A few months ago, it was the treatment of patients that had Western State Hospital in an uproar. Today, it's the treatment of staff. A nurse was recently assaulted, molested, and nearly raped by a patient, while in a separate incident on Easter Sunday two nurses and three attendants were beaten by a bar-wielding patient.
The incidents have some workers at the state's biggest mental institution worried anew about safety in wards that are understaffed, as was the unit where the Easter assaults took place. In that locked unit, called N-1, just two nurses and two attendants tend to more than 30 criminal violators.
Adding to the turmoil last week, Western's acting superintendent, Pat Terry, left abruptly in apparent disagreement over the hospital's direction. A Western spokesperson would say only that, "We're in the middle of a transition here."
Though workers eight months ago filed a grievance over new shortages in a hospital that has been historically understaffed, state officials failed to resolve the problem. Earlier this year, federal inspectors threatened to pull Western's $56 million federal funding in part over staffing levels.
"These people are in fear working there," says Tim Welch of the Washington Federation of State Employees in Olympia, which represents some of Western's employees. "They know the risks—assaults are sort of the price of doing business, and many don't even get reported. But the threat's more serious now with these shortages."
On April 26, a 35-year-old male patient attempted to rape the female nurse while she was passing out medications in a locked ward at the 128-year old Steilacoom facility. The patient broke into the nursing station, tried to knock out the woman, ripped her blouse, and fondled her. But she escaped and called security. Pierce County authorities are mulling charges.
Three weeks earlier, according to the Pierce County sheriff, a patient on a rampage tried to escape from N-1. Sundiata Botley, 28, who has a record of violence and theft, has been charged with the five Easter Sunday assaults. Officials say he somehow smuggled a fiberglass bar into the ward, using it in a long-planned nighttime escape attempt. He managed to obtain a set of keys and also got out onto a balcony, but was eventually subdued, officials say.
All five staffers, including a 63-year-old woman who suffered broken teeth and broken bones, were hospitalized. "Many staffers on that shift are over the age of 60, near retirement, overworked, and vulnerable," says Welch. "The work can quickly go from boring and mundane to abject terror."
Both the Department of Labor & Industries and the hospital are reviewing the incidents. L&I spokesperson Steve Valandra says the investigation should be completed next week.
According to a February letter from Western's chief operating officer and now acting superintendent, Pat Butler, to union officials, "Western State does not have any ward with guaranteed minimum staffing levels." The union contract is apparently silent on this issue, and the hospital keeps only "a subjective estimation of ward conditions" to determine staffing needs. In the N-1 unit, Butler said that the assigned staff of eight per shift has been operating at four due to what the hospital says are scheduling, vacation, and sick leave conflicts.
Butler wrote that he was worried about "staff perceptions regarding their safety." The hospital has become overcrowded, he said, with the opening of a new ward last December, creating "a staffing shortfall." The hospital geared up to hire new workers, he said, but suspended that effort while the facility prepared for the arrival of federal hospital inspectors.
Despite the hospital's preparation, the inspectors still found Western's health-care treatment inadequate due to poor record-keeping, staffing problems, and the underserving of patients (see "Cruel and Unusual Therapy," SW, 12/24/98). It was Western's second negative federal review in two years, fueling criticism that the hospital is a weathered monument of state-spending neglect. Particularly distressing to the Health and Human Services probers was the lack of care for developmentally disabled patients—including one locked in a room or kept in restraints 512 hours in one month.
After a return visit earlier this year, the inspectors approved changes and cleared the way for Western's continued Medicare and Medicaid funding, which provides half the hospital's budget. But a federally mandated state watchdog group, the Washington Protection & Advocacy System, says the problems continue and has sued to prevent the hospital from admitting more developmentally disabled patients unless changes are made. The advocates feel disabled patients are being abused and say hospital staffers have admitted they're undertrained and unable to "handle" DD patients.
Like hospital employees, the advocacy group sees Western's staffing as one of the hospital's core problems. In his February letter to the workers' union, operations chief Butler promised that, with the federal inspection completed, the hospital would resume its efforts to hire more trained help.
"We're waiting," says the union's Welch.