(Editor’s note: This is the fifth 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 — A recurring answer when asking local and state officials about patient violence at the Wyoming State Hospital (WSH) is: the new facility will help. Last week, WSH Business Manager Paul Mullenax led Herald staff on a tour of the new facility, which is under construction and scheduled to be functional by summer.
Approximately 150 workers are busy working on the new facility. Mullenax said that maintenance issues and health facility upgrade requirements were not cost-effective, so the state decided it needed to build a new facility.
Mullenax, who’s worked at the State Hospital for 26 years, said the construction of the new facility is being done in phases and Phase 2, the C, D, and E units, will be completed and ready for occupancy by July. Phase 3, which will be a complete renovation of the “old new” unit — the building with the blue roof, aka Phase 1 — will not be completed until 2021.
Mullenax said the hospital currently has 104 patients and is licensed to house 183. He said that when the Lander medical unit facility is completed, the state will move the WSH geriatric patients there. The Lander facility is projected to be completed a year after WSH is completed. Until then, those patients will be placed on Unit E.
As Mullenax led the tour, he described the rooms and the security measures that have been incorporated into the building. There are lots of windows throughout the units, including a large window in every single-occupancy bedroom.
“Those windows are double-pane safety glass and have been installed with 90 bolts, securing their placement,” Mullenax said. “Above the bedroom door is a pressure bar so if someone tried to hang themselves from the door an alarm would go off. All of the fixtures in the adjoining bathrooms and the door handles are anti-ligature (unable to be tied or bound to), as required (by the federal government), so there is no way they can put a rope around it or use it for hurting themselves.”
From the adjoining hallway, a locked door opens into each unit, which houses a nurse’s station and medication room, a common gathering area with a television, a staff break room, a seclusion room, a small dining area for patients with attached serving room accessible only by staff, a comfort room that patients can choose to use, therapy rooms, a small activity room and single-occupancy rooms with individual bathrooms. The C, D and E Units will each contain 24 beds.
Units F and G will house 10 patients on one hall and six on the other. They are the forensic units, or maximum-security areas. The number of male and female patients the WSH has at any given time will determine whether the patient is placed on F or G.
Throughout the tour, Mullenax pointed to many new or updated security features.
“If a patient tries to barricade himself in a room, the door is made to open in or out with a key, so staff can get in,” Mullenax said. “Also, the entire facility will have cameras, which will be monitored by [staff using] computers.”
Mullenax also said the new facility is setup in a way that allows food carts and mail carts to be more secure as staff transport food and deliveries throughout the facility.
Although the units are not completed, it appears they will be more hospitable and attractive for the patients than the old, historic facility. The many windows letting in light and the several enclosed outdoor areas, along with updated walls and flooring, will provide a more appealing atmosphere for the patients and staff.
The entrance for guests and staff will be moved, and near that will be a chapel. Included in the new facility is a gymnasium with a basketball court, padded walls, the opportunity for exercise and a “galley port,” a large garage where patients will be brought to the admittance area. Meals will still be prepared in the old facility and delivered to the new units until Phase 3 is completed.
Phase 3 will house the administration offices, a new cafeteria and kitchen, library with computers, exercise equipment room, security officers, laundry room, clinic area, doctor’s offices with a waiting room, medical records, a beauty salon and occupational therapy. Office staff will remain in the old facility until completion of Phase 3.
When Phase 2 is completed this summer, Mullenax said there will be an open house for the public before the patients are moved into the units.
Another safety concern addressed by officials was staffing. Contrary to the perception of many, local and statewide officials say there is not a staffing problem at the WSH. Several people — some current and former WSH employees — have put partial blame for the violence by patients there on an understaffed frontline, such as CNAs and aides who work directly with patients.
But, as reported in last week’s installment of this series, Mullenax and Superintendent Bill Rien, along with Wyoming Department of Health Public Informaiton Officer Kim Deti say the hospital’s frontline is not understaffed. Rien said staffing isn’t an issue when it comes to direct care or security. He said the biggest staffing problem at WSH is that it’s hard to attract professional staff: forensic psychologists, doctors and registered nurses.
Rien then explained the role of security personnel at the State Hospital — to provide backup on halls to assist CNAs and act as first responders to emergency situations. Sometimes security’s very presence works to calm down a patient. The training the workers get is to use verbal de-escalation first and if that doesn’t work, then a manual bear hug. Frontline staff have an emergency button to call for security when needed. Clinicians and security are trained in techniques of de-escalation. Rien said he considers the MANDT training to be effective.
For determining how many staff should be on any one hall, Rien said it has more to do with acuity than with numbers of patients. If there are fewer patients but their mental illness is more acute and less stabilized, and they are more impulsive then more frontline staff may be needed. The number of staff assigned is fluid based on the risk assessment, he said, something Mullenax reinforced during a recent tour of the new facility by Herald staff.
Mullenax said the ratio of staff to patient varies depending on acuity of the patients, but the usual ratio is one CNA for four patients and one RN for every 12 patients.
Rien said that the assessment of a patient starts even before they arrive at WSH. It begins with all the background information from a variety of sources; jail records, mental health centers, and doctors. Rien said the patients who come to the WSH have been in a designated hospital and the Wyoming Behavioral Institute (WBI) may send them to WSH. When they arrive at WSH, they have a personal assessment completed by the medical staff and a licensed practitioner. They decide which hall to put the patient on and if the patient needs one-on-one observation. If the patient commits an assault, a whole new risk assessment is done.
When a patient is discharged, Rien said they set up community support for them to keep the recidivism rate low. Usually if someone is going to come back, it is within 30 days of discharge, he said, adding that his staff watches carefully and tries to prevent repeat committments.
Concerning complaints from frontline workers who’ve said they feel very little support and are most concerned with their safety, Rien — who has only been at the helm for about a year — said he plans to develop an Employee Executive Committee, made up of representatives of direct care staff. The frontline workers on each hall will select a person to serve on this committee to represent their concerns and work on solutions. He said he will meet with them so he can hear their concerns directly and not have to hear it from the community at large.
“This is hard, challenging work,” Rien said. “My hope is at the end of the day, people will feel like they did something meaningful or important.”
Rien said he thinks the new facility will create a safer environment because all halls will be close together under the same roof. Patients participate in life skills classes, cooking, hygiene classes, group and individual therapy, activity therapy and recreational therapy. Security personnel will not have to drive or walk great distances from one hall to another and can respond in a timely manner, he said.
Deti said she also believes the new facility will help curb violence. The new facility will provide an updated, more modern environment with single patient rooms. She said the plan is to transfer some long-term patients (such as older patients with greater healthcare needs) to the Wyoming Life Resource Center in Lander after new facilities are available there in 2021. This will allow the WSH to focus more directly on its acute care role.
The State Hospital’s new facility will have smaller unit/pod sizes with three 24-bed units that can be separated into three eight-bed pods per unit. The forensic unit will have two 16-bed units that can be separated into two eight-bed pods per unit. This will allow for greater separation of patients based on acuity, Deti said. This will also allow the facility to staff the higher-acuity pods with an increased staffing ratio. There will be more treatment space to allow designated therapies to be targeted for specific patient groups. Single occupancy will help to relieve agitation and anxiety.
State Rep. Garry Piiparinen told the Herald that he is very much aware of the violent assaults by patients on employees and other patients. He said several years ago, he and former Rep. Allen Jaggi had tried to organize a meeting with employees to discuss their safety issues, but people were too afraid to talk about the problem. Piiparinen said he had talked to Alan Forslund, who was director of the Department of Health at that time, but received no help.
“I have read the Herald’s stories and have made copies of them and I am delivering them to the governor and to the House and Senate committees on Health and Labor today,” Piiparinen said in an email to the Herald on Feb. 24.
Piiparinen said he encouraged the legislators and the governor to read all of the stories and to look into this matter that has been going on for years and to do something for the safety of the employees.