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Data: Violence, restraints common at Minnesota Security Hospital

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Patient living
According to the Minnesota Department of Human Services, the patient living areas at the Minnesota Security Hospital in St. Peter, Minn., which include narrow stairways and limited sightlines, can contribute to patient and staff injuries and limit the ability to provide a safe environment.
Photo courtesy of DHS

Data provided by the Department of Human Services offer a glimpse into the tense and sometimes violent world of the Minnesota Security Hospital, a state-run facility that provides treatment to nearly 400 adults deemed mentally ill and dangerous by the judicial system.

Patients suffered 310 injuries in 2011. One patient was kicked in the jaw. Another was punched in the head. One swallowed a shampoo cap. Another was left with "bleeding knuckles after being physically contained."  One in five injuries was caused by a patient-on-patient assault. 

Patients spent a collective 1,772 hours — nearly 75 days — in seclusion last year. Hospital employees restrained patients 225 times.

Hospital policy allows employees to use restraints and seclusion only when a patient poses an immediate threat to himself or others. 

More on the Minnesota Security Hospital
• Story: State facility for the mentally ill risks losing license
• Graphic: Patient injuries in 2011
• Graphic: Time spent in restraint, seclusion

Despite recent scrutiny for licensing violations, DHS officials said they have not analyzed the data for trends or ways to improve patient safety.

"When I look at data like this, I have more questions than answers," said DHS Deputy Commissioner Anne Barry. "We need to look more closely at these numbers."

The data show wide fluctuations in the use of restraints from month to month over the past two years. In one month, staff did not restrain anyone. Two months later, they used restraints  20 times.

A spike in the numbers might be caused by one particularly violent patient or by one poorly trained employee, Barry said.

Patient injury data is also difficult to interpret, Barry said, because DHS has not compared its data to that at similar hospitals in other states.

DATA SHOW FACILITY STRUGGLING TO REFORM PATIENT CARE

Facility administrator David Proffitt arrived at the hospital in August 2011 with a mandate to reduce the use of restraints and seclusion. Proffitt said he was surprised to find the hospital failed to compile meaningful data for years. No one had looked for clues or patterns, such as whether the use of restraints and seclusion was more frequent at specific times or on certain units, he said.

"That's one of the things I'm hoping to fix," Proffitt said.

The data show Proffitt has struggled to change how employees respond to violent patients.

During the first six months of Proffitt's tenure, the number of reported incidents involving restraints more than doubled. In September 2011, the use of restraints hit a two-year high. Staff restrained patients 49 times — more than the first six months of the year combined.

However, DHS officials dispute the significance of the data. Barry, of DHS, said a change in reporting methods explains the increase in the use of restraints. The facility did not count restraint incidents that lasted less than five minutes until August 2011, Barry said, and also did not count handcuffs, "manual holds" or "carry blankets" that staff use to move people against their will. Once they started counting all restraint incidents, she said, the total number went up. Barry said the data should not be used to gauge whether Proffitt has been successful.

The data also show staff restrained patients for shorter lengths of time on average in recent months. For example, in September 2011, the average length of time a patient spent in restraints was 200 minutes. In December, it was 10 minutes.

DATA SHOW DECLINE IN STAFF INJURIES

The facility can also be a dangerous place for employees.

In 2010, employees suffered 97 injuries serious enough to require a report to the federal Occupational Safety and Health Administration, or OSHA. Nearly two-thirds of the injuries were caused by a patient assault.

Injuries dropped in 2011. Employees reported 65 serious injuries. About half were the result of a patient assault.

For an injury to be reportable to OSHA, it must require medical treatment by a health care provider. Bandaging wounds, taking X-rays, and using ice packs are not considered medical treatment. The OSHA number excludes most staff injuries, said Chuck Carlson, president of AFSCME Local 404, the union that represents Minnesota Security Hospital workers.

"You have to take that information with a grain of salt," Carlson said, who works as a security counselor at the facility. "If a client walks up to me tonight and punches me in the face, it doesn't count."

Carlson believes the injury rate could be even lower if employees had more training on how to respond to violent patients. Many injuries, he said, occur when employees try to restrain or confine agitated patients.

Proffitt, the facility administrator, expressed a similar view. He expects a new training initiative, which began in early February, will make the facility safer for patients and employees.

Hospital at Risk: 
Danger and Dysfunction at the Minnesota Security Hospital
► State facility for the mentally ill risks losing license over turmoil
―Published: Feb. 28, 2012
► Data: Violence, restraints common at Minnesota Security Hospital
―Published:  Feb. 28, 2012
► David Proffitt, head of Minnesota Security Hospital, resigns at state's request
―Published: March 27, 2012
► Former Minn. Security Hospital leader's 'extremely assertive' style rankled some
―Published: March 28, 2012
► State failed to review troubled past of ousted Minn. Security Hospital administrator
―Published: March 30, 2012
► Auditor to look at agency's hiring practices in wake of Proffitt dismissal
―Published: April 2, 2012
► Former Security Hospital head still getting paid
―Published: April 12, 2012
► After complaints, MN Security Hospital inspected
―Published: April 13, 2012
► Plan gives DHS more oversight in state mental health services
―Published: April 20, 2012
► Funding for St. Peter hospital renovations in doubt
―Published: April 27, 2012
► Security hospital worker 'emotionally abused' patient
―Published: May 1, 2012
► Security Hospital in line for fraction of funding request
―Published: May 4, 2012
► State investigating Security Hospital's handling of missing patient, stabbing
―Published: May 9, 2012
► Investigation shows complexity of caring for the state's most violent and mentally ill adults
―Published: June 8, 2012
► DHS confirms resignation of executive
―Published: Aug. 23, 2012
► More injured employees, fewer doctors at Minnesota Security Hospital
―Published: Aug. 29, 2012
► Minn. moves mentally ill patients to avoid legal action
―Published: Dec. 14, 2012