Hospital workers beat patient

A report on Umstead mental hospital says the staff failed to prevent violence

Investigators who have recommended withholding federal money from a state mental hospital in Butner described in a report Wednesday how three workers beat a mentally ill woman who was strapped to a bed.

A health-care technician at John Umstead Hospital overheard noises coming from a room that "sounded as if the patient was being hit with a hand," and then heard the patient say, "Go ahead. I can take it," according to the report.

Another patient choked, punched and chased patients and staff members at the hospital for weeks before the staff decided that she needed close monitoring, the report said.

Investigators have recommended that, for failing to prevent violence, the hospital should lose federal money, which makes up about 25 percent of its annual budget. The report Wednesday from the U.S. Department of Health and Human Services details the problems they found. The hospital staff will use the report to make improvements and have about 10 days to devise plans and pass another review.

Investigators have threatened all four state psychiatric hospitals with cuts this year and took the rare step of pulling money from Broughton Hospital in Morganton. This month, Dorothea Dix Hospital in Raleigh was added to the federal watch list. Investigators faulted Dix for failing to have doctors approve patient transfers from the admissions unit to other hospitals.

The problems come as the state is wrestling with the results of a mental health reform effort. Counties have shed most treatment programs, but the private companies that were to replace them have failed to fill the gaps for the most difficult-to-treat patients. At the same time, short-term hospital admissions have increased.

The report Wednesday on Umstead did not name any of the patients or hospital workers.

In the staff assault case, a health- care technician reported abuse in September of a 51-year-old woman who was in restraints. The woman, who said she was struck in the head, was in a "quiet room" and had her arms and legs tied down because she had attacked a clerk.

After the patient was assaulted, a technician left the room, went to the nurse's station and turned off a video monitor of the patient.

"I'll get that [expletive] again," she was heard to say.

A doctor checked the woman soon after she said she was beaten and found no obvious signs of head injury.

A technician involved in the assault later complained to her supervisor of red, swollen knuckles.

She told the supervisor she had to go to the clinic to have her hand checked because she injured it while subduing the patient during the earlier attack on the ward clerk.

She lost her job after a hospital investigation. Her two co-workers were allowed to return to work after five-day suspensions.

One was sent to work in the children's unit and the other was sent to the medical unit.

Patsy Christian, CEO for Umstead and Dix, said the workers were reassigned to parts of the hospital where they "would have better supervision."

Two weeks, six attacks

The report also suggested that the hospital took too long to adequately handle a 39-year-old woman who repeatedly punched and strangled hospital staff and other patients.

In her first two weeks at Umstead, in October, she attacked other people six times. It wasn't until the patient choked a staff member and threw her to the floor that her treatment team decided that two staff members should watch her at all times. Even then, round-the-clock monitoring was spotty, the report said.

Twice when the monitors weren't there, she attacked other patients. The staff did not routinely wear body alarms, as required by hospital policy.

Dr. Jim Osberg, the state Department of Health and Human Services administrator in charge of institutions, said it was hard to judge the effectiveness of the staff's response without knowing the details.

"We're going to look at those kinds of issues," he said.

The report describes other cases where:

* A patient in restraints who was supposed to be watched at all times was able to free her left arm and get her gown wrapped around her neck.

* Staff failed to monitor a patient's blood-sugar levels and give insulin as ordered.

Investigators faulted hospital leadership for failing to prevent patient abuse and provide enough qualified staff to make sure of safety.

"If there are shortcomings, we need to fix them," Osberg said. He said it would be impossible to eliminate assaults at state hospitals, because most patients admitted to the hospital are considered a danger to themselves or others.

"That's the nature of mental illness," Osberg said. "It's unpredictable."

At Dix, Osberg said, the deficiency is a paperwork problem that can be remedied with new forms reminding staff what steps and authorizations are needed before a patient is sent from the admissions unit to another hospital.

Inspectors gave Dix until March 4 to make improvements, and Osberg said work had already begun to meet the federal requirements.