Feds probe injury reports at Acadia Hospital

Posted Aug. 23, 2010, at 8:24 p.m.

BANGOR, Maine — The Acadia Hospital is the subject of a federal investigation into high rates of injuries among its employees amid allegations that policy changes, understaffing and inadequate training have led to unsafe working conditions at the Bangor psychiatric hospital.

William Coffin, director of the Occupational Health and Safety Administration office in Augusta, confirmed Monday afternoon that the agency opened an investigation at the hospital on July 26, based on an employee complaint.

Coffin would not comment on the specifics of the complaint, but he said the investigation could reveal violations either of specific workplace health and safety guidelines or of a more general requirement that all employers provide “a safe and healthful work environment.”

OSHA has jurisdiction only over employee well-being. Coffin said he was not aware of any patients at risk at the hospital. Coffin also said he did not know of any previous OSHA investigations at Acadia.

Calls to the Maine Department of Health and Human Services, which licenses hospitals in Maine, were not returned by Monday evening.

Officials at Acadia acknowledged Monday that the OSHA investigation is occurring and said they are cooperating fully.

“Staff and client safety is our highest priority,” said hospital spokesman Alan Comeau.

Comeau said he was not familiar with the specific allegations of staff injury under investigation. The hospital employs about 600 individuals.

Acadia Hospital employee Katie Gardner, a registered nurse who works on an adult psychiatric unit, said she is not the employee who contacted OSHA.

But Gardner, who has practiced at Acadia since last November, said several employees have been injured in recent months due to changes in patient care policies that have left staff more vulnerable to physically disruptive or combative patients.

She said pressure and anger among staff has been building for several months.

“There has been a lot of corner-cutting,” said Gardner, who has taken a leave of absence from her job in part because of working conditions at the hospital. “The hospital is very interested in cost savings … but at the expense of patient safety and employee safety.”

For example, she said, Acadia recently has done away with all forms of mechanical restraints used to keep dangerously psychotic patients from injuring themselves or others. Instead, she said, nurses and other employees are expected to de-escalate explosive situations by “empowering” upset patients and engaging them in seeking a solution to the situation that is angering them.

“It’s a nice concept,” she said. “But when someone is truly psychotic, that approach may not work.”

That change was made without providing sufficient staff training or support, she said.

“It seems exceedingly dangerous to me,” she said.

In an emergency, Gardner said, it is recommended that staff hold disruptive patients in a sitting position until they can be calmed or medicated. If the patient assumes a supine position on the floor, she said, staff members are supposed to release the patient and start over.

“Once you get a hold of someone who is struggling like that, it’s ridiculous to let them go,” Gardner said.

She said she knows of several recent injuries, including a staff member who was assaulted by a patient in the adolescent unit and will need surgery as a result. She said the rate of staff injuries at Acadia is much higher than the national average for psychiatric hospitals, but she could not provide specific figures.

Comeau also could not provide specific figures Monday afternoon.

Gardner said staff members have sought assistance from managers without satisfaction. Patient units are “consistently understaffed,” she said, and patients sometimes are ineffectively medicated against violent behavior by traveling physicians who are temporarily assigned to Acadia and do not develop effective working relationships with either patients or staff.

Speaking for Acadia CEO David Proffitt and chief operations officer Jamie Morrill, Comeau said Monday afternoon that hospital officials are cooperating with the OSHA investigation and look forward to its findings.

Already, he said, the hospital’s most experienced staff members have been assigned to work with less experienced colleagues to reduce the likelihood of personal injuries. Hospital administrators hold daily meetings and review interactions between staff and patients, he said, and all episodes of assault or accidental injury are reported to a national database.

Comeau said Acadia is committed to staff training and support.

“We want our staff to be able to come to work and do their jobs feeling like they’re safe,” he said.

The Acadia Hospital is an affiliate of Brewer-based Eastern Maine Healthcare Systems. It is licensed for 100 inpatient psychiatric beds and also provides outpatient psychiatric and substance abuse services.

Acadia has in the past been honored as the first psychiatric hospital in the country to be designated a “magnet hospital,” an indication of nurses’ satisfaction with the professional environment in which they work.

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