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

A union rep attributes the rise in assaults to a judge’s decision limiting use of restraints. Mental health officials say it’s more complicated than that.

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

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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.

“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.