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Critical condition: Can Mark Dayton fix one of Minnesota's most problem-plagued institutions?

MinnPost photo by Briana Bierschbach
This blind corner is one of the most dangerous places to be in the Minnesota Security Hospital.

On a recent Friday morning, Scott Melby, the security and program manager at the Minnesota Security Hospital, walks down drab, gray carpeted stairs in an emptied residential unit of the hospital. On a lower landing, in a corner near the stairs, he presses himself against the pale green block walls. In that spot, more than 20 feet and a flight of stairs away from the enclosed room where staff monitors the unit, he’s completely hidden from their view.

Within the secure, razor-wire confines of the security hospital — the state’s largest facility designed to treat Minnesotans living with acute mental illness — that blind corner is one of the most dangerous places to be, a place where attacks on patients or staff are most likely to occur. 

“If you have a unit that’s constructed this way, you just can’t see,” said Melby, stretching his arms out to show the size of the area that’s hidden from view.  “It really complicates things.”

When the new security hospital was built in 1982, the unit was designed to give staff the ability to see in two landings on separate floors at once, but they didn’t consider the blind spots next to each staircase. “Somebody thought this was a really good design,” Melby said. “When we have architects come in here now, they kind of chuckle a bit.”

The Minnesota Security Hospital, currently home to 216 patients, is at a turning point in its long and controversial history. The facility is "critically" understaffed, and the building is in need of security upgrades. There were more reported attacks within its walls in 2015 than any year in the recent history of the program, according to data from the Department of Human Services (DHS), which runs the hospital, and some staffers describe working at the facility as a constant barrage of assaults. The conditions led to the hospital being fined $63,000 for workplace violations last year, and forced the state to engage in a weeks-long mediation with labor officials.

Now, people like Melby have turned their sights to St. Paul. In a year when Gov. Mark Dayton wants to prioritize one-time spending, upgrades at the security hospital have risen to the top of his list. He's proposed spending $70.5 million to complete a major construction project on the campus, the creation of new, one-story residential units with modern amenities for patients and clear sight lines for staff. It’s the largest single project in the governor's capital projects wish list, his $1.4 billion bonding bill.

But the problems at the hospital go beyond the building: Dayton also wants to put an additional $24 million into increasing staffing levels and counselor training at the facility. 

“Those are just absolutely imperative in order to provide security and safety for people who work those jobs,” Dayton said last week during the unveiling of his plan to spend the state's surplus money. “There are just some things that just have to be done.”

But nothing's a given in 2016, with an unusually short legislative session that has already offered plenty of political obstacles. The security hospital is competing with hundreds of other proposals from around the state to get funding, and some Republicans are questioning whether more money will actually be able to fix a facility with a very long list of problems.

From St. Paul to St. Peter

The Minnesota Security Hospital sits on a 520-acre plot of land in St. Peter, 77 miles southwest of the Twin Cities. The town of more than 11,000 nearly usurped St. Paul to become Minnesota’s capital in the 1850s, after a few Republican legislators introduced a capital removal bill. St. Paul ultimately won that fight when another legislator disappeared with the bill into a hotel for a few days, but a decade later, St. Peter got a consolation prize: It beat more than a half dozen other towns to be home to the state’s first “asylum.”

MinnPost photo by Briana Bierschbach
Built in 1982, the Minnesota Security Hospital currently houses 216 patients.

By 1886, the Legislature had passed "an act for the establishment and location of a hospital for the insane in the state of Minnesota." Lawmakers needed to place to treat those considered mentally ill and dangerous. Other states were no longer accepting patients from Minnesota, and instead, they were filling up the county jails. Local leaders pitched St. Peter, purchasing farmland for $7,000 to give to the state to build the first hospital.

The Minnesota State Hospital for Insane – as it was called when it opened – accepted its first patient during the middle of a raging blizzard on Dec. 6, 1866. It would grow rapidly over the next 150 years to encompass more than 40 buildings, including facilities for part of the Minnesota Sex Offender Program and the only high-security nursing home in the state.

As time passed, states across the nation, including Minnesota, slowly reformed the way they cared for people living with acute mental illness, moving away from institutionalization and more toward therapeutic programs. In Minnesota, officials dropped “insane” from the name of the hospital, and in 1957 changed the name to its current moniker: Minnesota Security Hospital. By 1982, construction of the current facility was completed on the same campus. At the time, it was considered a model of its kind.

“The security hospital was being touted as being the best in the nation,” said Rep. Jack Considine, DFL-Mankato, who worked at the hospital as a behavioral analyst in the 1980s. “The people that were doing therapeutic containment were being flown around the country. They had come up with, at that time, a pretty reasonable program. When people were out of control, they were put into seclusion and they were monitored every 15 minutes with charts and then moved out as soon as they were calm.”

A shift in approach, a rise in violence

But the reputation of the hospital slowly deteriorated over time, though no one can say precisely when the shift began.

In 2008, after a yearlong investigation, the state’s Office of Mental Health and Developmental Disabilities reported about the widespread misuse of restraints and seclusion at a state-run facility in Cambridge, Minnesota. That included regular cases of patients being restrained face down, then secured in metal cuffs and leg hobbles. Other were being restrained and secluded for long periods of time — not because they were a risk to others, but as a means of punishment. 

As the state's largest facility treating patients with mental illness, St. Peter also came under scrutiny. “It turned from a long-term intensive mental health treatment facility and then it became more and more forensically focused,” said Roberta Opheim, the state of Minnesota’s Ombudsman for Mental Health and Developmental Disabilities. “They started using techniques that you would see in a more correctional setting. It turned to a security culture over the treatment culture.”

MinnPost photo by Briana Bierschbach
The canteen at St. Peter is one of the most popular stops on the campus.

Several family members of security hospital patients sued, and the state settled in 2010. As part of the settlement, the state of Minnesota agreed to limit the use of restraints. They moved toward a model that required permission from a doctor before restraints could be used, unless there was “imminent risk” of harm to staff or patients.

But things got worse in St. Peter. In 2011, the hospital’s license was put on conditional status after complaints about patient maltreatment, particularly the continued use of restraints. In 2012, all of the professional psychiatric staff resigned at once during the tenure of former director David Proffitt, who was criticized by staff for his aggressive leadership style. DHS later asked him to step down.

Yet turnover at the hospital increased, and other staffers were put on more frequent double shifts. The hospital struggled to fill key positions, instead using contract positions to fill staffing gaps. The state legislative auditor issued a scathing report in calling the program “critically understaffed” and lacking a clear mission.

In January 2014, the hospital had its first killing in more than 30 years. Patient Darnell Whitefeather entered the room of another patient, Michael Douglas, and punched him in the face. When Douglas hit the ground, Whitefeather stomped on his head several times with his foot. Douglas later died, and subsequent investigations blamed poor supervision.

Then, last July, a 16-year-old patient at the security hospital attacked a nurse, bashing her head into a wall and kicking her. The Occupational Safety and Health Agency (OSHA) opened an investigation into the incident, and the conditional status of the program's license was extended until the end of 2016.

The turmoil was born out in other statistics, too. In 2012, there were 65 recordable injuries at the security hospital and other forensic programs, meaning they required medical treatment, time off from work, loss of consciousness or death, standards set out by the  Occupational Safety and Health Agency (OSHA). That number rose to 100 recordable attacks in 2015, according to DHS, high highest level in recent history. All told in 2015, there were 250 attacks related to aggressive patient behavior, including those that didn’t rise to OSHA reportable standards. 

This year's big push

This isn’t the first time St. Peter has gone to the Legislature for help. The process to renovate the 34-year-old campus kicked off in 2012, when lawmakers passed $3.7 million in the bonding bill for some safety improvements and to start the design process for a renovation at the campus.

Funding requests went nowhere in 2013, but the following year lawmakers passed $56.3 million to do the first phase of construction of new residential and program facilities. Last session, lawmakers passed $10.4 million in emergency funds for security upgrades, which was used to install 150 more cameras around the hospital. 

But 2016 will be the program’s biggest ask yet. The $70.5 million requested is needed to complete the facility's renovation, but it is competing with hundreds of other projects around the state during an election year in which each legislator will be working to bring some of those construction dollars back to their own districts.

The $24 million Dayton is pushing for out of the surplus would address the other side of the issue: staffing. Minnesota Security Hospital currently employs 857 people in all of its programs, including 463 who work inside the hospital itself. Many of those employees carry the title of security counselor, and critics say the hospital needs to employ more people with therapeutic — instead of correctional — backgrounds. The money would allow for new hires and, more important, training for those staffers on how to de-escalate situations to avoid the use of restraints or seclusion.

Newly appointed DHS Commissioner Emily Johnson Piper, who took over the department in December, told legislators in the House Health and Human Services Finance Committee last week that the additional funds would add 100 staffers by 2017, and 300 total staffers over the next three years. “The ultimate goal is to provide a better environment and a more therapeutic environment,” she said.

Last fall, Dayton convened a group of legislators and other stakeholders at his home in St. Paul to discuss how to make make the facility safer. Several lawmakers, including Considine and Rep. Tony Cornish, R-Vernon Center, were part of the conversation and have introduced bills this session to try to achieve that. 

MinnPost photo by Briana Bierschbach
Executive director Carol Olson describes the additional bonding funds as “critical” to create a better environment for everyone living and working at the hospital.

“It’s kind of like being in the Legislature,” said Considine, who co-sponsored bills to fund construction work and increase staff levels and training at the hospital. “You can tell stories about it and you can describe it, but unless you are actually in it, it’s hard to know what the circus is like. It’s a really unique work environment. You can be standing there and all of a sudden someone will hit you, and you ask, ‘Why did you hit me?’ And it’s, ‘Well the voices told me to, or I thought you were my mother.’ ” 

Cornish is focusing his attention on current mediation going on between state officials and union management representing workers at the hospital. He and other Republicans don’t think increased funding is a silver bullet to fix safety issues at the hospital. He wants the state to allow workers to use restraints and seclusion more – but only “to a certain extent” – to protect themselves from attacks.

“We’ve had hearings and meetings about it, and in between our meetings somebody else gets assaulted,” said Cornish, the chair of the Public Safety and Crime Prevention Policy and Finance Committee. “After the last one where we thought we were making progress, just a few days ago, another guy got stabbed in the head with a pen.”

A 'critical' construction project 

Carol Olson, executive director of the security hospital, drives her car around the 150-year-old campus, past the brown-brick security hospital and razor wire, past the original 150-year-old building that housed patients, which is now a museum for the public (by appointment only). She comes around a corner to an open construction zone, where crews are in the middle of completing the first phase of the renovation.

The new residential buildings are sleek and modern, a striking contrast with the older buildings spread out across the campus. Each of the one-level units will include 24 beds, designed so staff can see everything going on inside. They could be open for use as soon as this fall, Olson said.

MinnPost photo by Briana Bierschbach
A quilt created by inmates at the hospital.

Part of getting better for patients has to do with their surroundings, Olson said, and the current building’s interiors aren’t exactly warm and welcoming. More money will allow some older units to get updated showers, lighting figures and sleeping quarters. A new canteen – the most popular spot in the current hospital – will be constructed for patients to buy snacks and other things, and vocational building where patients can work will also be built. Additional funds will also allow further separation between the security hospital and facilities for the Minnesota Sex Offender Program, which houses most patients nearing release on the St. Peter campus.

Olson describes the additional bonding funds as “critical” to create a better environment for everyone living and working at the hospital, but she also knows more needs to be done to deal with staffing issues.

“A building itself isn’t going to do it,” said Olson, who was brought on to run the program in 2012. “I see three prongs of what will really impact safety, including the right level of staffing and more training, helping people to de-escalate these situations.”

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Comments (2)

Dangerous Places

Read the book Behind the Gates of Gomorrah for one psych doctor's account of just how dangerous this environment is for hospital employees and clinicians

I would invest some serious money into exposing those "blind corners" written about in this article but also more security staff.

Odd Title

It is unrealistic to think that Mark Dayton can fix anything. He and the legislature will soon be at each others' throats--DFL leaders formost.