Attacks by patients increase at Oregon State Hospital

From the Oregonian, January 24 2009

Nurses and other workers are feeling more threatened than ever despite new security steps

When a conflict between two patients at the Oregon State Hospital escalated to a near riot on the night of April 11, Deb Dietzel found herself on the wrong side of two locked fire doors.

Joe Thurman a nurse at the Oregon State Hospital. The Oregon State Hospital in Salem has a record number of staff assaulted by patients last year. The hospital is taking steps to correct the situation. The DA said he could boost prosecutions but he doesn't have enough money. The hospital superintendent has even asked US OSHA in for a consult.

Joe Thurman a nurse at the Oregon State Hospital. The Oregon State Hospital in Salem has a record number of staff assaulted by patients last year. The hospital is taking steps to correct the situation. The DA said he could boost prosecutions but he doesn't have enough money. The hospital superintendent has even asked US OSHA in for a consult.

Dietzel, 51, a nurse at the state’s mental hospital for 14 years, says the rest of the staff had taken refuge in the day room. She was in another part of the ward and surrounded by a half-dozen male patients who were threatening to kill her.

“I thought I was going to die,” Dietzel said. “I kind of turned my back on them because I thought I was going to get it.”

Fortunately, another nurse came to Dietzel’s rescue, and the incident ended without harm. But Dietzel said: “It took a long time before I could talk about it without crying.”

In the first 10 months of last year, there were 323 reported injuries to state hospital staff caused by patients — a jump from 2007 and possibly the highest number of injuries in the hospital’s history. Officials can’t say for sure, however, because of poor reporting and record-keeping in the past.

Nurses and other workers say they feel more vulnerable than ever to attack from patients who are diagnosed as insane and not responsible for their actions and from other patients who staff say are committing premeditated crimes and getting away with it.

Concerned about the increase, hospital administrators have hired more aides for the most troubled wards, added security staff and next month will open a maximum-security unit for about a dozen violent female patients who administrators say create the lion’s share of the trouble at the hospital.

Last year, one violent female patient broke the arms of two workers within a 24-hour period. Hospital officials would not discuss details of those attacks, citing confidentiality issues.

But nurses and other workers say being kicked, shoved or knocked to the floor has become a regular part of the job at the state mental hospital. So is hitting the “panic” button at the nurses station to summon help.

Lonna Chase a nurse at the Oregon State Hospital.

Lonna Chase a nurse at the Oregon State Hospital. The Oregon State Hospital in Salem has a record number of staff assaulted by patients last year. The hospital is taking steps to correct the situation. The DA said he could boost prosecutions but he doesn't have enough money. The hospital superintendent has even asked US OSHA in for a consult.

Earlier this month, nurse Lonna Chase said she called for help only to be told another ward was also in trouble.

“We’re seeing more and more buttons going off and more anxiety,” Chase said.

A visiting state lawmaker got a firsthand look at the aggression last month when a patient threw water, dousing her and others. In another incident, she watched staff deal with a patient who didn’t want to be medicated.

“What struck me was the culture of fear — among staff and patients,” said Rep. Sara Gelser, a Corvallis Democrat who spent hours inside one of the forensic wards for treatment of people who have been found guilty of committing a crime while insane.

Hospital superintendent Roy Orr attributes some of the attack spike to improved reporting starting last January, the same month a federal Justice Department review team issued a scathing report on hospital conditions and patient care.

But Orr says the hospital is also seeing more patients who suffer behavioral disorders that make them violent, antisocial or resentful of authority. When appropriate, he said, he’d like to see patients punished for their actions. “I don’t want anybody to get the impression that I think any level of aggression on staff is OK.”

Last month, Orr invited the federal Occupational Safety and Health Administration to Oregon to consult on improving worker safety. He also started regular safety and security meetings with employee unions and with state and local law enforcement officials.

Policy change cited

Daniel Smith, a therapist at the Oregon State Hospital.

Daniel Smith, a therapist at the Oregon State Hospital.

Nurses and other hospital staff say attacks against them have increased as the hospital changed its practices in response to the Justice Department report, which threatened legal action if conditions weren’t corrected.

“We’ve tried very hard and very successfully to reduce our use of seclusion and restraints, and there has been more violence,” said Daniel Smith, a psychologist who had his nose bloodied by a patient.

The Oregon State Police major crimes unit investigates all serious incidents reported by the state hospital. State police Capt. Maureen Beddell says the hospital — not state prisons — was the No. 1 client for the unit’s Salem office in 2007 and 2008.

Between January and October last year, state police investigated 163 cases at the state hospital. Of those, 120 involved alleged patient misconduct.

The good news, Beddell said, is that the number of state hospital cases the major crimes unit investigated last year was lower than in 2007, including fewer felony assaults.

Still, she acknowledged: “If you’re the one that gets hit in the face, it doesn’t feel like it’s getting better.”

Difficult to prosecute

The Marion County district attorney’s office decides whether to prosecute patient-to-staff assaults in court. The cases are difficult to pursue because they often involve mentally ill patients and compromised evidence, said Paige Clarkson, a deputy district attorney.

A couple of years ago, Clarkson said her office prosecuted a patient who attacked a staff member with his pen and another who hit a worker with a table leg. In both cases, she said, the defendants pleaded guilty but insane. The punishment: more time at the state hospital.

Clarkson’s boss, District Attorney Walter Beglau, said he needs state financial help to prosecute more assaults. He’s also interested in finding ways short of prosecution to hold patients accountable.

“Let’s face it,” Beglau said, “We have not been able to provide good public safety services in that facility.”

Workers say they would like the hospital to create a trauma response team to help with emergencies in the wards and assist staffers with their post-traumatic stress. Orr says he’s willing to find a way to make that happen.

In the meantime, Dietzel, the nurse who was cornered by patients last spring, asked to be reassigned to the graveyard shift, when most patients are asleep.

The reason, she said: “It’s safer.”