Members of Oregon State Hospital’s Advisory Board want answers from the hospital’s leader after hearing from a staff member about the treatment of a transgender patient, a Black patient and a Black nurse.
The hospital’s advisory board sent a letter to Superintendent Dolly Matteucci asking for a review of the hospital’s patient rights policy so employees can confidently report incidents without fear of retaliation and know the complaints will receive a prompt and thorough investigation.
The Lund Report obtained a copy of the Sept. 28 letter. It’s the second public letter in a month about the state-run hospital that top officials have received from organizations that have heard employee concerns directly. Disability Rights Oregon sent a Sept. 27 letter to Oregon Health Authority Director Patrick Allen and Gov. Kate Brown after conducting a hospital visit and interviewing staff members who expressed a range of concerns, including a staffing shortage and a lack of treatment for patients.
The hospital responded Monday to that letter, outlining steps it’s taken, including stepped-up recruitment efforts and an updated policy that lets clinicians escalate concerns about a patient. According to a hospital official, the staffer no longer works there.
The advisory board letter calls on the state to set its sights higher at the hospital as it treats vulnerable people with better policies that protect patients and staff who report problems. The residential psychiatric care facility serves about 500 patients at any point and has a main campus in Salem and a smaller campus in Junction City.
“It has come to the attention of the Oregon State Hospital Advisory Board through good faith reporting, some concerning incidents and practices have occurred at the hospital,” the letter said. “These reports also highlight safety concerns and fear of retaliation from staff for voicing and reporting these concerns. These reports are especially troubling because we are at a critical juncture in this country's history. Endemic racism and transphobia are no longer swept aside to be dealt with later or forgotten entirely.”
The letter, which quotes accounts from the same staffer directly, reports the following incidents:
Black Patient Denied Eye Care
The letter said that, according to the former staffer, a Black patient was “continually exposed” to COVID-19 and denied care in the eye clinic. It also said the Black patient was assigned to a separate unit due to his violent history. That unit was designated for COVID-19 patients.
When the hospital had COVID-19 patients, staff placed those patients in one hall of the unit and the Black patient in the other hall, the letter said. Because the same staff were assigned to care for the Black patient and the COVID-19 patients, the Black patient was constantly exposed to the virus, the account said.
“Email reports of the concerns were not responded to,” the account said. “He was also denied care in the eye clinic initially due to the doctor being afraid, even though he would be accompanied by a nurse and two security guards. Throughout this, staff and the clients were put into dangerous situations. I feel as though my ethics were put in jeopardy and was genuinely concerned about my licensure in being asked to do things I deemed as illegal.”
Transgender Female Put In Male Unit
In another instance, a transgender patient who transitioned from male to female was placed in a “max security, ALL male unit because she wouldn’t take her meds,” the letter said. That patient, however, had no violent issues for three years.
“She has struggled badly since this and has decompensated due to the strain of it,” the letter said, quoting the staffer. “In my opinion this is unsafe and abusive. She identifies as a female and they are putting her at risk by placing her in an ALL-male unit as well as not honoring her identity. She has since had to be restrained multiple times and is assaulting people again. How could she not, as she is in an unsafe and caustic environment?”
Black Nurse Faced Racist Comments
In another instance, the staffer saw a traveling, contracted nurse face racist comments.
The letter said the nurse has more education and training than other employees there and someone said, “Oh well, I didn’t think you were an RN, we see your kind around here all the time and they aren’t actually nurses.”
The staffer said the incident was reported to human resources and nothing was done.
“The only response given was an email stating ‘Do you know what can of worms you’re opening?’” the letter said.
The advisory committee is asking for more commitment to education about diversity and equity. The committee also wants a timeline for a response to the allegations and information about who is responsible for follow-up work and putting changes in place.
Hospital Plans To Brief Committee
In a statement, Oregon Health Authority spokeswoman Aria Seligmann said the hospital takes all workplace complaints seriously and thoroughly reviews reports.
“We encourage patients and staff to voice their concerns and we do not tolerate any retaliation toward anyone who reports an incident” Seligmann said, noting the incidents were reported by a former employee.
The hospital’s chief medical officer has reviewed the two incidents involving patient placements and Superintendent Dolly Matteucci has offered to brief the advisory board members, Seligmann said.
It’s unclear from the statement whether the hospital’s leadership believes those patient placements were handled appropriately.
That briefing process will “provide a complete and transparent review of the clinical factors involved in each case, in a manner that protects each patient’s privacy,” Seligmann said. “She looks forward to answering their questions.”
As for the incident with the nurse, hospital managers reported it to the health authority’s Office of Equity and Inclusion, which handles the agency’s discrimination complaints, Seligmann said, adding that the hospital does not tolerate workplace discrimination. That office will investigate the matter and brief the advisory board.
Hospital Response To Other Concerns
Disability Rights Oregon staff heard repeated warnings from hospital staff and providers about overworked employees and a lack of appropriate care for patients. The advocacy group had toured the hospital without an escort, using its federal authority through Oregon’s Protection and Advocacy System. Disability Rights Oregon is the state’s federally designated mental health care watchdog.
Hospital staffers had expressed concerns that included chaotic patient transfers, inadequate discharge planning, a lack of substance abuse treatment for patients and a lack of clear protocols for transferring a patient to the COVID-19 unit. In their totality, the staffer interviews painted a picture of a hospital in “complete disarray,” Disability Rights Oregon wrote in its September letter to state officials.
Matteucci, the hospital superintendent, responded to Disability Rights Oregon in a letter on Monday. Matteucci acknowledged the COVID-19 pandemic and staffing crisis has hit the hospital hard. For example, the hospital had to suspend its so-called “treatment mall" and do unit-based treatment instead, which has fewer options for patients.
The hospital also converted a unit to treat COVID-19 patients, which required patient and staff transfers throughout the hospital.
“All of these steps have had necessary and unavoidable consequences,” the letter said. “Creating a COVID-19 isolation unit meant asking staff to move to other units to manage new patients with higher levels of acuity. The unit-based group treatment model lacks the variety of treatment opportunities we can offer in the treatment mall.”
However, Matteucci said those steps were necessary to keep COVID-19 infections down, noting the hospital hasn’t had any deaths from the virus.
Other points in the letter:
Staffing: Matteucci said hospital staffing continues to be a challenge with mandatory overtime shifts for employees. That comes as the hospital moved to enhanced staffing levels across units in response to recommendations from its nurse staffing committee.
“It’s no secret that these mandated shifts have had a significant impact on staff morale, but they have been a necessary tool to meet the enhanced unit staffing required under our most recent staffing formula and help patients get through the changes in programming the pandemic has forced on OSH,” Matteucci wrote.
The hospital has increased its contracts with staffing agencies and has 68 agency nurses, certified nursing assistants and mental health technicians on board. Oregon National Guard troops also serve in a support role at the hospital. They are due to be there until Dec. 31.
Treatment: On the patient treatment front, Matteucci said the hospital uses a “cohort model” with clinicians from treatment services and psychology staff to provide group treatment to patients in two or three units to offer a range of options and limit the risk of COVID-19 spreading.
The hospital has “begun to resume co-mingled patient activities” and plans to return to the treatment mall model after COVID-19 subsides, the letter said.
Matteucci said substance abuse treatment is available. But there are limits. For example, aid-and-assist patients are at the hospital because they need to regain competency so they can aid in the defense of criminal charges they face. Substance abuse treatment may be part of their treatment plan, but it’s not the primary objective of the admission, the letter said.
Patient Transfers: The superintendent stressed it’s not hospital policy to move patients between the Salem and Junction City campuses without clinical consideration. That was another staff concern.
However, Matteucci said the hospital had to “move patients throughout the hospital quickly to ensure the safe and appropriate placement of all of its current and incoming patients” to put its COVID-19 strategy in place and efficiently use the hospital’s beds.
Matteucci added that she has directed staff to incorporate “comprehensive clinical information” before a patient transfers. The hospital recently updated its policy so clinicians can escalate concerns and highlight a patient’s medical treatment needs.
Those processes were reviewed in late August and the hospital has a Nov. 15 target date to implement that latest revisions, the letter said.
Discharge planning: Matteucci said the hospital works hard to release patients when they can get help through community treatment programs and don’t need hospitalization.
However, resources are scarce and counties rely heavily on the hospital, including in aid-and-assist cases, the letter said.
“Too many Oregon counties look to the state hospital to commit mentally ill people who have fallen into the justice system because of a lack of appropriate treatment in their communities,” Matteucci wrote. “While Director Allen and I continue to make it a top priority to solve this issue, these problems will not be resolved until advocates and other stakeholders work to hold county officials accountable for their aid and assist decisions, not just the state.”
The letter also said the health authority has received $38.6 million to invest into community-based treatment options for people in aid-and-assist cases for the 2021-2023 budget cycle.
For Disability Rights Oregon, the watchdogging will continue.
“We are pleased to see the state has taken some steps to address the serious concerns we raised about staffing shortages and the impact on patients at the Oregon State Hospital,” Jake Cornett, executive director of Disability Rights Oregon, said in a statement to The Lund Report. “While the hospital points out that the Legislature provided $38.6 million in funding, we remain concerned about the state failing to meet its obligation to patients and the lack of a clear timeline to use that funding to address root causes and immediate concerns. We need leadership, not finger pointing at counties. For now, the State Hospital is going to remain under Disability Rights Oregon’s microscope as we continue to conduct unannounced, unescorted monitoring of conditions on the ground.”
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.