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‘Enough is enough’: Attacks on staff, overtime hours rising at state psychiatric hospital

November 26, 2018

LINCOLN — The first punch seemed to come out of nowhere. The second followed quickly.

With the third blow, Ron Glover crumpled to the floor of the Lincoln Regional Center hallway that he had been walking down a moment earlier, checking rooms.

The patient, 6-foot-6 Jayson Garett, delivered blows four, five and six to Glover’s left temple as other employees raced to intervene.

That evening, the mental health security specialist staggered from the scene, stars bursting across his vision and his brain feeling like it was coming out of his skull.

The June 8 attack was just one of multiple assaults and injuries of staff at the state psychiatric hospital in the last few years. Injuries have included broken bones, concussions, punctures and bruises. In one case, part of a staff member’s ear was bitten off, according to a former regional center psychiatrist.

State records show the numbers of assaults and injuries rising, along with overtime costs, temporary staffing hours and employee turnover.

“Enough is enough,” Glover said. “We are suffering life-altering injuries in the course of our jobs, and it seems like nobody cares.”

But state officials said they have made the regional center a priority for performance improvement over the past year.

Matt LaBouchardiere, the Department of Health and Human Services facilities director, listed workforce issues such as turnover, overtime and safety, as well as medical expertise, as top concerns. He said progress is continuing to be made every day.

“Our LRC leadership team is deeply committed to cultivating a positive work environment in which employees feel valued and engaged,” he said. “The direct care they provide to patients is tremendously important.”

The regional center houses Nebraskans with severe and persistent mental illnesses, as well as sex offenders with mental disorders. There are 238 patients on average.

Patients are sent there by local mental health boards or by court order. Courts order some criminal defendants to the hospital for evaluation and treatment before trial.

Others have committed crimes, including homicide, but been found not responsible by reason of insanity. Garett, for example, has been at the hospital since being found not responsible by reason of insanity for the 2004 stabbing death of Daryl Peed in Hastings.

HHS records show 58 patient-on-staff assaults during the first nine months of this year. At that rate, the year-end total would exceed that of any year back to 2014. The previous high was 75 in 2016.

Patient-on-patient assaults also are headed for a new high this year.

Meanwhile, workers’ compensation claims show nearly 110 incidents in the past 28 months during which patients injured regional center employees.

The total includes both assaults and cases in which workers got hurt trying to restrain a patient.

Last year, Dr. Farid Karimi, a former regional center psychiatrist, testified to a legislative committee that the regional center has more assaults than any other place he has worked, including maximum security prisons, jails, state hospitals, forensic units and private facilities.

“I was shocked by the number of assaults that I have witnessed” at the Lincoln hospital, he said.

He told the senators of the employee who had part of an ear bitten off and of another employee whose pants were ripped off by a patient who then sat on her and pummeled her.

Glover’s injury was among the most severe.

Doctors eventually diagnosed him with a traumatic brain injury, and the 60-year-old remains off work nearly six months after the attack.

He is working with therapists at Madonna Rehabilitation Hospital in Lincoln as an outpatient but struggles with memory, balance and vision problems.

In the immediate aftermath of the attack, Glover said regional center supervisors hindered him from getting medical attention. He said they would not call an ambulance, citing cost, or let another employee drive him to seek help, citing the need to maintain proper staffing levels.

Instead, he said he was told to drive himself to an urgent care clinic across town. He was also told to clock out so the hospital would not be liable for his driving.

Glover said he stopped multiple times on the way to the clinic, to throw up and because of trouble with his vision. He blacked out at one point and came to with his car sitting in a front yard, just a few feet from an east Lincoln home.

LaBouchardiere, the HHS official, disputed Glover’s account, saying that he had been offered medical attention and transportation. He said officials investigated the incident and concluded the proper process had been followed.

“Our primary concern is patient and teammate safety, and we take claims, like Mr. Glover’s, seriously,” he said.

He said HHS is taking a variety of steps to reduce assaults. One key step is the switch to a new crisis intervention and behavior management program. The program, called Handle with Care, includes methods of verbal de-escalation and physical restraint techniques.

Employees are undergoing training in the new program, which will replace the one in use currently, called the Mandt system.

“We are constantly focused on behavioral modification programming for those in our custody and we train our teammates constantly to deal with the threats of the job,” LaBouchardiere said.

He noted that there were fewer assaults on staff during the second and third quarters of this year, compared with the January through March quarter. However, assaults in those two quarters this year were higher than in the same months in 2017.

Other key changes involved removing the regional center’s chief operating officer and its medical director and naming John Reynolds to a new HHS adult facility administrator position. Reynolds oversees the Lincoln Regional Center and two other state institutions.

LaBouchardiere said the steps being taken have reduced overtime hours and turnover, especially among mental health security specialists, the front-line workers, since June.

But HHS spokesman Matt Litt clarified that overtime and turnover have not declined in absolute numbers. Rather, they are growing at a slower pace than they had been previously.

Agency records show that overtime for mental health security specialists increased to 50,809 hours last year, up from 30,829 hours in 2014. Through the first 10 months of this year, overtime for security specialists already has reached 56,964 hours.

Among all regional center employees, overtime has hit 80,630 hours so far this year.

The state spent $2.2 million on regional center overtime during the 2018 fiscal year, which ended on June 30. In the four months since, the cost has been $1.1 million.

Meanwhile, turnover among mental health security specialists this year stands at 41.4 percent, up from 30.5 percent in 2015.

Karimi, the psychiatrist, alleged in a lawsuit filed earlier this year that the turnover resulted from the assaults on staff. He claimed that mismanagement of the regional center allowed the assaults to happen.

He also alleged that regional center officials would not put patients on highly restrictive status to discourage repeated assaults.

Litt said HHS officials could not comment on the allegations because of the pending litigation. But he said Karimi’s employment with HHS ended Nov. 16. He said the separation was the result of “a personnel matter” unrelated to the lawsuit.

Jim Maguire, president of the Fraternal Order of Police, likened the situation at the regional center to the issues facing state correctional employees. The union started representing both state employee groups over the summer.

Both are dealing with staff shortages, leading to heavy amounts of overtime, including mandatory overtime. Long hours make it harder to deal with difficult and potentially dangerous people, contributing to assaults. Together, assaults and overtime drive more employees to call it quits.

Maguire said he has been inundated with calls and emails from regional center employees reporting fears about their safety, frustration with the overtime and anger about institutional policies that they believe put patients above employees.

“It’s a shame what is going on in the regional center,” he said. “Those folks in those jobs are being punching bags.”

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