Patient maltreatment sparks inquiry

In the wake of incidents of patient maltreatment, changes are being made at the Minnesota Security Hospital in St. Peter. Use of metal handcuffs, mesh face coverings, mesh blankets and seclusion are concerns.

While the use of such restraints has troubled many disability rights advocates, the seclusions incidents are particularly disturbing. In one substantiated case, a vulnerable adult had his mattress taken away and had to sleep on a concrete floor for 25 nights. In a pending complaint, a person was reportedly restrained, put in seclusion and left naked and without a blanket or pillow for a time.

The changes are applauded by mental health advocates and others who speak for humane, dignified treatment of people with disabilities. The allegations of maltreatment come in the wake of similar issues at Minnesota Extended Treatment Options (METO), where patients were also mistreated.The conditions at METO prompted a lawsuit and legal settlement with the state, as well as changes in how patients with develop mental disabilities are treated.

Gov. Mark Dayton and DHS Commissioner Lucinda Jesson recently visited the security hospital and promised changes. There is enthusiasm and support for the changes among hospital staff, said Deputy DHS Commissioner Anne Barry. “People want to be part of a high-quality environment.”

But does more need to be done at St. Peter? If problems continue, the facility could be steps away from losing its license and being taken over by the U.S. Department of Justice.

The security hospital, which is part of a larger campus at St. Peter, has had to answer three separate allegations of patient mistreatment over the past several months. Barry said that two incidents of maltreatment were substantiated after 18 months’ investigation. The DHS licensing division looked into the incidents, which were related to use of restraints and seclusion.

A $2,200 fine, the maximum allowed, was ordered by DHS. The hospital’s license was then put on conditional probation for two years.

A third complaint has since been filed and is being looked into.

Conditional license status means the hospital is very closely monitored. Reports are made every 30 days, to the DHS licensing divisions, about actions taken to correct problems there.

“This is a very serious action by the Department of Human Services, against one of its own facilities,” Barry said. Almost 400 people are at the Minnesota Security Hospital, which houses people deemed mentally ill and dangerous by the court system. Some patients are held there for assessment. Others are committed for a longer time, to undergo therapy and receive other help.

Patients there typically are those who have committed an aggressive crime, said Dr. Stephen Pratt. Pratt is overseeing the hospital operations. Patients may have a psychotic illness or delusional thinking. Some patients may have been found not guilty by reason of mental illness in a court proceeding.

Over the years there have been concerns about the care and treatment of hospital patients, as well as concerns about violations of their rights, said Roberta Opheim. She is state ombudsman for the mentally ill and developmentally disabled. She drew parallels to the past situation at METO when describing the state hospital’s issues, including a lack of centralized leadership and lack of training appropriate to the patient population. Improper use of restrains was also a key issue in the allegations against METO.

“Restraints are traumatic,” Opheim said, not just to patients but to those who have to witness a person being restrained. Others said practices at the state hospital need to change.

“There were clearly massive problems,” said NAMI Minnesota Executive Director Sue Abderholden. She said that use of restraints and seclusion reflect failures in treatment, and that such measures shouldn’t be done merely for the convenience of hospital staff.

Worker turnover and high-profile staff departures have roiled the facility. State officials are looking into whether current hospital director David Proffit has created a hostile work environment and made inappropriate comments to staff. An exodus of top psychiatrists has raised more red flags.

Attention has focused on Proffit, who took over leadership of the facility in August 2011. Although he pledged to improve patient care and reduce restraint use, use of restraints has more than doubled. Many staff members have left; others have complained about a lack of training.

 

Legislators have concerns

Members of the House Health and Human Services Finance Committee heard an update on the changes Feb. 20. Several committee members said that while they are pleased that corrective action is being taken, they still have concerns.

“I’m worried more generally about the quality of care,” said Rep. Erin Murphy, DFL-St. Paul. She asked what types of restraints would be considered acceptable.

Metal handcuffs, mesh blankets and the face coverings or “spit bags” are out. Spit bags are so named because they are meant to prevent patients from spitting on others. Instead, staff is being trained to de-escalate situations and use using soft Velcro and fabric handcuffs only in very serious situations. Barry said there may situations in which use of some form of restraint has to take place.

Pratt and Barry said the restraint methods used at the hospital will be similar to those used at other facilities. Changes in staffing and staff assignments are also being made.

“We’re working on a number of things to address problems,” said Barry, including stepped-up training on nonviolent communication skills.

“We are on a path toward correcting this.”

Upcoming actions include development and approval of new policies and procedures on use of restraints. Metal handcuffs and other forms of restraints deemed not appropriate will be removed from the facility.

 

A look at the numbers

Minnesota Public Radio has analyzed the data from the state hospital. There were 310 reports of injuries to patients in 2011, ranging from a punch in the head to another with bloody knuckles after he was physically contained. One in five injuries was caused by a patient-on-patient assault. Patients were restrained 225 times last year, hitting a two-year high in September 2011. Patients were restrained 49 times that month.

Patients spent a collective 1,772 hours—nearly 75 days— in seclusion. Hospital policy allows employees to use restraints and seclusion only when a patient poses an immediate threat to himself or others.

Employees were assaulted by patients at times, according to the MPR analysis. In 2010, employees suffered 97 injuries serious enough to require a report to federal Occupational Safety and Health Administration (OSHA) officials. Nearly two-thirds of the injuries were caused by a patient assault. In 2011 staff injuries dropped to 65 serious incidents, with half being due to patient assaults.

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