BREMERTON, Wash. (AP) — The lanky patient walked out of his room at Washington state's largest psychiatric hospital and spit on two patients before ducking back inside. A few minutes later, he came back out and punched two patients, so Larry Herbert, a licensed practical nurse, went after the man. As Herbert approached, the patient punched him in the face.
Herbert wrapped his arms around the patient, and they wrestled until another worker joined in and they all hit the floor. Herbert's knee went "snap, snap" as his body twisted in one direction then the other. He ended up in surgery with three torn ligaments and has spent the past six months on the couch, unsure when he can return to work.
Attacks like the one on Herbert are on the rise at Western State Hospital, leaving patients, their families and health care workers fearful on a daily basis, an Associated Press investigation found.
Thousands of nurses, mental health technicians and security guards have been punched, kicked, knocked unconscious, and bitten during patient assaults that resulted in hospitalizations and time off work in recent years, according to interviews and public records obtained by the AP. Disability claims by injured staff topped $5 million in less than three years, and the number of days missed due to injuries has more than doubled since 2016, the records show. The number of patients has remained steady.
Workers blame the hospital administration for the increase in assaults, saying they're not providing enough staff and they move dangerous patients into less-secure wards.
"Many employees work 20 or more double shifts per month," Nursing Supervisor Paul Vilja told the AP.
Hospital employees who work directly with patients put in 24,260 overtime hours during the first two weeks of September, at a cost of $944,280, according to payroll records.
Officials at the Department of Social and Health Services deny they're moving dangerous patients into civil-commitment wards and say staffing levels are stable.
"As far as understaffing, there is no understaffing," agency spokeswoman Kelly Stowe said.
The Washington Department of Labor and Industries launched an investigation at the 850-bed hospital in October after especially violent attacks in August and September.
The federal Centers for Medicare and Medicaid Services no longer oversees the facility. It cut the hospital's certification and federal funding in June after failing health and safety inspections.
The state health services agency documented more than 18,000 assaults by patients on staff and other patients over the past 10 years, but attacks on staff doubled in the past five years.
In the first nine months of 2018, patients attacked hospital workers 890 times, compared with 512 assaults for all of 2008, according to agency records. The hospital is on track to surpass the 2017 record of 1,058 staff assaults.
Injuries force workers off the job and that time has increased in the past three years, according to Occupational Safety and Health Administration reports.
Injured hospital staff missed 4,601 days of work in 2016; that number jumped to 9,893 days for the first 10 months in 2018.
Of the $7 million in injury claims made by staff since 2016, $5.2 million were for "assaults or violent acts by persons."
Hospital staff say the administration moves dangerous patients from high-security forensics wards to civil-commitment wards, which have fewer safeguards and lighter security.
When someone is arrested and found incompetent to stand trial, they're sent to the hospital's forensic ward to receive treatment to restore their competency. If treatment fails and the state wants to keep the person in custody for safety reasons, courts dismiss the criminal charges and order them civilly committed. The patient is "flipped" from the forensics side to the civil side.
The number of forensic flips has varied over the past 10 years. It dropped to 102 in 2015 but this year reached 155 by the end of September, surpassing the 139 cases in all of 2017.
The increase in forensic transfers coincides with the uptick in assaults, records show.
Staff say violent patients should be moved to high-security wards. Stowe said they move patients if they commit a "serious assault" while on a civil ward.
But that's not happening, according to staff.
Several months before patient Christopher Adams Jones fractured nurse Bernia Garner's spine, he assaulted Eloisa Panza, a mental health technician, according to a lawsuit filed by Garner.
Panza said Jones pushed her down and bit her leg. She missed three weeks of work. When she returned, Jones was still there and went on to assault Garner.
Stowe declined to comment on Panza's claims.
Staff also say the administration has moved people found not guilty by reason of insanity into the civil wards. These are people who have committed serious crimes but were found criminally insane. Western State has special forensic wards for these patients.
When AP asked how often they've transferred such patients out of the forensic wards, Stowe said: "There have been no NGRI patients moved onto civil wards."
But in December 2017, the Washington Department of Health investigated a complaint about an NGRI patient who was moved to a civil ward.
The man, charged in a double murder, lived on the forensics unit for more than 30 years but was hospitalized for medical issues, an agency report said. When he returned to Western State, they placed him in a civil commitment ward and staff complained.
At the end of the investigation, health officials found there was a "cause for corrective action against Western State Hospital."
