Six psychiatrists who treat more than 375 patients at the Minnesota Security Hospital in St. Peter have resigned in recent months, protesting the combative style of the facility's new administrator and leaving almost no experienced psychiatric staff at the state's only hospital for mentally ill and dangerous patients.
The departures are the latest hit to a hospital battered by years of management turmoil, and a new obstacle to Human Services Commissioner Lucinda Jesson's plans to reform care for the state's most dangerous patients.
Jesson has ordered an investigation into whether the new administrator, David Proffitt -- four months on the job -- has created a hostile workplace. She hired a Minneapolis law firm to investigate complaints brought by the now-departed forensics medical director and nurses who say that Proffitt made inappropriate sexual remarks during a lecture.
In addition to the six psychiatrists who've resigned since October, one has been fired and one is on medical leave. They've been replaced temporarily by department psychiatrists who are not familiar with the patients.
Departing psychiatrists spoke on condition they not be identified for fear of licensing action against them. They described a tense, angry workplace where they felt paralyzed because, they say, Proffitt repeatedly second-guessed their care decisions and threatened their jobs.
Jesson and her top executives now must quickly recruit and train a new psychiatric staff while transforming a workplace culture that department investigators described in 2010 as chaotic, dangerous and dysfunctional.
In December, the hospital was fined $2,200 -- the most possible under state law -- and its license placed on conditional probation for two years, in part because of serious maltreatment of two patients.
Jesson also directed Deputy Commissioner Anne Barry to spend at least one day a week at the hospital to work with Proffitt and monitor patient care and the use of physical restraints or seclusion. All incidents of suspected abuse will be reported immediately to Barry and Jesson before an investigation is complete.
"Putting the hospital on conditional license for two years is as serious a consequence as this agency has faced," Barry said. "We face an enormous task."
Proffitt said in an interview Friday that he was not aware that any of his actions might be considered hostile or inappropriate. "From my perspective, this work is complex and intense. [But] anything that's alleged needs to get looked at."
He said he could not comment on why the psychiatrists left. "We are required to change our practices and the vast majority of staff are enthusiastic in doing so," he said. "Some [psychiatrists] may decide they don't want to change, but that doesn't diminish the respect I have for them."
The departing psychiatrists include Dr. Jennifer Service, a Harvard-trained psychiatrist who served as the statewide forensics medical services director for eight years, and Dr. John Wermager, the hospital's director of psychiatry. Service also was responsible for the care of more than 145 mentally ill and dangerous patients who live in communities on provisional discharge.
Another psychiatrist, Dr. Michael Harlow, was fired by Proffitt in December after Harlow placed in seclusion a male patient who'd reportedly gotten out of control and threatened the life of a female psychiatric nurse. The patient was forced to the floor and restrained in handcuffs while his clothing was cut from him with scissors because staff feared he had hidden a weapon, according to sources with direct knowledge of the incident.
Top department administrators said in interviews that they believe the resignations stemmed from staff fears that they, too, might be fired for making a wrong decision.
Questions over vetting
Proffitt was hired in September amid questions over his vetting by top administrators. When he ran a hospital for the mentally ill in Maine, the federal Occupational Safety and Health Administration fined the facility for failing to provide a safe workplace and found more than 75 staff injuries not properly documented.
Assistant Commissioner Maureen O'Connell said in an interview then that she didn't think such information was important enough to tell Commissioner Jesson, who hired Proffitt without knowing his full background. "We concluded David Proffitt is a person who learns from his mistakes," O'Connell said at the time.
A month later, Proffitt allegedly engaged in a fist-pounding confrontation with Service, the forensics medical director, that was witnessed by others. That's when Jesson ordered the outside investigation.
Proffitt's inability to build a consensus among top level hospital staff led the department to offer him an internal organizational consultant to strengthen his interpersonal skills, according to officials.
Top department executives are hesitant to fire Proffitt, in part because they believe he deserves a full chance to prove himself a reformer who can give better patient care while keeping staff safe.
Proffitt's mandate is to aggressively retrain staff to use more behavioral tools to help patients modify their actions and sharply cut the use of restraints, handcuffs and seclusion. That directive resulted in a backlash by the departing psychiatrists and continues with nursing staff, both groups saying in interviews that they are short-staffed and have not been given proper training.
Both groups said they want to provide the best possible care to patients but resent Proffitt's second-guessing their treatment decisions.
In late December, Jesson cut short her vacation to meet with five of the psychiatrists, who warned of deteriorating patient care and staff safety at the hospital.
They described an intimidating workplace where doctors, nurses and administrators have been afraid to voice concerns for fear they will be fired or lose their licenses.
In a letter to Jesson, they stated, "David Proffitt's hiring is the most recent, and most destructive, in a long line of administrative decisions that have resulted in the complete disenfranchisement of psychiatry and medicine at the Minnesota Security Hospital."
The next day, Service received a certified letter from the department telling her that she was being reported to the state Board of Medical Practice for alleged maltreatment of a patient who suffered a broken nose and ruptured ear drum during a 25-day period. She told officials that she had been on vacation at the time.
Harlow, the psychiatrist fired in December, said he has retained an employment attorney. "The doctors feel horribly sad about all this. It was a good psychiatric team; you couldn't ask for a better group. Our motto was 'Hope and Recovery,' but the only thing Proffitt has promoted is fear and uncertainty."
Harlow now works at Hennepin County Medical Center in Minneapolis.
Proffitt said he believes his demeanor at work has not been confrontational. "This is what I find in life: Reality is a perception, and I strive to be principle-centered, transparent."
Paul McEnroe • 612-673-1745