Report: Western Psychiatric Institute and Clinic employees still not protected
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Months after the mass shooting in March at Western Psychiatric Institute and Clinic, a government-contracted workplace violence expert concluded that the hospital was not putting enough emphasis on protecting its employees from attacks by patients.
Instead, according to a report the expert submitted in August to the U.S. Occupational Safety and Health Administration, the hospital in Oakland was focused almost exclusively on the safety of its patients.
"WPIC's workplace violence prevention efforts are completely overshadowed by patient safety considerations. A number of initiative[s] designed to protect patients also infer staff safety," wrote Jane Lipscomb, a professor at the University of Maryland School of Nursing. "WPIC's management commitment to violence prevention is obscured by their nearly singular focus on patient safety."
Ms. Lipscomb's report is labeled as a draft and dated Aug. 31. It was obtained recently by the Pittsburgh Post-Gazette through a federal Freedom of Information Act request.
"I think it reflects employee experiences there," said Zachary Zobrist, vice president of SEIU Healthcare Pennsylvania, which represents about 200 employees at Western Psych, an arm of UPMC.
"Any time something happens on a patient-safety issue, protocols are changed immediately," Mr. Zobrist said. "On the flip side, if it's an employee that's injured, things are very slow to change or they don't change at all."
UPMC, which had not seen a copy of the report until provided one by the Post-Gazette, said it tries to protect everyone in its facilities.
"UPMC has not seen Dr. Lipscomb's draft submission before, and doesn't know what consideration if any OSHA gave it. On September 26, 2012, OSHA issued no citations regarding the Shick incident but did offer an Advisory Letter geared toward improving UPMC's program to prevent workplace violence," UPMC said in a statement released by spokeswoman Gloria Kreps.
"All those recommendations either have been or are being implemented. UPMC cannot agree, however, with Dr. Lipscomb's suggestion that we must balance the rights and safety of our patients against the safety of our staff. Instead UPMC strives at all times to protect the rights and safety of everyone in our facilities, including patients, staff, and visitors."
The U.S. Labor Department paid Ms. Lipscomb nearly $31,000 to evaluate workplace violence at Western Psych as an outgrowth of OSHA's investigation of the March 8 shootings by John Shick, a mentally ill man.
Shick killed milieu therapist Michael Schaab, 25, and wounded five other people before police fatally shot him.
Although Shick, 30, was a schizophrenic and had interacted with UPMC's mental health system, he was not a patient at Western Psych. He was upset with UPMC's treatment of what authorities said were phantom ailments, but it is still not clear why he targeted the facility.
OSHA's investigation skewed toward exploring the issue of overall workplace violence at Western Psych rather than dissecting the events that led up to Shick barging into the mental hospital with two handguns.
Per OSHA's direction, Ms. Lipscomb's report did not dwell on the shootings but rather on the everyday violence faced by the roughly 2,000 employees at the Oakland hospital, including the registered nurses, aides, secretaries and housekeeping staff represented by the SEIU.
Ms. Lipscomb, who has a doctorate in epidemiology, is married to William Borwegen, the SEIU's national occupational health and safety director.
She said she prepared the draft report and consulted with OSHA in a series of conference calls but received no written feedback. She said she agreed with OSHA's recommendations to Western Psych. But she also said she believed there was a link between workplace violence at the facility and what happened with Shick.
"Early on when I started to communicate with [OSHA], they made it clear that they wanted me to focus on the violence that was basically being caused by inpatients and not this incident with this individual, who only had some relationship with the ... the hospital but was not a patient at the time," Ms. Lipscomb said.
"I think they're related. I think if you have a comprehensive program in place, it needs to look at both. You need a system for knowing who's coming in and out of the facility who might be a problem regardless of whether they have a formal relationship as a patient."
According to a review of OSHA forms documenting work-related injuries and illness, there were 75 incidents of "patient-related staff injuries" in 2011, up from 48 in 2010, Ms. Lipscomb's report said.
For the first four months of 2012, there were 39 such incidents, which would include the shootings.
Extrapolating that data, Western Psych would be on pace for an increase in injuries for all of 2012 when compared with 2011 numbers, irrespective of the Shick incident.
UPMC, contacted Monday for this story, was unable to provide year-end numbers of patient-related staff injuries because of key personnel being off for the New Year's holiday, Ms. Kreps said.
"The increase in the number of injuries in 2011-2012 is cause for concern," the report states. "In-depth tracking and review of the circumstances surrounding these injuries is essential to reverse this trend."
In response to a FOIA request for the investigative case file on Shick, OSHA redacted specific information about the incidents of violence at Western Psych and much other relevant information about its investigation.
"There continues to be a strong reluctance to recognize the problem of workplace violence for fear of stigmatizing the potential perpetrators of the violence, in particular the mentally ill and developmentally disabled," Ms. Lipscomb's report said.
"This denial carries with it huge costs in terms of patient well being and care. We must begin to recognize that policies and practices directed towards preventing staff assaults benefits patients," according to the report.
"WPIC policies to safeguard the rights of the mentally ill and developmentally disabled, while laudable, must be balanced with the right of workers to return home safely to their family at the end of each workday."
Mr. Zobrist said his union believes that UPMC should have a management-level employee at Western Psych dedicated to employee safety.
Ms. Lipscomb's report noted that UPMC has a generic workplace violence policy throughout all its hospitals and clinics that focused on violence by domestic partners and co-workers.
"There needs to be someone at Western Psych that's focused on looking at employee safety just for that institution -- not just a security person but an employee safety person who can find the right balance with what the patients need as well," Mr. Zobrist said.
Ms. Lipscomb found troubling the answers two high-ranking officials at Western Psych gave during depositions to a U.S. Labor Department attorney.
In June, the attorney showed Kimberly Owens, vice president of inpatient and emergency services and chief nursing officer, an OSHA document called "Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers."
Ms. Owens said she was "not familiar" with it.
That same day, Carol VanZile, director of Joint Commission and regulatory compliance, told the Labor Department that it was her job to maintain Western Psych's compliance with various agencies' regulations including OSHA.
However, she also said she was not involved with the forms submitted to OSHA detailing workplace violence incidents and did not know who was in charge of that. Ms. VanZile also said The Joint Commission, an accrediting organization, does not have written workplace violence standards.
"... If we're meeting patient safety," Ms. VanZile said, "we're also ensuring worker safety, as well, related to those standards."
Those two examples are "an indication that they really don't think about worker health and safety from the perspective that they should," Ms. Lipscomb said.
In a third June deposition, Camellia Herisko, director of nursing and primary care services at Western Psych, described how the hospital looks for ways to improve worker safety. She gave several examples, including buying flexible pens that do not puncture workers' skin if used as a weapon by patients, sleeves to protect employees' arms from bites and utensils that do not snap.
"Do the staff, the nurses, do they communicate directly to you about, 'Hey, there's a safety concern, what can we do to address it?' " Labor Department attorney Michael P. Doyle asked.
"They have and they can, yes," Mrs. Herisko said. "I have an open-door policy. They email me a lot or come see me or I see them in the hall and they bring things up."
Mr. Zobrist, however, had a different take on UPMC's responsiveness, noting that it took months to install a metal detector after Shick's rampage and to discontinue the policy of having nurses scan visitors with hand-held metal detectors.
"That could have happened immediately or even prior to that incident," Mr. Zobrist said of the changes, "but they didn't [make the changes] because the focus isn't on employee safety as it should be."
Ms. Lipscomb praised Western Psych for mitigating workplace violence but said it could do more.
"I think that they were probably doing better than most institutions," Ms. Lipscomb said. "Is there room for improvement? Definitely. But they were doing a lot, as they should because they have a very high-risk patient population and they've got lots of incidents of staff injuries."
First Published January 2, 2013 12:00 am