Oregon State Hospital Grapples With COVID-19, Staff Shortages

Oregon State Hospital by Jessica Floum.jpg

Coronavirus cases at the Oregon State Hospital are rising quickly, as the number of infected patients doubled in the past week amid an outbreak in an admissions unit. The spike in cases has prompted the hospital to suspend admissions until Dec. 15.

Hospital administrators have quarantined ill patients, worked to trace the source of the outbreak and tried to address the similar rise in coronavirus cases among staff. But many employees say they are exhausted from the strain and increased responsibility stemming from staff shortages tied to COVID-19.

Six new patient cases and three new staff cases were linked to two patients who tested positive last week. Eleven total patients have tested positive for the coronavirus since October. There have now been 58 positive cases among employees since the pandemic began.

The state hospital treats up to 650 patients at its Salem and Junction City campuses, including people who have been civilly committed, found guilty except for reason of insanity, or found unable to aid and assist in their own defense. The hospital has about 2,300 employees across both facilities, including about 1,900 at the Salem hospital.

The terms of a 2002 federal lawsuit require the state hospital to admit a certain number of patients each week so people are not languishing in jail. State hospital spokesperson Rebeka Gipson-King said the facility has admitted 425 new patients under the federal court’s order since April 13.

After hospital officials confirmed last week that two new patients tested positive for coronavirus, the psychiatric facility began testing all staff and patients in the admissions monitoring unit where the two infected patients had been staying. Patients and employees in that unit don’t interact with others in the hospital, Gipson-King said. As of Friday, Gipson-King said all patients in that unit are considered “under investigation” for the virus. All but one patient were asymptomatic.

Before the recent outbreak, the state hospital had already started to limit the number of new people coming in to allow time to quarantine. Disability Rights Oregon, an advocacy group, has criticized the state hospital’s slower admissions process and has pushed for expanding community-based treatment for defendants with mental illness.

As the coronavirus infections spread at the state hospital, administrators gained approval to halt admissions entirely for at least a week, starting Wednesday. In a federal court document filed Friday, state hospital Deputy Superintendent Derek Wehr contended the extended pause was necessary for two reasons.

“First, if a large outbreak occurs between today and Dec. 15, the hospital may need to convert a third unit to either a COVID-19 quarantine unit or a PUI (persons under investigation) unit,” Wehr wrote.

Second, Wehr wrote, an average of 111 full-time nursing staff have been on COVID-19 related leave every day for the past two months, and administrators expect that average to climb in December. If there are not enough employees to cover every unit, Wehr wrote, that will limit the number of beds that can be filled.

But three staff members and a patient said they remain unhappy about administrators’ handling of the virus, which is now spreading through the hospital more quickly than it did during the first eight months of the pandemic. Two of those employees, and the patient, spoke under a condition of anonymity, saying they feared retaliation from hospital administrators.

Kim Thoma, the union president who works as an administrative specialist at the hospital, said the hospital is already at emergency staffing levels.

She said many employees grew more concerned when Gov. Kate Brown recently released her proposed two-year budget. That proposal, she said, contained $4.1 million in suggested cuts to the state hospital, as well as eliminating 16 positions. Gipson-King confirmed that the proposed cuts included eliminating seven nursing management and administrative positions, and seven positions in the psychology department.

Thoma, who worked as a mental health therapist at the state hospital for many years, said she fears the cuts would negatively impact patients’ long-term care.

Another state hospital employee, who asked not to be identified out of fear of retaliation, said the low staffing numbers are alarming, and that administrators have been pulling floor staff into positions for which they aren’t qualified. The nursing staff member said she was assigned to work as a mental health therapist, a position for which she has no training.

Gipson-King did not address the employee’s specific account, but said an emergency staffing plan that took effect Nov. 29 reassigned some staff from different units to fill in for nurses and other roles. Under the plan, if 10% of the staff is on leave, employees from areas such as social work, treatment services and behavioral health specialists will be tapped to assist in patient care. If more than 15% of full-time staff, or 138 employees, are on leave, employees could be pulled in from the psychology, nutrition or transportation and security departments.

Gipson-King said the exact roles of the reassigned staff would depend on training. Transport staff, who are already trained to work directly with patients, might fill in for a mental health therapy technician. She said only nurses would replace nursing staff.

She added that officials at the Oregon Health Authority, the hospital’s parent agency, are working to bring in people from outside the hospital to help.

But two employees said the new staffing plan had contributed to more tension among both workers and patients — and had led to an uptick in patient assaults.

One employee, who asked not to be identified for fear of retaliation said there were two attacks by different patients this weekend, one on an employee and one on another patient.

Gipson-King confirmed both attacks happened, and confirmed that the employee who was attacked required medical care. The employee who was assaulted had been reassigned to work on the treatment mall — the main treatment area where patients attend classes and therapy groups — and got hit twice in the face, Gipson-King said.

She said the patient who was assaulted is still living on the same unit as the alleged aggressor, but the latter now has a staff member supervising them to “redirect” them if they get near the other patient.

Data from the state hospital shows the average number of assaults — both patient-on-patient and patient-on-staff — for each month, per 1,000 patient days. Aside from an uptick in January of 2020, assaults on patients rose to the highest they’ve been in nearly two years, after the hospital enforced its emergency staffing plan in August. From August to September, the state hospital averaged 2.93 patient-on-patient aggressions per every 1,000 patient days. Assaults on staff since the pandemic began have ranged between an average of 2.5 and 3.5 per 1,000 patient days.

In late October, Thoma and several other staff members petitioned state hospital administrators to produce a clear and immediate plan to handle a potential outbreak at the hospital.

Thoma said staff members have so far not received a written plan, even as the outbreak grows. After the first patients tested positive for the virus in October, Thoma said the state hospital briefly offered testing to all staff, but is now only testing staff from certain units.

Gipson-King said the hospital is not the health care provider for its staff, so staff case numbers rely on staff reporting their positive tests. She said staff are screened for symptoms every day before work and asked if they have tested positive.

Gipson-King said the hospital is in the process of fitting all nursing staff for N-95 masks, and is prioritizing those who work on the quarantine unit. All patients on the admissions unit have been directed to wear masks outside their rooms, and others are encouraged to wear them.

But Thoma said the process to fit N-95 masks has been slow, which is a concern for staff members.

Gipson-King said administrators are listening to the concerns many staff have raised, and have responded to the best of their ability with things like the emergency staffing plan.

But a patient, who also asked not to be identified out of fear of retaliation, said he worries administrators still aren’t treating the virus with the urgency it deserves.

“They’re letting patients do a lot of activities,” he said in a Friday phone call with The Oregonian/OregonLive. “It just kind of feels like they’re minimizing things and not taking it seriously.”

—Jayati Ramakrishnan; 503-221-4320; [email protected]; @JRamakrishnanOR

This story was first published by The Oregonian/OregonLive and is shared here as part of an agreement among more than a dozen media outlets in Oregon to share COVID content.

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