(Editor’s note: This is the fourth 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 — Two million Americans are victims of workplace violence each year. According to statistics from the U.S. Bureau of Labor published in the 2016 New England Journal of Medicine, healthcare workers are nearly four times as likely to require time away from work as a result of violence more than for any other reason. Seventy-five percent of workplace assaults occurred in a health care setting. Psychiatric aides experience a rate of violence in the workplace 69 times higher than the national average. For psychiatric technicians, it is 38 times higher.

According to a Bureau of Labor Statistics report on occupational injuries to healthcare workers, the most common cause of injuries in state-run hospitals (which are predominantly mental health or substance abuse treatment facilities) was violence and other injuries by persons or animals. In 2015, there were 4,590 such injuries reported nationwide. The report specifically states, “workers in psychiatric hospitals are more likely to suffer injuries caused by the violence of others.”

The Centers for Disease Control (CDC) reported that in 2017 18,400 people experienced trauma from nonfatal workplace violence that required days away from work; 71% of those, or approximately 13,000, were in the healthcare or social assistance industry.

At the Western State Hospital in Seattle, according to KIRO 7 News, workers complain of an unsafe work environment and since 2009 there have been more than 1,900 injury claims against the hospital costing taxpayers $62 million so far. There were 3,000 pages of incident reports over the last two years. The Service Employees International Union has demanded that the hospital provide enclosed nurses stations, risk assessment for dangerous patients, and more staffing and more intensive training for nurses on dealing with high-risk patients.

Closer to home, the Utah State Mental Hospital (USMH) in Provo, Utah, experiences similar problems. According to superintendent Dallas Earnshaw, the violent patients who assault frontline workers is a national problem. He told the Herald in a recent phone interview that superintendents from many state hospitals are working together to attempt to solve the safety issues.

“Leaders are challenged,” Earnshaw said. “[They are] attempting to provide therapeutic care for patients and also provide a safe environment for everyone. I don’t think there is just one problem; we are dealing with a multitude of issues. There are resource issues, building requirements, staffing issues and the safety issue.”

Earnshaw said the USMH doesn’t call the Provo Police Department (PPD) unless there is a medical emergency. He said they employ their own security force and place two security personnel on each shift. However, the Herald received incident reports from the PPD dating from January 2017 through Nov. 22, 2019, which showed PPD responding to USMH 26 times for a variety of reasons including sexual assault, assault, drugs, abandoned 911 calls, a death investigation and an agency assist.

Earnshaw said that, over the years, our society hasn’t adapted to the sicker patients. He said there is a combination of types of patients now being sent to mental hospitals and some really belong elsewhere. There are patients with conduct disorders, anti-social behaviors, and psychotic illnesses. The state hospitals become the safety net and he said communities need to develop better mental health services and more resources. Earnshaw sees the problem as a systemic one and a multi-level systems approach to a solution is needed. As far as the resources needed he stated, “More money won’t solve the problem if we don’t do it right with the resources we get.”

Former WSH professional, Dr. Peter Heinbecker told the Herald; “In 45 years of practicing as a psychiatrist in state hospitals and maximum security centers in different states, the Wyoming State Hospital is by far the worst and most dangerous hospital I’ve ever worked in; it is seven- to eight-times the most violent.”

Heinbecker graduated from Saint Louis University School of Medicine in 1974. He is licensed in Utah in psychiatry and neurology and currently practices at a private hospital in Orem, Utah. He was employed as a staff psychiatrist at the WSH from June 2013 until July of 2018.

“While I was personally not physically assaulted by patients at the hospital, I observed other staff and patients who were assaulted,” Heinbecker said. “Dr. David Crowe was strangled twice by the same patient on the adult unit and almost killed. Administration showed little concern, according to Dr. Crowe. I was stalked, threatened, insulted and libeled by the administrator at that time. The head of human resources would abuse me with no warning and no right to any due process. Needless to say this made it very difficult to treat the very ill patients we try to serve.”

Recently, the Herald was informed by current employees at the WSH that a complaint had been filed with OSHA regarding the unsafe working environment at the hospital. When the Herald contacted OSHA, Tyler Stockton, communications manager with the Wyoming Department of Workforce Services, replied via email.

“There is a Wyoming OSHA investigation of the Wyoming State Hospital, but that case is open,” Stockton said. “OSHA regulations require that no information can be released about open cases until those cases are closed.”

Jeanne Thobro, Director of Wyoming Protection and Advocacy, said that a lawsuit has been filed on behalf of patients against the WSH regarding medication errors. Those alleged errors include wrong dosages, patients getting medication intended for other patients and documentation issues.

Thobro said that over a year ago, her agency had put the state on notice of their concerns. She said she reviewed the Wyoming Department of Health budget for 2021-22, which included a statement from the Director’s Unit for Policy, Research and Evaluation that mentions staffing limitations being one of the factors affecting capacity at the WSH. According to the Wyoming Legislature’s website, as of August 2019, turnover rates at WSH were 36% for CNAs and 26% for nurses.

“The goal of my agency is that the state lives up to their legal obligation to provide health and safety to the patients,” Thobro said. “We certainly want that safety assurance to extend to the staff as well.”

Emily Smith, executive director of Wyoming Guardianship Corp. (WGC), told the Herald, “As a court-appointed guardian of the most vulnerable Wyoming residents, we are still very concerned about the care given at the Wyoming State Hospital.”

Smith said the WGC and Wyoming Protection and Advocacy are on their third lawsuit with the WSH. She said the first lawsuit was when a patient was left unattended for more than 24 hours and had ants crawling all over her; the second lawsuit was settled out of court regarding ADA issues as well as alleging a patient was denied access to religious practices; and the third, which Thobro also mentioned, is the case currently active in regards to medication errors.

“We have to protect our clients, and the State Hospital is not always forthcoming with us,” Smith said. “We are hopeful that people are good and will do the right thing. Perhaps the new superintendent will make some positive changes.”

Smith said the problem is systemic and is caused by a lack of adequate funding from the Wyoming Legislature. She added that the WSH is an under-funded system and they have continual staffing problems. Community support and resources in Wyoming are minimal due to a lack of funding as well, she said.

“It takes adequate funding to keep people safe,” Smith said. “When people with mental illness end up at the WSH, they have exhausted all other avenues of care and are now in the most restrictive care available. These people have been shut down too often, and they don’t have the emotional capacity to deal with going from one resource to another — they just give up. As far as staffing is concerned, if you pay it, they will come. The Legislature needs to increase funding for mental health treatment at all levels.”

Wyoming Department of Health Public Information Officer Kim Deti said she doesn’t necessarily agree that the WSH is understaffed, though the department has asked the Legislature for funds for additional staffing.

“Staffing ratios vary day to day across different halls and units at WSH,” Deti told the Herald. “We always try to provide enough staffing to reasonably ensure patient and staff safety, within available resources. There are well-known challenges when it comes to staffing any healthcare facility in rural and frontier areas. However, WSH has made significant progress recently in recruiting and retaining staff, especially nurses and CNAs. Additionally, we have proposed a plan for additional hospital staffing; that plan is currently under review by the Wyoming Legislature.”

Deti also said treatment team staff work together to create individualized plans for each patient, and supervision varies by patient.

“WSH staff at are entrusted to care for some of the state’s most challenging and vulnerable patients. Our mission is to provide acute psychiatric stabilization and evaluation services to this population, and we must balance safety and security practices with the goal of providing treatment in the least restrictive environment,” she said. “Each patient has an individualized treatment plan to address behavioral issues as identified by the treatment team and with input from the patient. Treatment plans are reviewed and updated regularly to continue to address behavioral challenges. This includes the type and amount of supervision required for each patient.”

Deti acknowledged a rise in “physical aggression incidents,” but also said due to recent policy changes, more of those incidents have been reported to local police as assaults. She said the severity of incidents varies drastically, and the numbers she provided “reflect all incidents of physical aggression, regardless of severity or potential injury to staff or patients.”

Total injuries from patient-on-patient incidents grew from 71 in fiscal year 2016 (July 1, 2015 through June 30, 2016) to 135 for fiscal year 2019. As of Feb. 12, Deti said there had been 75 such incidents for this fiscal year, though it’s important to note that year doesn’t end until June 30.

Injuries from patient-on-staff are more prevalent and have also been on the rise. Fiscal year 2016 saw 322 incidents. Although 2017 took a big dip, totaling 144, the next two years saw large increases — 312 in 2018 and 432 in 2019.

The Herald interviewed Wyoming State Hospital Superintendent Bill Rien late last year for this series. He said safety is a priority.

“The safety of staff is a primary concern for administrators,” he said. “It is one of the most difficult issues we deal with and is a priority for all in the field. There is nothing else that affects the morale and mental well-being of staff more. The reality is, it (violence) happens.”

Rien said that zero tolerance, to him, means that every incident is studied and investigated, and every injury is taken seriously and with concern. The reality at the State Hospital is that they deal with people in crisis with anger management issues and with psychotics, he said. With this type of population, injuries occur. Most patients at the WSH are court-ordered to be there, and most have a mental illness and are potentially dangerous to themselves or others. A State Hospital is the only place where you can’t choose to turn someone away, Rien said.

“I admire the staff that works here,’ Rien said. “It takes a toll on them. They have to be alert for unpredictable patient behavior.”

Wyoming Department of Health Deputy Director Stefan Johansson praised Rien for the job he’s done in his short tenure.

“Through Bill Rien’s leadership this past year, the WSH has seen a dramatic reduction in the turnover rate of employees,” Johannson told the Herald. “We have only one nurse vacancy at this time. I see a real light at the end of the tunnel and, in four months, we will be ready to move into our new facility. This consolidated facility will improve security response dramatically. We are always trying to improve and have invested lots of time, energy, and finances to make those improvements.”

Both Deti and Rien, along with longtime WSH Business Manager Paul Mullenax, also pointed to the new facility as a big part of the solution to violent incidents at the State Hospital. The fifth and final story in this series will focus on funding and the new facility next week.