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Fear, violence strain staff at
state hospital
July 8, 2007
By Lee Williams
After nurses filed complaints
against attendants alleging patient abuse, their cars were keyed,
feces were wiped on seats and windshields cracked
Some staff at the Delaware
Psychiatric Center refer to the hospital's admissions unit as
"Little Vegas," insiders say, because if patient abuse happens
there, it stays there.
Nurses who report the abuse or try
to curb excesses of the attendants contend the state mental hospital
is neither a pleasant nor a safe place to work. Many nurses fearful
of attendants are unwilling to talk publicly. Those who buck the
system have received threats of violence. Others have had their
vehicles keyed, windshields broken or tires slashed -- at work and
at their homes. When one nurse reported attendants were loafing on
her unit, she found feces smeared on the seats of her car.
Current and former medical staff at
the state's mental hospital say they've struggled with this issue
for years. In 1999, Dr. David T. Springer sent a memo, signed by 11
other psychiatrists and medical doctors working at the hospital, to
then-Gov. Tom Carper, the secretary of Health and Social Services
and every state senator outlining problems similar to those nurses
complain of today.
Springer also included a list of
recommendations for improving patient care and employee safety, but
none was implemented before he was fired. The doctor sued, claiming
he had been wrongfully terminated. The state paid him more than $1
million in taxpayer dollars to settle his claim.
Karen Stoppel is a registered nurse
certified in psychiatric and mental health with 23 years of
experience, the past 18 months at the mental hospital. The hospital
currently serves about 250 patients who've been committed to the
institution.
Stoppel believes that she likely
will be disciplined for speaking out about the climate of fear and
patient abuse she has witnessed, but believes Delaware residents
must know what happens at DPC.
The most horrific case of abuse
occurred outside her office in Kent-3 or K-3, the admissions unit
referred to by some as Little Vegas, when hospital staff restrained
an out-of-control patient.
"It was the worst thing I've ever
seen in my professional career," Stoppel said of an attendant who
she claims nearly suffocated the patient with a towel. "They're
lucky the patient wasn't killed."
The attendant was investigated by
the hospital and by state regulators -- who did not talk to him
personally -- and was cleared. He continues to work at DPC.
Weeks after Stoppel reported the
incident, someone cracked the windshield on her Chrysler Sebring and
left a threatening note underneath a wiper blade.
"May this be one of many
surprises," the note said.
Stoppel, who has a master's degree
in nursing and has worked at several psychiatric facilities, is
convinced the busted windshield "is a direct result of reporting the
abuse." She has yet to repair the damage, Stoppel said, because
"it's going to happen again."
Hospital administrators responded
to the continuing threats of violence and vandalism earlier this
year with a letter to all employees noting that state policy
prohibits violence in the workplace. Renata J. Henry, director of
the division of Substance Abuse and Mental Health, and DPC Director
Susan Watson Robinson signed the letter, explaining that the
"administration deplores the acts of vandalism and intimidation that
have plagued our campus."
But in an interview with The News
Journal, Robinson said there is no proof that violence at the
hospital is work-related.
"I know there is a perception out
there that the vandalism must be done by the nursing assistants, but
I don't agree with that," said Robinson. "We're an open campus."
As it is located on Du Pont Highway
near I-295 outside Wilmington, anyone can come on the state
psychiatric center's campus and vandalize cars, Robinson said. The
hospital may soon solicit bids for security cameras in the employee
parking lots (which Springer suggested in 1999), she said. Robinson
also pointed out that several incidents of violence were domestic in
nature, not work-related.
Deborah Hammond, however, believes
the violence is retaliatory, and unequivocally work-related.
A registered psychiatric nurse with
decades of experience, Hammond quit DPC in 2005 after only three
months, explaining she could not work in an atmosphere unsafe for
patients and medical staff.
"The nurses work in fear of the
attendants," Hammond told The News Journal. She made her decision to
leave after hearing that a nursing colleague had been followed
leaving work and that rocks were thrown through the windows of her
home.
"I'm a strong nurse," Hammond said.
"They would have retaliated against me. That's why I left. I've got
grandchildren. I couldn't risk that."
Hospital administrators were made
aware of Hammond's feelings in an exit interview with a human
resources officer. The human resources officer told the hospital's
chain of command that, given Hammond's experience and credentials,
including years of supervision, she wanted to learn why Hammond was
quitting after only 90 days.
"What she had to say was very
disturbing," said an e-mail forwarded from human resources to
hospital leaders, a copy of which was obtained by The News Journal.
"Nurses are not respected in this
hospital," Hammond said in the exit interview. "Attendants can do
what they want. You follow up on their assignments and they just
give a nasty look, like, 'Who are you to tell me anything?'
"I saw attendants watch TV, talk on
their cell phones, take extended breaks, play games on the computer,
sit around chatting in groups and I saw quite a few nurses who were
afraid to speak up about it. When they did address it, I heard
attendants make nasty, threatening remarks to the nurses. As an RN,
I don't feel safe writing the attendants up. I'm afraid of the
repercussions."
Fewer patients, more complaints
Since 2001, reports of patient
abuse, neglect or mistreatment at the Delaware Psychiatric Center
have tripled, even though the patient population has dropped by more
than half. Despite the more than 100 complaints, most of which
were filed by the medical staff, only two employees were convicted
of crimes in 2006 -- one for felony theft and another for patient
abuse.
When abuse is alleged, the
complaint is investigated internally at DPC, and then forwarded to
investigators at the state Division of Long Term Care if the
hospital's investigators believe there's a strong possibility the
abuse occurred.
In the complaint made by Stoppel,
investigators at the Division of Long Term Care never interviewed
the attendant accused of abuse, even though they cleared him of all
charges.
Robinson said the upsurge in abuse
complaints is evidence of increased vigilance under her stewardship.
Henry appointed Robinson, her
one-time deputy, as DPC director in December 2006.
"I think it's our commitment to
quality patient care," Robinson said. "We investigate everything. We
investigate more than we're required to. I think that's a good
thing."
And Robinson does have support
among some medical staff who dispute reports of attendant abuse.
"I have been working for the DPC
for the last seven years, holding several different positions from
staff nurse to middle management and had no difficulties with the
nursing assistants and the certified nursing assistants," Regulatory
Nurse Specialist Yvonne Owens said in an e-mail. "I have had
coaching and counseling sessions and had also initiated disciplinary
procedures. I have felt respected, and well appreciated by the
staff. Of course every organization has its difficult employees, we
are no different."
Dawn Rogers, a registered nurse at
the hospital, said she has always felt "safe and secure."
"I knew beyond the shadow of a
doubt that I was working with a solid team who were in support of
each other and were focused on patient care as the No. 1 priority,"
Rogers said in an e-mail. "I have never been spoken to harshly,
threatened or even challenged by an attendant."
Many of Robinson's employees,
current and former, say just the opposite is true.
"They should shut that place down.
There's nothing professional going on there," said Judith Bigford, a
certified nursing assistant who worked at DPC until she was fired
this year. A letter to Bigford from Robinson's boss, Renata Henry,
indicates she was fired because she failed to complete her
orientation after she was injured on duty -- even though she worked
months after her orientation period should have been completed.
Bigford, a native of Trinidad,
spent 20 years as a correctional officer at New York's Rikers Island
prison complex, which houses more than 16,000 inmates. She received
a 9/11 award from New York City for her role in recovery efforts
after the terrorist attacks.
"The people in charge of DPC run it
like the mob," Bigford said. "There are threats. The employees are
afraid to talk, so they suffer in silence. I was told on day one
that you don't say anything, or they'll hurt your car."
One attendant, Bigford said, would
ask patients who had done time in prison whether they enjoyed being
raped by other inmates.
"I'd see stuff like that and it
would break my heart," she said. "They take away their dignity."
Phillip Williams Sr. and Gregory
Boston, union leaders who represent the attendants and other
staffers at DPC, said reports of abuse are exaggerated -- and just
part of the everyday job at the hospital.
Attendants, who perform a variety
of duties on the floors where the patients reside, receive in-house
training. They are not medically educated and need only basic job
skills to qualify. In 2005, there were about 75 full-time registered
and licensed practical nurses out of about 550 full-time employees.
The union leaders said their
members are frustrated by the increase in "PM46" investigations, the
form used to document suspected patient abuse, neglect or
mistreatment.
"We tell [union members] they can't
base a determination on whether the system is broke based on the
number of PM46s going on," Williams said. If abuse is found "it goes
through channels" and does not necessarily result in termination of
the employee.
Both union leaders promised that
they would arrange interviews with their members, but only one was
willing to talk for the record.
Robert Gray, who has been a
certified nurses aide at the hospital since 1994, acknowledged
problems in the past. But he said, "Over the years, to me, it's
gotten so much better there."
Contested firing
Late last year, an unofficial group
formed at DPC for the purpose of getting Director of Nursing Gloria
Harrison fired.
The group included Philip Thompson,
director of the admissions unit, and Boston. It met several times,
and even took minutes of what was discussed at their meetings.
According to these documents, the
group considered Harrison a "target." They claimed she was
"domineering," displayed a "lack of professionalism" and had "poor
relationships with her staff and across disciplines."
Harrison was fired last month for
alleged misuse of short-term disability leave. Some of her nurses
insist, however, she was terminated for reporting patient abuse, for
backing her nurses and for her unwillingness to play politics with
Robinson and Henry, neither of whom are medically trained.
Robinson acknowledged meeting with
the unofficial group, "because as leadership of the hospital, we
encourage everyone to bring issues to the forefront."
She said the group played no role
in Harrison's termination, but declined to discuss her reasons for
firing Harrison, a decorated Army and Air Force veteran with
distinguished nursing credentials.
Harrison's nurses adored her.
"She was a fabulous boss, probably
the best," Stoppel said. "She was on the units. She was visible. She
was accessible. She cared about every employee."
Harrison would park her car at
former nurse manager Rhonda Montgomery's house before their shift,
and the pair would carpool to the hospital to reduce the likelihood
of vehicle vandalism.
"She's a nurse's nurse," Montgomery
said. "Her biggest concern is patient care. She tried to bring the
unit directors under medical's control. That's when all of this
started."
Harrison has not contested her
firing in court, but says she may bring suit against the state.
"My termination was unjust, and I'm
reviewing all options," she told The News Journal. "Though I'm no
longer employed by the DPC, I am still very concerned about the
welfare of the patients."
Wrongful termination
The last time a medical staffer
at DPC alleged he was wrongfully terminated, the state paid more
than $1 million in damages.
Dr. David T. Springer's 1999 memos
contained numerous suggestions and recommendations for improving
care at the facility. During a court hearing on his wrongful
termination claim, Henry said under oath that the suggestions were
sound. But none of these improvements was ever instituted at DPC,
Robinson acknowledged.
"I'd have been surprised if
anything had changed," Springer told The News Journal. Like some
other current and former medical employees interviewed for this
story, Springer said the nurses worked in fear of the attendants.
"And the physicians did to some
degree, too," he said. "It was well known there were people who
would slash tires or put feces on the cars of anyone who threatened
an attendant with discipline."
Current staffers say the issues
documented by Springer in 1999 remain problems today.
"Staff is afraid to speak out on
issues affecting patient care and safety, as they are afraid of
being punished by the administration," Springer wrote eight years
ago. "Staff has also expressed fear of speaking out and/or
disciplining the staff for fear of getting their tires slashed,
having feces smeared on their car or worse. The administration has
been made repeatedly aware of the problem, with no action to date."
In an e-mail obtained by The News
Journal, Vincent Meconi, secretary of the Department of Health and
Social Services, was informed about a union meeting at the hospital
that focused on violence in the workplace. That meeting was called
after "one of the nurses had her windshield broken, and threats of
action to come, made against her," the e-mail explained.
Meconi didn't attend the meeting.
In a following e-mail, the Cabinet secretary was told "there are
facts that are being hidden from you by layers of administration,
and I am not sure if it is because they want to deal with the issues
themselves, but they have not been addressed. I try not to give
motive to actions, but know that information that you need is being
stopped before it reaches you."
Meconi denied that medical staffers
at DPC are afraid of the attendants.
"Let me just say that I have not
heard that alleged until prior to last week," Meconi told The News
Journal. "We've had no grievances on the subject. I have not heard
the issue raised."
Meconi described the level of care
patients receive at DPC as good, and provided a laundry list of
outside groups that monitor care within the facility.
"I have a lot of external
indicators who indicate things are going OK," he said.
He refused, however, to allow The
News Journal access to the facility, citing federal patient
confidentiality laws.
He also shrugged off the 300
percent increase in reports of abuse and neglect as a byproduct of
the institution's zero-tolerance policy.
"We saw the spike, rewrote our
policies, and tried to take a more aggressive stance," he said. "It
was something we expected and deliberate. It's not necessarily a bad
thing."
Five minutes after Meconi's
interview with the newspaper, Jim Lafferty, executive director of
the Mental Health Association in Delaware and chair of the
governor's advisory council to the Department of Substance Abuse and
Mental Health, called the reporter to explain what a good job Meconi
is doing.
"Since Secretary Meconi took over,
I've seen many positive changes at the hospital," Lafferty said. "As
far as patient care, I think it's at a pretty high level."
Keeping a watchful eye
Under an agreement with the state,
the Delaware chapter of the National Association on Mental Illness
sends volunteers into DPC to monitor conditions in the seven units.
The volunteers report anything out of the ordinary back to NAMI-DE
and hospital officials, usually cleanliness and safety concerns. For
instance, when a NAMI volunteer found several patients had been
given portable CD players, with earphones and cords that could be
used for self-harm, the practice ceased.
As executive director of NAMI-DE,
Rita Marocco takes her turn walking the floors -- and shares all she
learns with hospital administrators.
In DPC's Mitchell Building, where
the state houses the criminally insane, the attendants approached
Marocco with a question once they learned she was the local NAMI
head.
"They asked me why they couldn't
retaliate against patients who called them names and gave them a
hard time," Marocco said. "I couldn't believe it. I didn't know what
to say. I told them because you're the staff and they're the
patients. I don't know who's in worse shape over there."
Problems for the state hospital
began several years ago, Marocco said, when federal regulators
balked at staffing shortages. The DPC responded by contracting with
local hospitals to offset in-house staffing concerns.
"In concept, it's a good idea for
people who only need short-term care," Marocco said. "But DPC holds
the purse strings. Those patients requiring long-term care are still
discharged. They're neither stabilized nor put into a stable
environment."
NAMI-DE has learned that about 30
percent of the patients discharged from just one unit are homeless.
"They're discharged into homeless
shelters or onto the street," Marocco said. "What we've created is a
chronic revolving door at these hospitals, which costs money and is
not effective."
To try to offset this, DPC began a
"frequent user program." The program requires a certain number of
admissions at community hospitals before DPC will admit them.
Marocco said the program required four admissions, but Robinson
could not confirm the number.
"You can imagine what's happening
to this patient during these admissions," Marocco said. "This is the
effect of running the state hospital like a business rather than a
care facility."
With its more than 55 group homes
spread across the state, NAMI-DE also advocates for community
placements rather than hospitalization.
Marocco has long known that staff
members at DPC are afraid to speak out.
"These are not urban legends," she
said. "What we expect from a psychiatric hospital is that their
people work toward providing what's best for the patients in their
care. In my opinion, they've come up short."
Contact investigative reporter Lee
Williams at 324-2362 or lwilliams@delawareonline.com.
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