Western State Hospital cited and fined for failing to protect assaulted nurses

Mar 27, 2019

Washington's largest state-run psychiatric hospital has been cited and fined for failing to protect workers from assaults by patients. 

The enforcement action this week by the Department of Labor and Industries (L&I) follows a months-long investigation triggered by three violent patient-on-nurse assaults last year at Western State Hospital (WSH) in Lakewood, Washington.

In two of those assaults, the nurses were pushed to the floor and stomped by patients. In the third assault, a patient bit off a portion of a nurse's ear. 

The L&I investigation found that Washington's Department of Social and Health Services (DSHS) "did not do everything reasonably necessary to protect employees" from workplace violence, according to a copy of the citation obtained by the public radio Northwest News Network. 

The hospital was also cited for failing to report a work-related hospitalization of a staff member within the required eight hours and for not enforcing the hospital's own Accident Prevention Program. 

DSHS was cited for one serious and two general safety violations and fined $4,900. The agency has 15 days to appeal and has until late April to address the violations.

Among the remedies ordered by L&I:

  • Identify work areas and tasks that require two or more staff with the goal of eliminating assaults
  • Ensure adequate staffing to protect staff from assaults on all wards and all shifts
  • Enclose all nurses' stations
  • Implement a plan to transfer assaultive patients to specialty wards

In a statement, DSHS said it has already taken steps to reduce the likelihood of assaults. That includes enclosing the nurses' stations in eight of the hospital's 29 wards, with three more wards in progress. However, DSHS said to enclose the remaining 18 wards will require additional appropriations from the Legislature.

Other steps that have been taken include a longer new employee orientation period and the implementation of new training programs focused on crisis prevention and crisis intervention. The hospital also plans to create a specialty transition ward for the hospital's 10 most violent patients, but that too will require funding from the Legislature.

"We appreciate the feedback from L&I and will use it to continue to improve safety at the hospital," Kelly Stowe, a DHSH spokesperson, wrote in an email. 

Attorney James Beck is suing DSHS on behalf of four WSH nurses who were assaulted by the same patient in 2018, including Bernia Garner, the nurse whose earlobe was severed in September. In a phone interview on Wednesday, Beck welcomed the L&I action.

"We're hapy to see that the Department of Labor and Industries has taken action against Western State Hospital regarding the ongoing, serious and systemic unsafe work environment," said Beck. "Now that another agency of the state is mandating prompt changes, I can't imagine there would be any excuse for not complying quickly."

The L&I findings are just the latest in a long series of setbacks for the troubled and aging 857-bed state hospital.

Last June, WSH lost its federal certification and with it $53 million in federal funding, about 20 percent of the hospital's annual budget, after a months-long turnaround effort felt short. 

In 2016, a "root cause" report found ineffective management, staff reductions and high turnover had created a "culture of helplessness" among staff at WSH. Since then, new leadership has been brought in to run the hospital and the Legislature has increased funding to address ongoing staff shortages. However, the hospital continues to rely overtime shifts to meet staffing level requirements, according to Stowe.

Earlier this week, House Democrats unveiled a budget proposal that calls for an additional $123 million in spending at both Western and Eastern State Hospitals over the next two years to address safety concerns. The funding would add 530 full-time positions at the facilities and fund specialty programs for patients with intensive needs who pose a risk to patient and staff safety.

On Wednesday, a spokesman for the Washington House Democratic Caucus said that funding would cover the cost of enclosing all nurses' stations and opening the speciality ward for violent patients. 

The House capital construction budget also includes $53 million for safety enhancements and ward renovations at both state hospitals. 

The Washington Senate is expected to release its budget proposals by the end of this week.