Avoiding danger as a Western State Hospital patient requires close attention, Selena Bertino says.
Her son, Reid, has learned to move to the other side of the room if violence is brewing. To stay away from certain patients even if it means refusing to stand in line. To keep an eye out for surprise attacks like a cafeteria beating he took in 2012. Safest of all, to stay in his room.
Bertino believes her son is mentally stable and should be freed from the Lakewood psychiatric hospital. In fact, she said, that stability is the reason he has been able to mainly stay out of harm’s way, something that is difficult for many of his fellow patients.
“You really have to be sane to be safe in that place,” Selena Bertino said.
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Reports from recent federal inspections of Western State Hospital shed light on the dangers described by staff, patients and family members like Bertino. Inspectors say the facility has put patients at risk of psychological harm, physical injury and death.
Officials with the state Department of Social and Health Services received the more than 100 pages of inspection reports from the federal Medicare agency this month and must show improvement by March 1 to keep more than $60 million a year in federal money.
Attacks on employees tend to receive more attention partly because they are regularly reported as DSHS performance measures. But inspection reports show and DSHS records confirm that patients are assaulted even more often than staff.
You really have to be sane to be safe in that place
Selena Bertino, mother of a Western State Hospital patient
278 Patient attacks on other patients over less than four months between July 1 and Oct. 25 — more than two a day — according to federal inspectors. The same review found 195 patient attacks on staff.
The 827-bed hospital averaged more than two daily assaults on patients during a recent stretch of nearly four months, inspectors found. Counting assaults on both patients and staff, there were more than four a day.
The reports also reveal at least two patients have ended their own lives in recent months, and call out gaps in how the hospital identifies and reduces risk of suicide.
PATIENT INJURIES UP
How serious the problem of violence at the hospital looks depends on who’s describing it.
While DSHS says the hospital is similar to or better than average nationally for frequency of assaults, federal inspectors concluded the hospital has “high rates” of assaults on both staff and patients.
While the state says both kinds of assaults have declined over the years, with occasional upticks, federal inspection reports pointed to “increasing numbers” of assaults by patients on other patients and similar growth in assault-related injuries to staff.
Inspectors cited data from 2013 to mid-2015 for the increase. DSHS’s new assistant secretary for behavioral health, Carla Reyes, points to a five-year time frame for the decline.
DSHS provided the analysis of assault numbers that inspectors relied on. It found no statistically significant increase or decrease over the two-and-a-half-year period in either assaults on patients or staff, or injuries to staff from assaults – but it shows a significant increase in assault-related injuries to patients.
Attacks on patients in late 2014 and early 2015 appear to have been more serious than before, producing more patient injuries.
“Any assault is too many assaults, whether it’s patient-to-patient or patient-to-staff,” DSHS deputy assistant secretary Victoria Roberts said last month. She added the agency must “try to continue to bring those numbers down, knowing that we’ll probably never get to the point where we can reduce all of them, just by virtue of the nature of the population that we serve.”
That population includes people who have been detained against their will by civil court proceedings, others undergoing treatment to restore competency to answer criminal charges, and still others declared not guilty by reason of insanity.
That last category includes Reid Bertino, whose break-in to a family member’s home led to a fight, then a burglary charge, then an insanity finding and finally a stay at Western State Hospital that has lasted more than four years and past his 30th birthday.
A judge determined in November that Reid Bertino lacked a concrete plan that would allow for release, in a ruling that acknowledged staffing problems at the hospital as a factor.
Early on in his detention, Reid Bertino said, a roommate attacked him while eating dinner. They were no longer roommates after the assault, but that didn’t keep the other patient away from him.
“You know you’re in a strange place,” Reid Bertino said, “where you have to learn to watch your back when you’re using the drinking fountain.”
Violence tends to be random, he said, with the perpetrators no more in control of their actions than the victim.
DSHS said patients can be kept apart in safety rooms after assaults, and sent to another ward if deemed clinically necessary.
Last Sunday, Reid Bertino said, a blindside attack knocked another patient unconscious. Hours later, the attacker was again walking around the ward unrestrained, he said.
Inspectors faulted the hospital in the reports received this month for overuse of restraints. As part of satisfying inspectors’ immediate concerns last month and winning a temporary reprieve from loss of funding, DSHS agreed to use restraint and isolation only as a last resort.
The agency says less isolation and restraint actually reduces assaults because it promotes an environment conducive to recovery.
At the root of many of the safety problems is a lack of trained staff. DSHS’s Reyes said staffing is the hospital’s No. 1 problem.
High turnover has left hundreds of vacancies open, and even when there were many fewer vacancies, employees and outside reviewers identified short staffing at the hospital.
To free up staff, the hospital has retreated from a planned expansion that would have helped address court rulings demanding more timely treatment.
According to inspection reports, 66 of 149 nursing employees hired between April and October have resigned.
The most recent round of threats to federal funding came after one patient beat another patient who was bound to a bed by restraints. Inspectors concluded a major contributing factor in the assault was the hospital’s reliance on on-call staff who didn’t know the two patients’ history.
It’s among several incidents that “reflected a systemic failure of the facility to ensure sufficient staff to provide treatment and maintain safety,” according to the reports.
As part of its plan for improvement, DSHS told regulators it would do more to keep staff off of unfamiliar wards, prevent the most dangerous wards from being short-staffed and send backup when a patient is being supervised as a danger to others. The agency agreed to train employees in how to defuse tensions, even if it took more overtime.
The inspection reports connect staff turnover to a recent suicide on the Western State Hospital campus. About the patient’s death, the inspection report gives few details.
But the report notes that the hospital had assigned six attending psychiatrists in succession to the patient over six months.
“This rapid turnover lessens the likelihood that a therapeutic relationship between the patient and his/her attending psychiatrist can be established,” inspectors wrote.
Days after that death, according to the reports, came another suicide.
The reports have more detail about what happened to the person they call Patient No. 4.
The reports say even though Patient No. 4 was admitted to the hospital after a suicide attempt, “there was no information in the record indicating the facility assessed the patient for risk of suicide or provided interventions to monitor the patient for suicidal thoughts.”
Seven months later, on Aug. 27, Patient No. 4 was talking about going to jail. Inspectors said that was a delusion but one with potential significance, since Patient No. 4 had been “distraught about going to prison for assault” around the time of the original suicide attempt. Staff didn’t recognize the connection, inspectors said.
On Aug. 29, an entry in Patient No. 4’s records described the patient as “pleasant and cooperative.” No time was given for that entry, but at 4:03 p.m. a nurse looked for and found the patient dead in a bathroom.
Inspectors said several staff members working on the unit Aug. 29 hadn’t been offered suicide training during employee orientation. It did not detail the training for staff members present two days prior, when the patient was reported to be distraught.
Employees receive suicide training within six months of hiring and then every year thereafter, Reyes said. She said she didn’t know if the unnamed workers described by inspectors were too new to have received the training.
She said the hospital is checking with employees who received the training to make sure they understood the concepts.
An internal review after one of the suicides yielded a recommendation for an in-depth suicide risk assessment for all patients upon admission or transfer within the hospital. That hadn’t yet been implemented as of Nov. 4, inspectors found.
The latest improvement plan was sent to regulators Monday, including a proposal to add training on suicide risk assessments by January.