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Western State: Can it ever be made a safer
place to work?
A push for improvements in 'most dangerous' work sites
lets workers stay
Nov. 15, 1999
By Gestin
Suttle
The News Tribune
A
6-inch scar resembling railroad tracks stretches
from Edith Harlow's left elbow. And she still winces when she rolls up her car
window.
These are the grim reminders of a beating the Western State Hospital nurse
suffered on Easter Sunday, after a patient attacked Harlow and her colleagues
with an exercise bar.
More than one staff member on average is assaulted every day at Western State,
according to hospital data. And statistics show that working at a state
psychiatric hospital puts one at higher risk for assault than police or jail
work.
Harlow and others who work at the Lakewood hospital know their jobs are risky.
Their patients include people accused of murder, arson, kidnap and rape. Some
are there to be evaluated before trial; others already have been found not
guilty by reason of insanity.
But the workers believe their work at Western State is more dangerous than it
needs to be. They say hospital administrators, state officials and lawmakers who
set hospital funding don't care enough about violence prevention to pay for
safety improvements. Their concerns focus on three areas: lack of safety
equipment, inadequate staffing and insufficient training and prevention
programs.
Officials, on the other hand, say they are concerned and that safety
improvements are being made.
"I think we have made substantial progress on a bunch of fronts," said Lyle
Quasim, secretary of the state Department of Social and Health Services, which
oversees the hospital.
Nevertheless, the hospital frequently is faulted for unsafe working conditions.
Just last month, the state Department of Labor and Industries cited and fined
the facility $9,200 for doing too little to protect its workers. Among the
problems:
* The in-house emergency phone system was not effective.
* Padded shields that would help protect staff members against violent patients
were not provided on most wards. Staff members weren't told where the pads were,
nor were they trained on them.
* There was no way to identify which locked doors on the forensics wards were
opened.
Jerry Lovrien, CEO of the hospital, vowed to pay the penalty and continue
working to fix what was wrong.
Among changes: installation of phones with a dedicated line and a unique ring so
that employees will know immediately if a colleague needs help, Lovrien said. In
addition, the hospital is nearly doubling its training team to 14 members, said
Pat Buker, who was the hospital's chief operating officer until the end of
August.
Safety also should improve after a replacement facility is built at Western
State - if it's designed correctly, said Rep. Eileen Cody (D-Seattle),
co-chairwoman of the House Health Care Committee and a member of the House
Budget Committee. The $46 million project would include a new 240-bed facility
to replace the 1930s-vintage structure that now houses the roughly 250 patients
who have been committed by the courts for evaluation or treatment on the same
site.
The new building is on schedule to open in mid-2001.
Still, the unions representing Western State workers contend the hospital needs
more staff now. And Labor and Industries contends the hospital needs more safety
equipment and must train its workers better.
In the same month that Harlow was beaten, another nurse was attacked when a
patient forced his way into a medicine closet and tried to rape her. The nurse
was locked in; her colleagues could not open the door because she had the only
key on the ward. Her co- workers had to leave the floor to get a key, but the
nurse was able to escape on her own before help arrived, hospital officials
said.
"This is unreasonably dangerous. When you have incidents like that (Harlow's
beating), we say, 'We told you so,'" said Bob Lenigan, a staff psychologist and
president of Local 793 of the Washington Federation of State Employees, which
represents 1,800 Western State staff members, including the licensed practical
nurses and most of the other workers.
Patients more violent
Over the years, the concentration of violent patients has increased at the state
psychiatric hospitals, as less violent patients are moved out of institutions,
said Jon Wagner, recreation specialist at Western State and the facility's
safety committee chairman.
More than 90 percent of the roughly 1,000 patients at Western State have been
committed involuntarily by a county-appointed mental health professional or a
court because they are gravely disabled or dangerous - either to themselves, to
others or to property, Buker said.
On Western State's unit for the criminally insane, now called the Center for
Forensic Services, most patients are free to walk outside their rooms and along
the bare-floored corridors. Nothing except yellow tape on the floor divides the
nurses' station from the rest of the ward.
The hospital built one Plexiglas-enclosed station on the forensic unit to see if
nurses wanted them on the other floors. But it was controversial because it
hindered communication, said Jeff Thurston, a clinical nurse specialist in the
forensic unit and acting chairman of the Service Employees International Union's
Local 1199. The local represents 280 registered nurses at Western State.
The violence at Western and Eastern State hospitals has concerned state
officials for years. So in 1993, the Labor and Industries wrote a report
outlining the violence and recommending steps the hospitals could take to curb
the attacks.
Among the suggestions: Emergency pagers that staff members could wear, cordless
phones and padded shields to protect against out-of- control patients.
But by 1997, Western State still had not adopted many of the suggestions, and
that year, Labor and Industries investigated the hospital and found it lacking.
The agency faulted Western State and listed 14 measures the hospital should
implement to better protect workers and patients. Among them: cordless phones,
better review and follow-up of incidents, panic buttons on the wards and
personal protective items for staff members on the "critical" wards.
Almost a year after L&I's 1997 findings, Western State outlined in writing the
steps it was taking to address the agency's points, including:
* Designating a staff safety task force.
* Creating a group panic phone number.
* Providing cordless telephones for staff members.
* Implementing "sister ward" response teams, whereby neighboring wards would
respond in an emergency.
* Providing personal protective items, such as padded shields, to those on
"critical wards."
Of those measures, two - the "sister ward" response teams and group panic phone
number - were fully operational when Harlow was attacked.
The staff safety task force apparently met monthly from November 1997 to April
1998, and "sort of petered out there," said Bill Proctor, chief psychologist and
chief of staff development. The group was recalled in March to produce a final
report, then started regular meetings after the attack on Harlow.
Pat Terry, who was acting CEO of the hospital until May, said the hospital tried
using the padded shields, but staff members found them awkward. Harlow said the
shields just weren't provided, but are now.
More staffing sought
Following the attack on Harlow, the hospital set up an assault review team of
managers, workers and union officials. It came up with a list of things the
hospital should do to protect workers.
Those are the same or similar to many of the measures recommended or required
years before by Labor and Industries. The requests include personal alarms that
nurses can wear and activate when they need help, and a panic button on each
ward.
The union also wants at least one additional staff member per shift per ward.
Today, Western State officials say they have taken many steps to improve
hospital safety. For instance, panic buttons that link the wards to the security
station have been installed on the forensic wards. The hospital added
single-push emergency buttons to the medicine rooms and now makes sure each ward
has an extra key to the rooms. A committee is looking into personal alarms.
Other measures had been implemented, such as two-way radios, but on a limited
basis.
Harlow believes some of the safety equipment would have helped her. As it was,
all Harlow could do was try to push a button on a nearby telephone for
assistance.
"You have to pick up the telephone and you have to find 'group call' and hit
'group call,'" all while being beaten, she said. "I hit buttons, I don't know
what I hit."
On that April night, patient Sundiata Kavier Botley struck Harlow repeatedly,
got her building keys and escaped through a locked door to a fire escape
stairwell. There, he was one locked door away from being free on the hospital
grounds before help arrived and subdued him.
Harlow suffered a shattered elbow, two broken fingers, bruising and a loose
tooth. Four of her colleagues - the two already there and two others who came to
their aid - also were injured.
Harlow returned to work for two weeks in July but did not feel safe enough to
stay. Today she is on medical leave and says she suffers from post-traumatic
stress disorder.
Safety in numbers
Of all the changes that can be made at Western, Harlow and many of her
colleagues believe additional staff would help the most.
"I would like to see more people on my ward," said Wagner.
But it's hard enough to get an adequate staff in the midst of a general nursing
shortage, hospital officials say, much less in the difficult field of public
psychiatric-care nursing, which has a lower rate of pay.
In addition, there are no standards dictating minimum staffing levels for
psychiatric hospitals, according to hospital administrators, nursing union
officials and health care financing and accreditation organizations. That's
because each ward has a different mix of patients who need varying degrees of
supervision, they said.
Still, many in the industry agree that the more people you have on shift, "the
faster you can respond" to a problem, noted Wagner.
On the night Harlow was attacked, she said, three health-care workers were on
the ward with 28 patients. That was one fewer staff member than five hospital
officials from around the country said would generally be acceptable at their
facilities.
For instance, on the ward for the criminally insane at Arizona State Hospital,
no fewer than four staff members are on duty on the unit with even fewer
patients - 21 - during the evening hours, said Jack Silver, CEO of the hospital.
At the privately run Puget Sound Hospital in Tacoma, mental health director Gigi
Arrington said she doesn't operate with fewer than four staff members on a
psychiatric unit with 30 patients.
Staffing levels are a concern, too, for advocates of the mentally ill.
Mark Stroh, executive director of the Washington Protection & Advocacy System,
said the group filed a class-action lawsuit against Western State in U.S.
District Court in Tacoma, taking issue with the treatment of people with
developmental disabilities.
Staffing levels were not addressed specifically in the lawsuit, but the group
"shares the concerns" over them, Stroh said.
Among the suit's allegations: the staff uses restraints excessively and too
often secludes patients. The suit also charges the hospital with not
appropriately monitoring the quality of care and having inadequate psychiatric
evaluations. Those criticisms echoed findings last year by the U.S. Department
of Health and Human Services, which temporarily threatened to cut $56 million in
funding.
After the attack on Harlow, Western State administrators assigned at least four
nursing staff members per shift on the forensic wards, Buker said. But the
hospital went back to the reduced staff because it couldn't keep paying the
extra overtime, said Local 1199's Thurston.
Jann Hoppler, director of DSHS's mental health division, said that while
legislators had asked the hospital to come up with a model for ideal staffing,
they did not provide money to increase the staff to those levels. Based on this
model, the forensic wards should have an additional 61/2 positions spread over
three shifts, seven days a week, Hoppler said.
It's always hard to get money for Western State, Rep. Cody said, for several
reasons:
* Operational funding for mental health care isn't a high priority. Rep. Steve
Conway (D-Tacoma) said he didn't see much of a public outcry after a 1993 L&I
report that said state psychiatric hospitals were such dangerous places to work.
* The average lawmaker doesn't know much about mental health in general or about
Western State Hospital in particular. The hospital has tried to raise awareness.
It gave tours of the facility this summer and nine lawmakers came, said Kris
Flowers, spokeswoman for Western State.
* The funding formula for mental-health treatment is pegged to how many poor
people are receiving welfare assistance. As welfare rolls drop, Cody said, so
does the amount of money available for mental health treatment for the poor.
Cody, herself a nurse at Group Health Cooperative and a member of the same union
as Harlow, said she hopes to change the funding formula next year.
* DSHS doesn't always ask for money to pay for safety features at Western State.
If the governor's budget leaves out some of the things the agency asked for,
DSHS officials are reluctant to take their case directly to the Legislature,
Cody said.
More severe assaults
Gary Moore, director of Labor and Industries, said his agency will continue to
investigate violent attacks such as the one on Harlow. "Clearly the injury rates
are such that they warrant our attention."
And Conway said the governor's office is putting pressure on DSHS to do more
about violence at Western and Eastern state hospitals.
Terry, the former Western State CEO, noted that the hospital's assault rate has
generally been on the decline in recent years, while the rate of workers'
compensation claims for assaults has generally been steady. According to Labor
and Industries, there were 139 violence-related workers' compensation claims
paid in 1996. In 1997, there were 189 such claims. Last year, there were 163 of
those claims.
The hospital's Flowers says that while the number of assaults has declined, the
severity of assaults has gone up - possibly because the greater concentration of
violent patients.
DSHS's Hoppler knows workers are concerned about the pace of the hospital's
progress.
"It doesn't surprise me the staff are shaken and scared. I wish we had a better
way of communicating that we do take this very seriously," she said.
"Unfortunately, nothing will give us 100 percent guarantee that there won't be
an event like (the attack on Harlow) in another few months."
Staff writer Joseph Turner contributed to this report.
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SIDEBAR
State pays price for injury claims
When a worker is hurt and needs time off, it not only exacts a physical and
emotional toll, it also costs financially.
In 1996, the state paid out $615,114 for violence-related workplace injury
claims at Western State Hospital, according to the state Department of Labor and
Industries. In 1997, the state paid $953,939 for such injuries. Last year, the
state paid out $631,326 for claims of violent injuries at the hospital.
Western State, like other state-run hospitals, pays a workers' compensation
premium that is 3 1/2 times higher than the average for other industries,
according to Labor and Industries. Western State may pay more than $1.43 per
worker hour, while the state average for other industries is 40 cents an hour,
the department reports.
SIDEBAR
Risk of assault
The state Department of Labor and Industries lists the following industries as
the most at risk for getting assaulted on the job.They represent the highest
workers' compensation claims rates for state funded employers in the state from
1992 through 1997. The claims rate is per 10,000 workers:
1. Psychiatric hospitals, averaging 872 claims.
2. Residential care, averaging 417 claims.
3. Skilled nursing care, averaging 254 claims.
4. Nursing/personal care, averaging 240 claims.
5. Job training services, averaging 145 claims.
6. Detective and armored car services, averaging 103 claims.
7. Administration of social and manpower programs, averaging 94 claims.
8. Rooming and boarding houses, averaging 87 claims.
9. Police protection, averaging 85 claims.
10. Correctional institutions, averaging 68 claims.
11. General medical/surgical hospitals, averaging 65 claims.
12. Child day care services, averaging 60 claims.
13. Specialty outpatient clinics, averaging 55 claims.
14. Drinking places, averaging 50 claims.
15. Home health care services, averaging 43 claims.
16. General government, averaging 43 claims.
17. Elementary and secondary schools, averaging 37 claims.
18. Apartment building operators, averaging 31 claims.
Weighted average for all industries: 17.1 claims.
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