LAKEWOOD — A psychiatric patient “head-butted” a nurse so hard she fell back and slammed her head on a door, causing injures that kept her home for three months. An agitated patient knocked a nurse onto the cement floor and forced him out of work for seven months. A nurse who tried to stop a patient attack was injured so seriously that her recovery took more than two years.
Hundreds of employees at Washington state’s largest psychiatric hospital have suffered concussions, fractures, bruises and cuts during assaults by patients, resulting in millions of dollars in medical costs and thousands of missed days of work.
In some cases, the attacks led to assault and even attempted murder charges, according to court records.
Federal regulators have threatened to cut millions in funding at Western State Hospital four times this year over patient safety concerns, and attacks on medical staff have contributed to worker shortages they say is the root cause of the violence at the 800-bed facility.
Missed work, medical claims result from staff injuries
Western State Hospital in Lakewood is Washington state's largest psychiatric hospital. About two-thirds of its more than 800 beds are filled by people who have been ordered held under a civil commitment because they are a danger to themselves or others. The other one-third of patients are in the forensic unit. They've been held after being found not guilty by reason of insanity, or were ordered by a judge to receive treatment to have their competency restored.
The medical staff is made up of registered nurses, mental health counselors, psychiatric technicians, nursing aides, psychiatrists and psychologists.
Hundreds have been assaulted by patients, which resulted in missed work days and medical costs that sent total claims into the millions of dollars.
Some examples:
• Health care support worker kicked by a patient suffered sprains to multiple body parts. Missed 958 days of work. Total claim: $255,556
• Registered nurse assaulted by patient suffered bruises to multiple parts of her body. Missed 966 days of work. Total claim: $488,740
• Psychologist struck by patient suffered multiple injuries. Missed 120 days of work. Total claim $23,300
• Psychiatric aide struck by a patient and suffered multiple contusions. Missed 407 days of work. Total claim $78,186
• Licensed practical nurse was assaulted by a patient and suffered sprains. Missed 199 days of work. Total claim $287,097
• Registered nurse was struck by a patient and suffered a sprained neck. Missed 686 days of work. Total claim $199,319
• Registered nurse was attacked by a patient and suffered a sprained back and neck. Missed 68 days of work. Total claim $56,034
• Psychiatric technician was struck by a patient and suffered a knee injury. Missed 206 days of work. Total claim $39,726
• Psychiatric aide assaulted by a patient suffered psychiatric distress. Missed 318 days. Total claim $96,520
• Registered nurse was attacked by a patient and suffered a fractured hand. Missed 59 days of work. Total claim $6,642
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SOURCE: Washington Department of Labor and Industry
Attacks on medical staff can have long-lasting effects, said Dr. Joseph Wainer, a hospital psychiatrist.
“After an assault, staff can become frightened of patients,” he said. “They never really get over it.”
Injured employees missed 41,301 days of work between 2010 and 2014, according to Occupational Safety and Health Administration records. And on-the-job injuries forced staff to move to other jobs, like desk work, for 7,760 days during that period.
Workers’ compensation insurance paid $6 million in wage and medical costs for claims to injured hospital workers between January 2013 and September 2015, according to records obtained by The Associated Press through a public records request.
More than half of the 700 injures reported by nurses, psychiatric technicians, counselors, psychiatrists and other workers during that period were caused by violent patient assaults, according to records.
During one attack on Nov. 25, 2014, a staff member pleaded for his life, according to court records.
A patient who was found with a billiard ball inside a sock and a nylon rope — items he said he planned to use on staff — confronted a nurse outside his room and began yelling. He punched the nurse in the head, knocking him to the ground. When another staff member tried to help, a different patient wrapped his arm around the worker’s neck.
As he fell to the ground, the worker called out — “Help me, I have kids!” — before losing consciousness, the police report said. The patients were charged with attempted murder and assault.
Staff initiated 711 “code gray” calls — emergency alerts asking for help — in the first six month of 2015, according to a report obtained by the AP. Eleven patients have died at facility since 2012 in circumstances deemed to be “sentinel events,” which are defined by federal regulators as “an unexpected occurrence involving death or serious physical or psychological injury.”
Many of the injured workers end up leaving the hospital, Wainer said.
Nursing supervisor Paul Vilja said hospital officials are filling the shifts by implementing mandatory overtime or by hiring temporary and on-call workers who don’t know the patients or their treatment plans.
“This is part of the problem,” he said. “They approach patients in a way that sets them off.”
Wainer added: “It’s not their fault, this job requires a lot of experience.”
And until recently, some medical staff couldn’t call for help during an attack.
The state has cited the hospital three times for safety violations since 2013 and ordered $49,550 in fines. The most recent citation in January was for failing to provide staff with dependable safety devices that could be used to alert others during assaults.
The personal alarm pendant system they were using didn’t cover some “blind spots” inside buildings, including some kitchens, hallways, courtyards, elevators and stairwells, inspectors said. It also didn’t work outside on the hospital grounds.
Those defects in the system resulted in serious attacks.
“Employee was cornered yesterday and sexually assaulted,” an inspector wrote in her January report. “Nobody heard her calling for help.”
The Department of Social and Health Services reached a settlement with regulators in June by promising to upgrade its campus two-way radio system, add security mirrors, make sure safety pendants have fresh batteries and require monthly training sessions.
Victoria Roberts, deputy assistant secretary for the state agency that oversees the hospital, said the state has been working to make conditions safer at the hospital, but staffing problems and the nature of the facility make it tough.
“You’ve got a lot of high-risk patients coming into a setting where there are staffing issues and a high turn-over rate,” she said. “We have a large number of committed staff and they’re doing their best with limited resources.”
Wainer said the number of assaults on medical staff is increasing and the “superficial efforts” being made by officials to fix the problems are having little effect. The most pressing problem — staff shortages — hasn’t been resolved and the lack of workers means shifts are so busy that few have time to attend safety training sessions, he said.
“We’ve endured, as much as possible,” Wainer said.
