[NYAPRS Enews] CL: Amid Reforms, Staff Still Fear NYC Hospital's Climate

[Matt Canuteson]

Amid Reforms, Staff Still Fears Hospital Climate

Emily Feldman City Limits May 19, 2009

 

The notorious Behavioral Health Unit at Kings County Hospital Center has
experienced a number of major changes in recent months - moving to a
shiny new building at the hospital, acquiring new administrators, and
implementing a host of reforms required by a U.S. Department of Justice
report documenting the facility's shocking negligence in practically
every area of patient care. 

 

The psychiatric ward's poor reputation sank even lower last June when
hospital cameras captured a 49-year-old patient, Esmin Green, dying of a
pulmonary embolism on the floor of a staffed waiting area. Green's
highly publicized death, along with the DOJ investigation - which
exposed a place where inadequately treated patients wandered the halls,
violence erupted routinely, hospital police sometimes dealt too
aggressively with disruptive patients, and staff even sometimes watched
patients fight as a form of amusement - expedited the city's efforts to
open the new facility and implement reforms. While staffers acknowledge
that change was needed, they say some new practices actually make their
jobs more dangerous. Most hospital police officers have been removed,
and physical and chemical restraints for patients are being used less
often. In a massive mental health facility that sees some of the city's
most seriously mentally ill patients, staffers say they fear for their
own safety, and need ways to protect themselves when violence breaks out
among patients. 

 

"The violence I saw was unprecedented," said a former Kings County
Behavioral Health clinician who did not want to be identified for fear
of being labeled a whistleblower. "Everybody who works in a mental
health hospital has seen people assaulted, but people at Kings County
were beaten. ... There were days that I didn't go into the inpatient
unit because it was so violent." 

 

Speaking outside the new "R Building" on Feb. 5, when he announced both
progress made and further plans to improve mental health care, NYC
Health and Hospitals Corporation President Alan D. Aviles acknowledged
the challenge of managing violence at Kings County Hospital. The
facility and Brookdale Medical Center are the only two hospitals in
Brooklyn equipped to handle "patients who often present in extreme
crisis, who often suffer from co-occurring substance abuse that
complicates both diagnosis and treatment, patients who too often have
records of incarceration, patients who often come here after acting
violently towards themselves or others." The majority are admitted
involuntarily because they are a danger to themselves or others. 

 

"Inevitably, we will continue to struggle with the daunting challenge of
accurately identifying and most appropriately treating patients who are
prone to assaultive behavior," Aviles said. "Although the measures taken
today have reduced the number of incidents of patient-on-patient and
patient-on-staff violence in recent months, given the aggressive
behavior exhibited by many of our most seriously mentally ill patients,
it would be disingenuous of me to suggest that we could prevent all such
future incidents, but we can do better."

 

Two weeks before Aviles made his statement, members of the Municipal
Hospital Employees Union, Local 420 of DC-37 - which represents many
staff members at Kings county - testified before the state Department of
Labor in support of proposed workplace violence prevention regulations
for public employees. Local 420 Health and Safety Coordinator Carl Jones
expressed concern about the prevalence of violence against staff,
particularly in the city's mental health facilities. In testimony at the
hearing he said, "Not a day goes by without at least one of [my members]
experiencing some form of violence, or threatened violence, in the
workplace. The violence takes many forms ranging from patient-on-patient
and patient-on-staff violence, especially in the psychiatric units and
emergency rooms, to verbal abuse from supervisors who are trying to
manage with staff shortages." 

 

The employee violence prevention regulations were officially adopted
last month, but they're not intended to stand in for other measures at a
place like Kings County. Among the reforms Aviles announced was the
replacement of police officers in the unit with "behavioral health
associates," known as BHAs, who are non-uniformed crisis intervention
specialists. That's because parties including the DOJ and the Mental
Hygiene Legal Service, a patient advocacy agency with charges against
Kings County pending in court, have accused some hospital police of
acting violently towards patients, and involving themselves in
situations that, they say, could have been managed by clinicians. 

 

Mental Hygiene Legal Service deputy director Dennis Feld said that the
hospital police in the run-down "G Building" often contributed to the
culture of violence at Kings County. "They were nasty. They cursed a
lot, they were denigrating to the clients, and they had their metal
expandable batons," Feld said. Whatever violence there may have been
against staff "didn't justify the hospital police's use of force in
their interventions." 

The former police officers were members of HHC's own police contingent,
also referred to as peace officers, who did not carry firearms, but had
the ability to use physical force, including deadly force, to make an
arrest, prevent an escape or disarm individuals carrying unauthorized
firearms, as well as having the power to issue summonses.

 

Now BHAs are the hospital's primary defense for patients and staff
facing violence. But employees say the problem is they aren't always
immediately accessible. According to the former clinician on the unit,
long waits for intervention have resulted in "times when staffers,
including highly senior staff, were beaten with furniture, left with
lacerations and fractures, and brought to the emergency room on
stretchers." 

About BHAs, HHC spokeswoman Pamela McDonnell would say only that they
"are used in emergency as well as the inpatient units." A representative
from Local 420 said this new group of employees has not yet joined any
union. 

 

Nationally, there is some debate over whether psychiatric hospitals need
police, and how they should be trained. "I have seen security guards
used very successfully on in-patient units, but these guards were
trained very well, communicated with patients in a very therapeutic
manner, and their physical presence on the unit was enough to maintain a
safe environment without physical intervention," said Michele Valentino,
chair of the American Psychiatric Nurses Association's workplace
violence task force. The nurses' association released an extensive
position paper in 2008 on workplace violence. The paper cited findings
that "psychiatric nurses are assaulted more frequently than other
members of the interdisciplinary team." 

 

Harvey Rosenthal, executive director of the New York State Association
of Psychiatric Rehabilitation Services, said that cutting out hospital
police and restricting use of restraints were steps in the right
direction. He referred to Mohawk Valley Psychiatric Center, an upstate
facility that sees similar patients to those at Kings County that has
successfully reduced the use of restraints since the 1990s. He said it's
not patients who create an atmosphere of violence, but institutions that
"treat patients like they're problems and focus on control instead of
treatment and healing." 

 

Steve Miccio, executive director of the Poughkeepsie-based group
Projects to Empower and Organize the Psychiatrically Labeled (PEOPLe),
who has been participating in reforming Kings County's psychiatric ER
and visiting there since November, also basically backs the change.
Miccio said he can tell that patients and staff who were accustomed to
seeing uniformed police are now fearful for their safety, but he's
confident that the transformation from "a uniformed and punitive
structure" to "a more humanitarian kind of institution" will result in a
safer environment for everyone. 

 

Once the "illness-based model" is replaced with a "wellness-based
model," fear will dissipate, he said. Whether DOJ's recommended remedial
measures, including the near-elimination of hospital police and reduced
use of restraints, are having the intended impact is still unclear. The
DOJ continues to monitor the hospital's progress, and says it's too
early in the process to measure a change in violence. 

 

One thing that is clear and everyone seems to agree on, is that the
hospital has a long way to go. The way the former Kings County clinician
sees it, progress will only begin when "there's a healthier relationship
between patients and staff, and a culture of trust and respect" - words
nearly identical to those found in the DOJ report. 

 

http://www.citylimits.org/content/articles/viewarticle.cfm?article_id=37
46&content_type=1&media_type=3

 

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