due to “noise, lights and stress,” according to a 2004 hospital report.

She reportedly told a therapist that she had tried to strangle herself to relieve her suffering, then lashed out at prison staffers when they confined her to a restraint chair.

“She states that she frequently becomes detached from herself during these times,” stated the 2004 report. “Her understanding of these events are that her intense anger leads to primal rage and that she cannot think about anything else. Her only feelings and thoughts are those of ‘fight’ and that she feels like a cornered animal.”

In April 2004, Hogenson was returned to the state hospital — this time entering the forensic program — for more psychiatric treatment.

Transfer to men’s unit

Housed in obsolete and decaying buildings, the forensic program holds hundreds of patients judged guilty of crimes except for insanity.

Patients occupy about a dozen treatment wards, including two maximum-security wards for men.

Last year, clinicians responded to Hogenson’s assaultive behavior by taking extraordinary action. They transferred her to Ward 48B, a high-security unit for men. She became the sole female patient there.

The strategy backfired when Hogenson allowed a male patient into her room for an overnight tryst. Employees reportedly found the two patients together in bed the next morning. The incident sparked an investigation that looked into lax staff supervision and allegations of abuse. Ultimately, employees were cleared of wrongdoing.

In recent months, Hogenson has received individualized treatment on Ward 50I, an all-female medium-security ward. Her treatment program keeps her separated from other patients and requires staffers to keep her on a close watch.

Segregation from other patients has brought some relief from conflicts that can occur on the ward, Hogenson said. Even so, she sometimes resents being kept apart from fellow patients.

“It makes me feel like a piece of —-,” she said, “like I’m unworthy.”

Hogenson views the new maximum-security unit as a type of punishment.

In contrast, hospital officials said the new program will provide some of the hospital’s most challenging patients with intensive care on a specialized unit with extra staffing.

Periodic evaluations will determine how long each patient stays in the high-security program, Zakes said.

“I think their treatment care plans will be more structured and more focused in this unit,” she said. “We’re really hoping that they’re going to get better and that they’re going to be able to progress in their treatment.”

New unit

Oregon State Hospital soon will open its first maximum-security unit for female patients.

The new program will be housed within a treatment ward in the hospital’s 126-year-old J Building.

Space for the first five female patients has been created by installing a dividing wall between separate areas for men and women on Ward 48B, an existing maximum-security ward for men.

About 20 male patients will continue to occupy the men’s portion of the unit. A handful of female patients soon will reside in private rooms on the other side.