State Hospital corrects Oregon OSHA violations, but employees say ‘it’s not enough’

An Oregon State Hospital employee left the Salem campus last November in an ambulance, bleeding from the forehead, his foot and ankle fractured and his ribs cracked from a patient assaulting and biting him.

The nurse manager's injuries required corrective surgery. He returned on restricted duty after 105 days away from work.

The number of aggressive patient assaults on state hospital employees resulting in injuries has not decreased since the Oregon Occupational Safety and Health Administration cited the hospital for three workplace safety violations, according to a final inspection report the Statesman Journal obtained from OSHA.

OSHA fined the hospital more than $54,000 and gave detailed instructions on how to investigate employee injuries that result in lost time at work, provide recommendations for assault prevention and maintain consistent incident reports.

The psychiatric hospitals in Salem and Junction City have corrected how they handle reporting employee injuries, provided more accessible training to staff and improved reporting systems for specific assaults, the 816-page report says.

OSHA's initial report found 78% of injuries at the hospitals were not being investigated. From November 2022 through April 2023, however, each of the 156 hospital employee injuries were investigated, Oregon State Hospital data confirmed.

“We take each injury seriously and believe we have developed a system to thoroughly evaluate and respond to incidents,” said Karen Jamieson, the chief financial and operating officer of the state hospital.

OSHA also provided recommendations for improving workplace safety, including providing assault prevention and protection training and ensuring all employees know how and when to report incidents, involving more employees in safety assessments.

“Unfortunately, staff still do not feel safe,” Katherine Hays, president of the Sub-Local 392 chapter of the hospital workers union, told the Statesman. “We're still continuing to see a lot of assaults and some of them fairly severe."

The process of addressing workplace safety is a complex, step-by-step process that is aimed at preventing future violence, said OSHA spokesperson Aaron Corvin.

"Addressing workplace violence is about risk reduction, not risk elimination," Corvin said. "The reason, in part, is because it involves human behavior, which can be unpredictable."

Changing patient population, staffing shortages

The Oregon OSHA investigation in 2022 found there were “frequent violent altercations” between patients and staff which resulted in staff injuries and often time away from work.

The hospital was initially given until Nov. 1, 2022, to correct violations, but got three extensions to allow more time for completing investigations and establishing incident reporting systems.

Oregon State Hospital has struggled to adapt to an increase in the number of aid and assist patients, who are admitted because they're unable to aid in their own defense due to a mental health condition.

These patients often have not had prior mental health care and can experience severe symptoms of their mental illness. Hospital staff have said many assaults on staff have been committed by this population.

“Unfortunately, providing care in a forensic psychiatric hospital can increase the risk of injury,” said Jamieson.

Being short-staffed also has made it harder and riskier for hospital workers to do their jobs, OSHA acknowledged. And when employees miss work due to injuries, the number of staff in a unit drops even more.

Oregon OSHA's evaluation of the hospital's corrective actions concluded in April. Up to that point, staff members this year had missed 737 days of work because of lost time following an injury or illness.

There were 339 open positions within the hospital system, which represents more than 12% of the workforce, the hospital confirmed.

The aid and assist patient who attached and bit the nurse manager has a "history of violent behavior." The hospital's investigative team determined staffing was lower than normal when the attack occurred because some workers were on scheduled breaks and other patients were being escorted to meals.

The hospital assault investigation identified the causes of the incident, but did not initially provide recommendations for prevention of future assaults, inspector Linda Patterson noted in the OSHA report.

Since November, Patterson has had consistent conversations and check-ins with hospital administrators to evaluate progress and "ensuring they are corrected for the purposes of prevention."

The hospital sent data to OSHA in April showing it had completed and submitted recommendations for prevention for 89% of assault investigations that happened between mid-December 2022 and late-April 2023.

Jamieson said hospital administrators believe they are headed in the right direction and hopeful the new incident reporting system and investigation process help get to “the root of the problem."

"We are optimistic about the future and hope to see a downward trend in workplace violence," she said.

Oregon State Hospital's new process on assaults

OSHA told the hospital that staff needed clearer instructions on how to report patient assaults and that multiple incident reporting forms needed to be located in a central place for staff to easily access them.

The hospital now has a fully functioning online incident reporting system, OSHA said in its report, and all of the more than 2,000 employees have gotten emails with incident reporting tip sheets and training videos.

Periodic emails also clearly describe what a reportable incident is and when and how to report it, investigators said.

“When reviewing the policy, please take note of some additions to the list of ‘reportable incidents,’” said one of the periodic emails to staff that was shared with the Statesman.

Other changes related to assaults on staff that have been implemented include:

• There is a designated hospital team responsible for investigating assaults and contacting any managers involved with investigations.

• Nearly daily safety drills that have been moved from the cottages outside into hospital buildings to make them more accessible for employees to do before or after shifts.

• Employees can be involved with investigations as “unit safety representatives” and join multiple safety committee workgroups.

Patient aggression against staff persists

Aggressive acts against staff since 2022 have included spitting, pushing, grabbing, scratching, punching, kicking, stabbing with objects like a pen, throwing objects, and head-butting.

From January to May this year, patients moderately or severely injured 53 hospital staff.

Two employees recently sustained severe injuries and had to take time off work, according to a report the Statesman obtained via a public records request.

“Pt (patient) then came after a nearby staff and punched the staff in the back of the head as the staff was entering the nurse’s station. Pt then ran toward another staff and punched him in the face,” according to the report.

Hays said hospital management has taken steps to consistently contact staff after an incident to determine what could have prevented the assault.

Managers also have created a hospital-wide contraband list to decrease the items available to patients that could be used to harm staff members, she said.

“The hospital has taken steps to get those things in line and follow the directives they've (Oregon OSHA) been giving, but it's not enough,” said Hays.

Morale remains low amongst hospital staff, she said, and some staff have struggled to adjust to the investigation process because they haven't felt comfortable talking with managers.

"Unfortunately, morale and staff feeling like they're being heard and their concerns are being addressed seems to be one of the big discussions,” said Hays.

Sydney Wyatt covers healthcare inequities in the Mid-Willamette Valley for the Statesman Journal. Send comments, questions, and tips to her at SWyatt@gannett.com, (503) 399-6613, or on Twitter @sydney_elise44

The Statesman Journal’s coverage of healthcare inequities is funded in part by the M.J. Murdock Charitable Trust, which seeks to strengthen the cultural, social, educational, and spiritual base of the Pacific Northwest through capacity-building investments in the nonprofit sector.  

This article originally appeared on Salem Statesman Journal: Oregon State Hospital corrects violations; no decrease in assaults on staff