'We're not protected'
Treatment assistants fear for safety
By Nathan Hegedus
New Hampton - First, he separated his prey from the flock. Then he attacked.
On an afternoon in late September, a patient at Mid-Hudson Forensic Psychiatric Center asked to go to his bedroom.
A male staff member walked the patient to the door and turned his back to unlock it.
The patient punched the staff member in the back of the head. The assistant's head hit the steel door frame and he slumped to the floor, unconscious.
He woke with the patient kicking him in the back so hard it split him open.
He was hospitalized, out of work for weeks.
Yet nothing happened to the patient, says the assistant.
Two hours later, the same patient attacked a supervisor. Only then was the patient restrained. But only for a while.
Today, the assistant, who did not want to be identified, is back at work. He encounters the man who put him in the hospital and the patient acts like nothing ever happened.
"It's a 100 percent fact he'll do it again," claims the assistant. "He's attacked five people since me. He'll get me sooner or later. Just because they're crazy doesn't mean they're stupid."
The attack was not an isolated incident at Mid-Hudson. Instead, it is becoming the norm at an institution that houses what staff members describe as a motley collection of rapists, killers, cannibals and pedophiles - all with serious mental illnesses.
The Security Hospital Treatment Assistants, or SHTAs, are the most vulnerable. They spend their days in constant contact with the patients - watching them, counseling them and jumping in when things go violently wrong.
In interviews with SHTAs at Mid-Hudson and a subsequent investigation, the Times Herald-Record has learned:
-The treatment assistants are punched, kicked, scratched
and spit upon with alarming regularity. Since late October, there have
been more than 20 reported assaults on staff members at Mid-Hudson,
according to incident reports from the New York State Correctional Officers
and Police Benevolent
-The rise in violence is directly related to new rules meant to reduce the use of restraints and seclusion rooms at the hospital, staff members say. The rules are meant to protect patients from abuse and protect staff by encouraging them to defuse problems before they escalate.
But the new rules, first implemented about two years
ago, are failing miserably, staff say.
-In an effort to produce good statistics for reports, the hospital administration is pressuring staff to reduce restraint and seclusion orders with little regard for employee safety, say the SHTAs. The situation is deteriorating, with a sharp increase in assaults in the past six months, they
-Staff members, who do not wear uniforms, often take violent patients to outside hospitals and medical offices with only handcuffs and have almost no authority to discipline the patients.
-The state Office of Mental Health rejects all staff concerns about the new guidelines, poor communication or any potential deficiencies in the training at Mid-Hudson.
"I can't speak for [the staff]," says an OMH spokesman about why the SHTAs would go public.
-The state has the right intention, though poor execution. The reduction in restraint and seclusion of mentally ill patients is an admirable and achievable goal, says a national expert. But it must be done deliberately and carefully. Staff must be consulted and trained.
MID-HUDSON is a complex of brick buildings behind a 15-foot fence topped with razor wire off Route 17M in New Hampton. It is home to more than 250 men and women deemed both mentally ill and too violent for society. It is the largest forensic facility in New York state.
The patients are watched over by a staff that carries no weapons and wears no uniforms. There are no uniformed guards inside the hospital; they only patrol its perimeter.
This combination of a hospital setting, dangerous patients and a haphazard change of rules is a bad prescription for staff members' health.
SHTAs have the highest worker's compensation claims in the state, says Mitzie Vilsaint, a senior SHTA at Kirby Forensic Psychiatric Hospital in New York City and vice president of law enforcement for the union.
"OMH is in denial," she says. "They are attempting to generate stats to show it is less dangerous [when it isn't]."
But the staff members don't just worry about themselves, they say. They worry about the public.
Every day, patients are taken to hospitals and doctors' offices in places like Middletown and Goshen.
"If you're at a clinic with your kids, I come in, just me, with a guy - agitated, cussing, spitting, 300 pounds," says Bruce Hammond, a SHTA and union rep. "And I have no authorization to do anything."
Nothing has ever gone seriously wrong on an outside hospital visit, say hospital, state and union officials. But staff members worry that these visits are a tragedy waiting to happen, especially if they are losing control of patients inside the hospital.
By any measure, patients at Mid-Hudson can be a dangerous bunch. Patients have included a man who strangled his roommate with a pair of socks and a high school teacher who killed - then ate - a teenager.
There are about 40 patients per unit, with several treatment assistants watching over them. The hospital also employs nurses, social workers and doctors, among others.
But the SHTAs are the front line.
"We're probably the only people in the state of New York who can go to work and be beat up with impunity," says Babatunde Are, a SHTA supervisor and union representative.
The other state forensic centers are Kirby Forensic Psychiatric Hospital on Wards Island in New York City, forensic units within the Rochester and Central New York psychiatric hospitals, plus 19 satellite units within state correctional facilities.
Patients come from three general groups:
- People who committed crimes but were found not responsible due to their illness.
- People undergoing psychiatric evaluations to determine their mental competency to stand trial.
- Patients at other state civil psychiatric hospitals, such as Middletown Psychiatric Center, who are too dangerous to stay. These patients can be the toughest to control, say the SHTAs.
In 2001, about half the 569 patients to come through
Mid-Hudson had some sort of schizophrenic disorder, with psychotic disorder
the other primary diagnosis.
Almost 90 percent of the patients were men. About half stayed less than six months.
Most longtime patients are stabilized with medication. But there are a core group of uncontrollable people, staff members say. And there is a constant influx of new patients, many straight from Rikers Island.
These new, usually unstable, patients are often the most dangerous, treatment assistants say.
A few weeks ago, on his first day at Mid-Hudson, a patient asked an SHTA, who did not want to be identified, to take him to the bathroom.
The patient dawdled. He washed his hair in the sink. He shook his head, splashing the assistant with soap and water, taunting him. Then the patient swung. More assistants came in. During the struggle, the patient sank his teeth into the original assistant's arm for 20 searing seconds.
The assistant has not worked since and has a sprained spine and injured shoulder to go along with the nasty bite on the biceps.
Last week, two more SHTAs ended up in the hospital after
subduing a violent patient. One of them needed 12 stitches to his face
after a patient got a finger in the SHTA's mouth and "tried to
rip the flesh off my face," says the SHTA, who did not want to
ACTING EXECUTIVE director Howard Holanchock is the driving force behind the new policies, according to the treatment assistants.
Holanchock did not return a phone call seeking comment.
OMH spokesman Roger Klingman denies the union claims.
"The point is meeting nationally recognized standards for treatment," he says. "Where alternatives [to restraint and seclusion] are employed, the injury rate for both patients and staff drops."
The idea is to intervene with a disturbed or angry patient before a crisis erupts, he says.
All staff go through a "battery of training," developed with the input of Mid-Hudson staff. This includes managing and preventing crisis situations, he says.
The state is exploring adding "de-escalation skills" to the training to help staff defuse volatile situations before resorting to restraint or seclusion.
Mid-Hudson is also revising its ward coverage plan so there are more senior staff and clinical personnel on the floor, he says.
"It is a secure facility," Klingman says. "But
it is also a hospital. It must function like one."
THERE IS a national movement away from using restraints and seclusion on mentally ill patients - tools brutally abused through the years.
A 1994 state report showed that about 100 people died in restraint or seclusion in New York between 1984 and 1994.
That same report showed Mid-Hudson with the highest number of restraint orders in the state, with 349 orders for every 100 patients. At the time, administrators pointed to Mid-Hudson's volatile population to explain the high numbers.
In 1999, the Joint Commission of Accreditation of Healthcare Organizations came out with new standards meant to reduce restraint and seclusion. The rules were a response to an alarming number of deaths, says spokeswoman Charlene Hill.
Many patients, who were previously abused, can be "retraumatized,"
if they are restrained or isolated, according to Oscar Miller, of the
National Mental Health Association and former commissioner of mental
health for the state of Maryland.
Reducing restraint and seclusion is a noble and workable achievement, he says.
"The question is the how," says Miller. "The
question is about pace and adequate training."
In time, a more open culture can be developed at a forensic facility.
Patients, even dangerous ones, appreciate that and respond to it, Miller says.
But the hospital must become "staff secure" first, with enough treatment staff and uniformed security mixed in, he says.
Staff concerns must be dealt with before, not after,
the policy changes, Miller says: "Otherwise it won't work, and
there will be people pointing fingers. It is a question of communication."
MID-HUDSON treatment assistants say communication is poor.
The SHTAs say they don't want a return to the old days, when many staff at forensic facilities were hired "based on how big they were and how well they could fight," according to assistant Jerry Golden.
Many, if not most of the assistants, have a background working with the mentally ill, Golden and others say. They took their jobs to help people, not to abuse them.
"We have a sense of compassion [for the patients]," Golden says. "But there has to be compassion for ourselves."
The administration has provided nothing new - no training, no tools, no support - to replace the old methods, say Are, the SHTA supervisor, and others. "It has swung so far left I'm just waiting for a staff member to come out dead," Are says.
At an Oct. 10 meeting to discuss the potential closing of the center's Special Treatment Unit, or "the box," administrators advocated "the value of humor in calming" dangerous patients, according to meeting minutes.
The administrators also proposed the use of swings, water beds with vibration and music, rides around the perimeter in a car and the use of "sumo suits" as alternatives in dealing with volatile patients.
On a doctor's orders, patients can still be restrained and sent to seclusion at Mid-Hudson. Yet this process takes dangerously long and doctors are increasingly reluctant to order restraint or seclusion, staff members say.
So staff are often left with out-of-control patients for torturous minutes waiting for a doctor to arrive.
Eric Munro has been a treatment assistant for about 18 months. One morning in October, a patient was returned to his ward from "the box" by a staff doctor.
The patient paced back and forth, clearly anxious, Munro says. The patient asked Munro if he was his friend.
"Yeah," he answered. "Is everything OK?"
Munro called the doctor, who insisted the patient was fine.
The patient walked to the other side of the room. Munro
looked down to write a note. The patient charged across the room and
hit Munro with a roundhouse punch to the head.
Munro was knocked out cold.
"Doctors aren't held liable for their actions," Munro says. "And [the administration] is trying to tell us that Mid-Hudson is not a violent place anymore."
Last week, another patient pushed Munro down a flight of stairs. He might have a torn rotator cuff. He has been stabbed with a pencil. He sees patients throwing hot coffee and water.
"It's gotten worse, and we're not protected,"
he says. "They opt to ignore things. They opt to cover up things.
And this is our administration."
Mid-Hudson's most notorious
The names of current and former patients at the Mid-Hudson Forensic Psychiatric Center are confidential for medical reasons. But a review of old news accounts reveals a few of the more notorious patients to call Mid-Hudson home through the years:
- Archie Bristol: In 1998, Bristol strangled his roommate, Anthony Pizzo, with a ligature made from a pair of socks. At his sentencing, Bristol said, "Did I feel bad about it later? Yes. Did I feel bad about it at the time? No."
- Adam Berwid: In 1978, on Long Island, Berwid fatally stabbed his wife in the neck. Then, with his two children, he sat up all night over the body. He signed for a telegram for his wife the next morning. The telegram warned her that Berwid had escaped from another psychiatric facility.
- Marie Conklin: In 1998, Conklin, of Middletown, stabbed her toddler to death then stabbed herself. In jail, while she was pregnant, she stabbed herself again.
- Paul Harnisch: In 1999, former Orange County Assistant District Attorney Paul Harnisch, driving his wife's Volvo, ran down a man in-line skating on the Heritage Trail in Chester.
- Larry Logan: Logan, formerly of Newburgh, battered to death a hospital worker at Rockland Psychiatric Center in 1987. He thought she was slipping him birth control pills instead of his medicine.
- Albert Fentriss: In 1979, Fentriss, a Poughkeepsie social studies teacher, shot and killed an 18-year-old man. He sexually mutilated the body, then cooked and ate part of the body.