The state’s efforts to privatize and economize health care at the state’s remaining facility for the intellectually impaired have resulted in regular assaults on staff by patients, state officials have discovered.
Almost every day, sometimes several times a day, a mentally impaired resident at Pinecrest punches, bites or otherwise violently lashes out at the mostly middle-aged women who help the individuals dress, eat and function in the world.
The sudden and dramatic increase in violent attacks is an unintended consequence of “real quick privatization,” says Louisiana Department of Health Deputy Secretary Michelle Alletto, whose responsibilities include the 95-year-old facility near Pineville.
Looking to save money, the state slashed budgets, laid off personnel and in 2013 closed other public facilities, intending to send the bulk of the patients to small, privately-owned group homes in communities around the state where their needs could be addressed on a more individualized basis. Pinecrest Supports and Services Center got the rest.
The new group is younger, mostly male with less mental impairment; and because they oftentimes have histories of behavioral problems and brushes with the law, can’t find placements elsewhere. Budget cuts in other state agencies limited programs that treated these individuals in the past.
The youngsters now make up slightly fewer than half of the 426 residents. But Pinecrest is the facility of last resort and the law restricts the state’s efforts to move them elsewhere.
“Because they have a diagnosis with a developmental disability, they do meet that requirement for the care that’s provided at Pinecrest,” Alletto told The Advocate last week. “The criminal element is something that is very much recent on our radar and an issue of greater concern.”
LDH Executive Counsel Stephen Russo was around when the Jindal administration decided to close the remaining facilities in favor of using small group homes.
The conversation at the time “was mainly budget and downsizing,” Russo said. “I can’t say that (the violence) was expected. It was never really discussed. So I don’t think people anticipated we would be dealing with what we’re dealing with.”
Opened in December 1921 as the State Colony and Training School, Pinecrest was established to care for “any person affected with mental defectiveness from birth or from an early age, so pronounced that he is incapable of managing himself and his affairs …” The campus has residential-looking homes on spacious wooded lots, a town square, a school, even a cemetery, with very much the feel of a suburban gated community. Deputies who are friendly but armed limit access from the outside world.
“We stabilize them, try to teach them self-management skills, and when they’re ready, return them to the community,” said Shannon Thorn, Pinecrest’s administrator.
Almost overnight Sonja Perry, a direct care giver for nearly 20 years at Pinecrest, saw the older profoundly and severely mentally impaired individuals being moved out. These were patients she had worked with for years, often developing personal bonds so close that she was included when their families came to visit.
The new arrivals are younger and more aggressive with lesser mental impairments, officially diagnosed as mild or moderate.
“I call them the new breed,” Perry said. “I still like my job, but some days it’s just, well, overwhelming.”
There had been incidents before. Perry, whose grandmother and aunt had worked at Pinecrest, said that was largely the result of the patient’s disability: agitation from a change in routine or involuntary spasms.
She knew things had changed when a new arrival who had lost smoking privileges because he was selling his cigarettes to other patients, calmly walked into a common area and cold-cocked Perry with a punch to the face. Then, growling like a dog, he tried to bite a chunk out of her cheek. Other staff pulled him off her.
For the 12 months prior to Feb. 28, the staff filed 524 reports, required by workers compensation regulations, for incidents at the facility where three years ago virtually no violence took place.
The assaults are not extreme. Nobody was murdered or raped, but 196 staffers were punched, usually in the face, and 65 were scratched in the past year, according to the reports. Forty-seven percent of the assaults required the employee to seek medical attention.
The Louisiana Department of Health calculated that 347 incidents were related to the residents’ aggressive behavior and a little over 5 percent of those cases resulted in lost work days.
After a series of particularly disturbing incidents earlier this year, Alletto dispatched Dr. Brandi Kelly to do individualized assessments on the residents causing the most problems.
Kelly’s Feb. 17 review, along with reports of client-on-client violence and patient case files are all private under state and federal law. But incidents that could evolve into worker’s compensation claims are public records.
The worker’s comp forms -- heavily redacted to remove the name of the staffer and the patient number –- are public records. They include a short description of what happened, when and where.
“Attempting to separate three young men during a fight,” read the report of witness to a May 9 incident that took place in a hallway of Home 312, staffer “was struck several times and head bent backwards on two occasions. He (the staffer) was hit by young man with fishing rod, wall clock, fist and other things.”
A client, read another report, was stopped from stealing a staffer’s telephone on April 14 and “hit her in mouth, scratched her leg leaving a 7-8 inch scratch on right leg.”
In a Feb. 13 incident, the patient grabbed the staffer’s arm “and attempted to break it.”
Perry, an officer in the employees union, says worker’s comp forms are only the tip of the violence iceberg because no publicly available forms are filled out unless the “slap leaves a mark.”
Local 712 of the American Federation of State, County and Municipal Employees began collecting statements from its members that provide a little more detail.
Staffer LaTasha Barnes told of having her car vandalized on Feb. 10 while in the work parking lot. She suspected a patient who had been harassing her at work and phoning her home. He was angry at her for wrongly assuming she had changed his “behavior guidelines,” which dictates the services rendered and how to handle specific clients. She phoned the police but they wouldn’t take a report.
Many of the statements collected by the union complained about how they are unprotected by police and, often, are removed from direct patient care.
Although they continue to be paid, many of the workers feel that removing them from patient contact for a short period amounts to official discipline for an incident in which they were a victim. For many years, when such incidents were rare, the initial presumption was the staff did something wrong, even if a minor oversight.
Pinecrest administrators started training staff on techniques such as blocking, which involves backing away from a confrontation while clearing the room of others and trying to isolate the attacker.
And they received instruction on a technique called a “basket hold”, which is designed to immobilize the aggressor. In performing a “basket hold”, the staffer wraps her arms around the patient and grabs their arms until they have calmed down.
“How can a woman of around 100 pounds physically put a 300 pound boy in a proper basket hold? Her arms cannot even reach around him,” four nurses wrote in a statement collected by the union.
Thorn, the Pinecrest administrator, said removing staff from direct patient care is not disciplinary, in most instances, but more of a need to regroup and reassess. The difficulty with involving police is that the resident is officially documented as being mentally incapable, which makes a successful prosecution highly unlikely, he added.
For years it was accepted that incidents on the Pinecrest grounds were to be handled internally. Alletto said she was shocked when she found out that police weren’t called “because we’ve always done it that way.” She reversed that policy and in February sent out memos directing staff to call police when they were victimized.
Alletto has requested 85 more full-time staffers for the budget year that begins July 1 to focus more on individualized care and to decrease the staff to patient ratios.
Pinecrest also is bringing consultants to train staff how to recognize trigger points and de-escalate situations before they get out of hand, Thorn said. They’re teaching anger management and coping skills techniques.
“We are working on procedures and protocols that can help our staff better understand the new population,” Thorn said.
But perhaps the most far-reaching official reaction is Russo’s review of federal and state law to see what flexibility the Louisiana Department of Health has in moving out disruptive patients.
“It’s hard for us to discuss, but some of these kids have criminal histories and if they’re actively involved in criminal behavior on campus that is a patient safety issue and that is a staff safety issue,” Alletto said. “I want to take all these kids in and help them get on a better trajectory. Unfortunately, we are not equipped at Pinecrest to deal with criminal behavior.”
But the staff has lost its patience, says James Ray, AFSCME field representative and a Methodist minister. “They always say be patient, it’s going to get better. But the state, as an employer, has a legal obligation to provide a safe workplace, which they are not doing,” he said.