Assaults at State Hospital, while down, continue to haunt staff and patients

The above X-rays show titanium plates and screws after vertabrae in the neck are fused, similar to the surgery one former employee at the Wyoming State Hospital had after he said he was attacked by a patient and is now permanently disabled. (COURTESY PHOTO)

(Editor’s note: This is the first in a series of five stories about assaults at the Wyoming State Hospital and how local and state officials have attempted to curb violence by patients there.)

EVANSTON — Although assaults at the Wyoming State Hospital (WSH) hit a six-year low in 2019, violence there has continued to traumatize staff and at least one patient, who reached out to the Herald after he was assaulted multiple times by another patient, ending up at Evanston Regional Hospital on one occasion.

Many frontline staff have expressed their fears and safety concerns at work but patients and other personnel have experienced abuse and assaults at WSH, some saying their voices are barely heard. Although incident reports provided by the Evanston Police Department have shown numerous patient-on-patient assaults, one patient is trying to give victims a cumulative voice.

Paul Brookhouse has been a patient on Johnson Hall, the criminal forensic unit, for five years. He said another patient on that hall has continually harassed and assaulted him. Just a few months ago, Brookhouse said he was in the cafeteria walking to a table with a cup of coffee in each hand. Another patient came up behind Brookhouse and started beating him, according to a police report. He was badly hurt and taken to the emergency room at Evanston Regional Hospital. Brookhouse was found to have a severe neck injury for which he said he’s received several injections for pain and has been in physical therapy.

Brookhouse was ordered to be housed at the WSH after pleading not guilty by reason of mental illness to second-degree murder charges in Sheridan County. He was accused of killing James Drake in June 2014, according to an article in the Sheridan Press.

He told the Herald that he wanted criminal charges filed against the other patient, so he said he called the Uinta County Attorney’s Office and left messages. He said his phone calls were never returned. He then called Wyoming Attorney General Bridget Hill, and she told him charges were up to the county attorney. When he told her that the county attorney’s office was ignoring him, the Attorney General told him to try complaining to the city council. Brookhouse said he thought to himself that calling the city council would be futile, so he gave up and called the Herald instead.

“I have witnessed this same patient assault three CNAs on the hall. At this time that patient is in lockdown but once he calms down, he will be released in a mixed group again,” Brookhouse said. “It is a cycle with him, and he picks on certain people to attack.”

Former Evanston Police Sgt. Don Shillcox also reached out to the Herald after he noticed a sharp increase in reported assaults at the State Hospital in 2016. In fact, Shillcox, a law enforcement veteran of 35 years at the time, was so alarmed about the rising assaults that he wrote then-Wyoming Gov. Matt Mead to express his concerns.

“I am dismayed that the situation at the WSH (Wyoming State Hospital) has not changed in the year and a half I have been away from Evanston,” Shillcox said. “Clearly the welfare of the employees and patients is no concern to the administration of the WSH, or the State Department of Health.”

Assaults by patients on nurses, CNAs, security personnel and other patients have persisted over the last five years and have resulted in local police officers being called to assist dozens of times. In 2017, police responded to reports of assaults 41 times, a nine-year high, and two more than in 2016, when Shillcox made Mead aware of the problems at the hospital.

Shillcox said he wrote Mead as a concerned citizen. In October of 2016 there had already been 27 assaults reported to the Evanston Police Department; 12 of those assaults were patient-on-patient and 15 assaults were patient-on-employee. These were only the assaults reported to the police, and many of them ended with trips to the local emergency room because of serious injury. 

Shillcox said that many times when he was taking a report as a police officer at the WSH from a victim of an assault, other staff would admit they had been assaulted by the same patient in the past. When he asked why they didn’t report it, they said they had been told it would do no good and that it was pointless.

Mead sent Shillcox’s letter to Tom Forsland, then-director of the Wyoming Department of Health, who responded on Nov. 18, 2016.

“WSH also serves as the safety net for the State for patients other providers have turned down or [have] been unable to treat (including detention centers) or where they could not manage their violent tendencies,” Forsland told Shillcox. “… The WSH plays an important role in the mental health treatment system and the violent nature of some of those patients.”

Forsland said at that time that safety staff had been increased at the hospital to nine employees, which had reduced violent episodes. Those safety staff had been given Mandt training and it appeared to be effective, Forsland said. He ended by stating that they had taken action to reduce the number of incidents and were seeing positive impacts so far in 2016. But EPD reports tell a different story, and Shillcox expressed his disappointment in a recent Herald interview.

“The Department of Health’s meager attempts to address the problem of ongoing assaults was just ‘window dressing’ and had no effect whatsoever,” Shillcox said. “Shame on them.”

Assaults did drop, however, in 2018 and again in 2019. EPD responded to 22 reports of assault at the WSH in 2018 and half as many last year.

Injuries suffered ranged from relatively minor injuries to permanent disability. Several suffered financial damage as well, from loss of income and large medical bills beyond what Workers Compensation covered.

Evanston Police Lt. Ken Pearson also expressed his concerns about the assaults at the State Hospital.

“It puts my men at risk as well,” Pearson said. “It also takes them off the streets where they are needed. I personally wouldn’t work at the hospital. I feel for the workers there. We have seen broken ribs, broken arms, testicles ruptured, dislocated shoulders, hair pulled out and more.”

Some former and current employees said employees are nearly helpless in these situations because of restrictions on the use of force to control a combative patient.

Many facilities such as the WSH have a policy that requires employees to use the training they receive in orientation to de-escalate a potential threat from a patient. This training is called Mandt Systems Training and, according to mandtsystem.com, it is based on the philosophy that all people have a right to be treated with dignity and respect. Gradual and graded alternatives are used for de-escalating and managing people. The Mandt System recommends a combination of interpersonal communication skills and physical interaction to reduce injury for all involved.

Mandt training requires that the threatened person first use communication skills to attempt to calm the combative person. If that doesn’t work, it calls for physical vertical restraint — a side body hug. In that instance, one staff member steps 45 degrees behind the perpetrator, places their pelvis against the patient’s hip and reaches around him or her, pinning the patient’s arm against his or her body, but leaving the other arm free. A second staff member is supposed to do the same restraint on the other side of the patient’s body. If the staff member is alone with the patient, they use a behind-the-body bear hug. When all else fails, local police are called to help.

The Herald interviewed several former and current employees, but most, out of fear of retaliation, asked for their names not to be used. A current WSH employee, Eric Ward (not his real name) had this to say about the environment at the hospital: “The Wyoming State Hospital is not a hospital, it is a detention center. It’s no different than a prison. The patients are court ordered to be there, they are in locked buildings, and can’t leave of their own accord. Terminology is all it is when you call it a hospital. I say, call it what it is — a prison.”

Ward said he thinks the root of the violence problem at the hospital are flaws in the criminal justice system.

“We have the worst of the worst up there on Johnson Hall; murderers and others that are there while their lawyers are trying to work their cases,” Ward said. “Many of the frontline workers are just kids hired off the street, and patients aren’t going to respect them or take orders from them.”

In the more than two decades that Ward has worked at the hospital, he said he has witnessed or experienced a total of 300 escalated events. He said he loves his job and said it is very gratifying to be able to help some of the patients.

“But … not everyone there is mentally ill, they can con people,” Ward said. “They’re not stupid. They know what they are doing, and they can get away with it, again and again. [There are] no real consequences for the patient who assaults. I have been hurt many times and have the scars to prove it.”

Another longtime employee, Timothy Cooper (not his real name), has worked with many administrators and different policies. In his opinion, what is happening at the hospital is a multi-faceted problem. One of the problems is the state cutting funding, he said, which has led to reduced programs and work therapy available to patients. Budget constraints are part of the reason for cutting staff and security, Cooper said. Contrary to Forsland’s claim that safety staff had been increased to nine employees, Cooper said there are only two to three security personnel on duty per shift.

Cooper affirmed that assault rates have escalated in the past few years. He said he thinks the frontline staff workers are doing the best they can with the resources they have. He sees the increase in assaults as being a result of cause and effect; the patient can act out and suffer no consequences except to be removed from the scene and given a candy bar to calm them down. He said the employee who is injured sees this as rewarding the aggressor and they feel no concern is shown to the injured person.

“Once a worker was stabbed with a pencil by a patient and she filed charges but the county attorney dropped the charges,” Cooper said. “The worker was moved to another hall and the administration told the worker that she wouldn’t have to work on the same hall with that patient again. But soon after, that patient was put on the worker’s hall anyway. The sad reality is you are a fine worker until you get hurt, then you are the ugly stepchild. They don’t care. If you are hurt and can’t do certain chores, then administration tells you that maybe you shouldn’t work there at all and the possibility of getting assaulted is part of the job.”

In 2015, while working at the WSH, Joel Romero (not his real name) was assaulted by a patient on Johnson Hall. Romero said he was asked by coworkers to stop a male patient from leaving the locked area. The patient was not allowed to go to the cafeteria because he had not showered.

When Romero tried to stop the patient, he was punched in the arm, then took uppercuts to his jaw, injuring his neck. Romero said he had an armful of books and was standing in a doorway when attacked. He said coworkers weren’t able to help him in the doorway, and they were in an area that had two more locked doors, so it really hadn’t been necessary for him to attempt to stop the patient in the first place.

Romero was left with bruises on his arm and damaged teeth and had to have anterior cervical discectomy fusion to two levels of neck vertebrae. A permanent titanium plate with six screws was placed in his neck. He said he also had to have surgery to repair a torn meniscus from the attack. He said he experiences chronic neck pain and has been deemed to have 8% permanent disability.

To make matters worse for Romero, he said he was placed on paid administrative leave for more than two months and not given a reason why. He said he was told to be alert during his leave and he had to go to the human resources office within an hour of being notified or he would face a charge of insubordination. 

Romero said he felt a hostile work environment had been created as he was also accused of bad performance after he was injured by a patient. He appealed and the accusations were not upheld but he chose to resign rather than work with his accusers.

Romero said the Mandt system is less than ideal.

“Mandt is only as good as the present staff’s abilities,” he said. “It takes security too long to respond and even longer if police respond. You’ve got to be willing to risk your life to control a psychotic patient. A lot of staff hesitate to take the chance of injury.”

Romero said that when he asked an attorney about filing a charge of hostile work environment, he was advised not to pursue it as the state has more money for attorneys and that the case could drag on for a long time.

“There is no compensation for pain and suffering and depression from this experience,” Romero said. He said his former goal was to work at the WSH until retirement, but now he is living out of state and looking for non-violent work.

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