Attacks on St. Peter state hospital staff have more than doubled since 2011 ruling on restraint use

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In 2011, St. Peter reported 78 assaults, according data provided by the Department of Human Services. Last year, it reported 173.

Attacks on staff at St. Peter mental health programs, including the Minnesota Security Hospital, more than doubled in 2014 from 2011 — the year the state agreed to limit use of restraints as part of a lawsuit settlement.

Last month, a 16-year-old patient at the security hospital brutally attacked a nurse, bashing her head into a wall and kicking her. The assault prompted many to question whether it could have been prevented. Those interested include the Occupational Safety and Health Agency, or OSHA, which opened an investigation into the incident late last month. 

Local AFSCME representative Matt Stenger also came out on the offensive, telling the Star Tribune and Minnesota Public Radio the conditions of the 2011 settlement have led to a rise in attacks. “That’s when all these assaults started happening because the clientele started figuring out it didn’t matter what they did,” Stenger told MPR.

MinnPost took a look into assault data to see if Stenger’s claim holds up. Attacks are certainly not a new phenomenon at St. Peter, where, in addition to the security hospital, there is also a nursing home as well as competency restoration and transition services programs. But they have increased.

In 2011, St. Peter reported 78 assaults, according data provided by the Department of Human Services. Last year, it reported 173.

“There has been an increase,” says Carol Olson, executive director of the forensic service programs on the St. Peter campus.  “One couldn’t argue with that.”

From 2009 to 2011, these programs reported a total of 277 assaults, according to the data. Of those, 145 required a report to OSHA, meaning the attack was severe enough to warrant medical treatment, days off from work, job transfer, loss of consciousness, significant illness/injury or death. In the three years after the ruling, St. Peter reported 415 attacks, 196 six of which required an OSHA report. 

The change in policy came after a critical report from the state ombudsman’s office on treatment of patients at Minnesota Extended Treatment Options, a state-run, 48-bed treatment program for mentally disabled people in Cambridge, Minnesota. The report – titled, “Just Plain Wrong” – found widespread misuse of restraints and seclusion, including regular cases of patients being restrained face down, then secured in metal cuffs and leg hobbles. Staff also strapped patients to boards, and frequently left them restrained for longer than the 50 minutes allotted by the facility’s policy. Several family members of these patients sued, and the case was settled in 2011.

At St. Peter, staff hasn’t stopped using these methods of dealing with patients entirely, but it has limited use to extreme cases, when the client is showing signs of “imminent risk” to self or others, says Olson. As soon as that risk subsides, staff must cease the procedure.

Olson believes the change based on the judge’s order has contributed to the rise in assaults, but it’s not the only factor. The department has been understaffed, and relied on a rotating cast of contract workers who are sometimes inconsistent in how they treat patients. Earlier this year, staff visited a facility in Missouri to see how similar hospitals operate, and they’ve been slowly implementing new ideas. Staff members are also going through training on alternative means of handling difficult patients, such as body protection methods.   

Retraining staff is still a work in progress, and many of these changes have contributed to the higher attack rate, says Olson. “We have work to do there yet. I would not argue that we’ve done it all.”

In the meantime, this year is also shaping up to be high for attacks at the hospital. According to the DHS data, there have been 129 total as of June 30.

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Comments (3)

  1. Submitted by Greg Kapphahn on 08/11/2015 - 04:21 pm.

    To Cut Through to the Heart of the Matter a Bit

    The stark choice is between staffing levels sufficient to deal with sometimes-dangerous, and sometimes mentally-unstable residents,…

    I.E. MUCH higher levels of staffing than currently maintained,…

    or the use of chemical,…

    or in extreme cases, physical,…

    restraints.

    The judge could order huge reductions in the use of restraints,…

    but the state has NEVER staffed up the St. Peter facility to levels sufficient to keep the staff who work there safe.

    Of necessity, part of the needed staffing increases would include supervisory personnel sufficient to make sure that protocols are being followed,…

    a chain of command/responsibility clearly in place at all times and places,…

    as well as VERY clear duties being spelled out for those working each shift be delineated.

    To do so would be EXPENSIVE.

    Currently, lack of staffing has, far too often, meant that management personnel,…

    who are, themselves, trying to cover far too many bases,…

    just fall back on the misguided canard that everything on every shift is everyone’s job,…

    which means, of course, that NOTHING is actually ANYONE’S job.

    These practices apply not only to St. Peter, but to the Community Behavioral Hospitals, as well.

  2. Submitted by Stacey Mueller on 08/11/2015 - 06:02 pm.

    I have worked there for 10 years. I understand the need for growth and change. The problem lies in the fact that everything that was policy and procedure literally changed with a days notice. We were told that we were no longer allowed to use ANY type of restraint, PI, cuffs, or any actions which were punitive in nature. So with in a very small amount of time we went from fully functional to chaos. People were fired for following what was still in the policy books. People were fired or their professional licenses were in jeopardy for following Doctor’s orders or Doctor’s fired for making the newly “wrong” decision about a patients treatment or safety observation levels.
    All of this was just thrust upon us. No talk about well guys we’re in for some change and we’ll be operating differently and we plan to train you and we are going to replace the current policies and procedures and we’ll work with you on solutions to some of our more difficult people. It was instantaneous, it was forceful, and it was all accomplished by intimidation, humiliation, and fear.
    It was decided that patients did not have “rules” as it was too punitive. Patients may assault a staff or another patient and then shortly there after are allowed to go on community outings or leisure activities in the facility when clearly they have threatened staff or harm to another patient who may be at the same activity. Staff are questioned about their decisions to restrain a person after assaulting someone…was that the least restrictive measure you could have used? What lead up to this could we have done things differently? Of course the answer is always yes there.may always be a better answer BUT we are told in morning meetings when we bring up dangerous precursors “Let’s wait and see” “Oh it’s not that big of a deal.” Security Counselors by FAR spend the most time with the patients, we are the people that counsel them, help them through low spots, support them on trying to learn new skills to help them reach community placement, cheer them on when they have been successful. Most of us have College educations, and real world experience working with people. Yet we are ALWAYS the first to get blamed or told that we don’t know what is best for the patients…tragic at least appalling at best…Sometimes (most times!!) the least paid are the best persons suited to make good decisions…yet those that have the least or no patient contact at all are the ones making decisions that have terrible ramifications for the patient’s treatment . It is a very sad State of Affairs!!

  3. Submitted by Paul Udstrand on 08/12/2015 - 08:52 am.

    Typical administrative incompetence

    I used to work on psych units and an ongoing problem (with our healthcare systems, not just psych) is incompetent management and administration. This is a field where those who know do, and those who don’t know “manage”.

    There are many aspects of incompetent management but the biggest one, and the one on display here, is administrative panic. Typically problems slow boil for months or years despite constant efforts by direct care staff until something “big” happens and they administrators panic. They don’t know how to handle the situation, so they hire consultants who may or just a as frequently may not know what to do, and then they ignore the consultants advice anyways because they don’t want to actually take any action they might be held responsible for. Then “bam” something someone has usually been warning them about for months or even years finally happens and they still don’t know how to deal with it.

    In this case, incompetent administrators decided the way to deal restraint injuries and improper restraining practices was to ban restraints all-together. It’s hard not to characterize such a decision as stupid, but unfortunately it’s sooooo typical of our executive class.

    Look, patients CAN be physically restrained safely, but you need the staff and training to do it. Only someone completely unfamiliar with THIS patient population would ban any physical restraints of any kind in the first place. I’ve seen a lot of psychiatrists who typically deal with run of the mill psych patients dive for cover behind the nursing station when someone get’s really violent.

    Not only can restraint be done safely, but with certain patients restraint is simply necessary for everyone’s safety. Anyone who’s actually worked direct care with patients like this would predict this outcome. If you decrease staff (because of magic tax cuts that reduce operating budgets) you will increase staff and patient injuries. Injuries not only cost more money, but they take staff off of active duty and eventually drive them away. Once you create a work environment with high turnover and put a certain number of inexperienced staff with insufficient numbers on units with some of the most difficult psych patients, you have a recipe for a perfect storm. Anyone who’s worked on such units would predict this, and I’m sure they did, and their warnings were obviously ignored.

    Beyond basic staffing issues we also magnified the problem with budget cuts in other ways. One problem is that a lot of patients ended up at St. Peter by default because we defunded or failed to create more appropriate treatment options.

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