Regulators have recommended a nearly $73,000 fine against the Iowa Department of Human Services after finding serious workplace safety violations at a state-run psychiatric hospital where several employees have been assaulted by combative patients.
Staffers at the Independence Mental Health Institute struggle to manage violent outbursts due to inadequate emergency response plans, low staffing levels, poor communication and ineffective safety shields that they’re not trained to use, according to an inspection conducted by the Iowa Occupational Safety and Health Administration.
The American Federation of State, County and Municipal Employees Council 61, a union that represents hospital employees, said the institute faced an urgent “safety crisis” after employees were injured in at least four incidents over nine days in June, and filed a complaint that triggered the investigation.
The DHS-run hospital in Independence, about 40 miles (65 kilometers) north of Cedar Rapids, treats patients with severe and complex psychiatric needs.
Regulators found seven serious and three minor safety violations and proposed a $72,770 fine, which would be one of the largest against any Iowa government agency. They also ordered DHS to quickly fix the problems.
The Associated Press received details of the citations last week through an open records request.
“They deserve every penny of that citation,” Council 61 president Danny Homan said Monday. “They were cited for everything they should have been cited for. They weren’t doing training. They weren’t providing a safe workplace.”
DHS spokesman Matt Highland said the agency is reviewing the citations, which were issued in September. He said the hospital is hiring 3 1/2 new staff members authorized by Gov. Kim Reynolds earlier this year and that those hires would improve safety, which is the agency’s “highest priority.”
“DHS facilities’ mission is to serve Iowans with the greatest need, including individuals who often have aggressive behavior,” Highland said. “We train facility staff thoroughly to employ best practices that balance the safety of both patients and staff.”
Homan criticized DHS for contesting the citations rather than negotiating a resolution and accused it of moving too slowly to fill the open jobs. The date for an administrative hearing on the agency’s appeal is expected to be set Thursday.
A report outlining the violations said the hospital didn’t appoint any emergency responders and that low staffing meant that workers could be delayed or unavailable to respond to incidents.
Switchboard operators who call for staff to respond to attacks frequently work without backup and could be on break during an emergency, the report said. Available employees have no way of communicating whether they are responding, meaning those on the scene don’t know if help is on the way. Employees can’t call 911 without permission from the nursing supervisor or facility doctor, which delays access to professional assistance in the event of serious injury.
The hospital also doesn’t have procedures outlining when staff members should use restraints or shields, the citations said. The hospital gave employees shields for protection against attacks but didn’t ensure that they were the right size and didn’t provide training on how to use them, the citations said.
In one of the June attacks, a patient punched a treatment worker and slammed their head into a wall. Another worker was hit in the head after a patient escaped restraints, according to AFSCME. A nurse who was punched in the nose and scratched was then moved to work on a sex offender unit with another worker who had already been assaulted, the union said. When that worker went to respond to another emergency, the nurse was left alone on the unit despite the hospital’s promise to not do that due to a history of sexual misconduct by patients, the union said. The nurse quit immediately after that shift.
In October 2018, another nurse needed surgery and suffered an impaired memory after an attack that injured her head, knee and shoulder. She was later fired after exhausting her medical leave and being denied catastrophic leave.
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