Changing culture and filling jobs have proved difficult at the Minnesota Security Hospital.
Nobody stopped Bill Turnbull the night he turned himself into a battering ram and slammed his head repeatedly into a concrete wall.
Nurses and aides at the Minnesota Security Hospital stood and watched — in fear for Turnbull’s life, but also in fear for their jobs if they dared to intervene. A state hospital once infamous for the overuse of patient restraints was now under new rules. To restrain Turnbull, they would need permission from their supervisor. But when they called her at home, records show, they were turned down repeatedly, and his ordeal went on until dawn.
The events that unfolded that night in August 2012, detailed in licensing reports and other documents, reflect breakdowns in patient care that continue to shadow the state’s largest psychiatric hospital, Minnesota’s core treatment facility for the mentally ill and dangerous.
Nearly two years after the hospital’s professional psychiatric staff departed in a mass resignation, the state still has not hired a full complement of psychiatrists, documents show. Basic medical record-keeping has been neglected, employees have been placed in danger and patients have been discharged with inadequate safeguards, according to internal memos, federal records and agency files reviewed by the Star Tribune.
Dysfunction at the hospital, a sprawling facility that houses more than 300 patients on the outskirts of St. Peter, Minn., has rippled through the state’s mental health system, contributing to backlogs in patient care and delays in court placement of the mentally ill. “The hospital infrastructure to care for the most sick and most dangerous people in Minnesota is broken,” said Dr. Jennifer Service, who resigned as the hospital’s medical director in 2012.
Top officials at the state Department of Human Services (DHS), which operates the hospital, say they’re making progress, rebuilding the staff and changing the culture. Over the past four years, they note, more than 130 patients have been discharged and only 24 were ordered back by a judge, an indication of successful treatment. This year, 48 patients were discharged, records show.
“We’ve made some progress, but every time something isn’t done in an exemplary way, we’ll report it,” said Deputy Commissioner Anne Barry, who now oversees reforms at the hospital. “The leadership feels strongly about accountability.”
Barry says her mandate is to restore public confidence that Minnesota’s most challenging mental health patients will receive the care they deserve and have realistic hopes of being discharged into stable living arrangements. “We want a more therapeutic environment, and we want to work on getting more capacity in the communities so that they have stable places to live,” Barry said. “We are showing that people can recover and they can move on. For a long time we were not moving.”
Even so, a Star Tribune review of patient records, along with more than a dozen interviews, shows lingering problems.
• The hospital has been hobbled by turnover and resignations. In the psychology unit, for example, turnover has averaged 25 percent annually since 2009, records show, and of the 15 doctorate-level psychologists on staff, eight were hired in the past two years. At least 20 have resigned since 2006. Currently the hospital has just one full-time, on-site psychiatrist, and that official, Dr. James Christensen, is not board-certified in forensics, DHS acknowledges. Nurse practitioners perform much of the psychiatric care.
• Staff turnover and unclear mandates have made it a dangerous workplace. Staff injuries rose nearly 50 percent between 2011 and 2012, most of them involving assaults by patients. They have fallen this year, but the hospital still recorded more than 70 injuries serious enough to report to the federal Occupational Safety and Health Administration.
• Patients can go weeks without seeing a psychiatrist. Legislative Auditor James Nobles, in a scathing report this year, called the hospital “critically understaffed” and suggested inadequate care may violate patients’ constitutional rights.
One result is that basic patient care and case management continue to fall short, according to records and interviews with people with firsthand knowledge.
In an incident last January, for example, a patient suffering a stroke went untreated for four hours while a staff doctor failed to respond to emergency calls from nurses, records show. In the meantime, the nurses did not call 911 or seek help from a clinic steps away. The nurses were cited for neglect and reported to the state Board of Nursing; two doctors directly involved escaped disciplinary action.
In another episode, DHS licensing investigators concluded this month that Christensen committed maltreatment during an incident last April by threatening an uncooperative patient with the use of electroshock therapy. Their finding was changed to “inconclusive” by DHS Inspector General Jerry Kerber, who said that, after much consideration, he didn’t find sufficient evidence to conclude that Christensen’s remarks caused enough emotional distress to harm the patient. Christensen denied to investigators that he ever made such a threat.
Still, investigators’ notes show that, as the incident unfolded, a staff psychologist recounted hearing Christensen tell the patient, “You should be afraid of me. I am the one who is going to shock your brain with electricity.” The patient was described as being “shocked and upset,” according to agency records.
The episode so angered the state ombudsman for mental health and developmental disabilities that this month she filed a formal request to have Human Services Commissioner Lucinda Jesson reconsider the finding.
“I’m gravely disturbed, because there is a huge power differential between the doctor and the patient as shown in that threat,” ombudsman Roberta Opheim said. “Just because you’re short-staffed does not allow you to [ignore] the law when it comes to respecting patient rights.”