Omitted from recent articles and opinion pieces about Atascadero State Hospital are accounts of the chronic understaffing that has resulted in violent attacks on staff and patients and diminished patient care. There is a long, sordid history of neglect by ASH management to remedy ever-deteriorating working and living conditions at the facility.
In 1990, the U.S. Department of Justice Civil Rights Division closed its eight-year investigation into “unconstitutional conditions of confinement” at ASH. The DOJ told ASH to reduce the level of violence and excessive use of restraint, seclusion, and medication, by increasing staffing in two specific ways. ASH management has stubbornly disregarded such direction for more than two decades.
The ASH executive director denies injuries have escalated; dismisses employee complaints about dangers; paints those who speak up as nothing but a minority of ignorant, recalcitrant workers; blames their use of sick time for forced overtime; and attributes the increasing violence to a recent change in admission policy. Distraction, diversion, and distortion, including blaming the victims and shooting the messengers, are tactics long employed by ASH management.
The DOJ told ASH to increase Level of Care (LOC) staff by one for each person assigned to medication preparation/distribution and for each person assigned to one-to-one patient supervision. These positions should be immediately filled in addition to the minimum required for non-critical patients, or the staff will continue to be unable to supervise and care for the general population on a ward. The failure of ASH to implement the DOJ recommendations hampers staff’s ability to monitor patients’ conditions, intervene in their behavior, and provide sufficient care and treatment.
The DOJ investigation documented the facts that “the actual number of staff at any given point available to patients is considerably lower than the stated minimum,” “actual staffing levels did not allow patients to take full advantage of available services,” and “the current determination of minimums negatively impinged on the ability of patients to go to programs … [which] leads to more medication usage and more seclusion and restraint since patients are left on wards without structure.” The DOJ concluded in its Summary of Major Findings: “LOC staff needs to be in attendance in sufficient numbers such that ratios are maintained without counting into the ratio of the medication person and those LOC staff providing one-to-one coverage.” In defiance of the DOJ directions, ASH often fails to make that work.
The DOJ again intervened in ASH in 2006, imposing a new plan and program that further restrict workers’ ability to use medication and restraint/seclusion to control patient behavior—and further complicates their task with meaningless and counter-productive paperwork—without any mandate for staffing adequate to meet objectives.
In 1990, the DOJ investigation described how this so-called “treating the chart” conflicted with patient care, finding that the “medical record … continues to be … burdensome, cumbersome, and time consuming for all disciplines … [which] place[s] an increased burden on LOC Staff,” which “requires personnel to simply fill it up with verbiage, which is noncontributory to good patient care” and which “ends up with reams of duplicative paper work which do nothing useful to assist the team in the care and treatment of its patients.”
The DOJ also concluded, in its “Summary of Major Findings: “The medical record system needs to be reviewed and overhauled such that it facilitates rather than interferes with patient care and treatment.” It is obvious ASH has failed to implement the DOJ’s directions in this area as well.
Though the so-called “criminally insane” predictably do lose control of their behavior, such outbursts are excessive because ASH fails to provide enough LOC staff, who are the eyes and ears of the treatment team and its first responders. Chronic understaffing, forced overtime, and useless paperwork, coupled with management intimidation, criticism, and retribution, result in a debilitated workforce incapable of fully executing its primary mission. Under such conditions, it’s impossible to successfully treat the mentally ill.
I know this because I worked at ASH as a psychiatric technician from 1972 until retiring in 2002, having previously worked with developmentally disabled children and emotionally disturbed teenagers in state hospitals since 1969. The decades of neglect and abuse suffered by ASH patients and staff borders on criminal and must be stopped. Patients, who have been damaged by circumstances beyond their control, and LOC staff, who have been incapacitated by irrational bureaucratic demands and restraints, are being battered.
It’s time for decisive action. Lip service by ASH management, tinkering by politicians, and federal meddling will not suffice. It’s time for intensive on-site, inside-out action by the California legislature focused on providing real investment in staffing and protection of the staff from management intimidation and harassment.
Atascadero resident David Broadwater is a retired psychiatric technician who worked since 1969 with the mentally disabled and ill, including work from 1972 to 2002 at ASH. Send comments via the opinion editor at email@example.com.
-- David Broadwater - Atascadero
-- David Broadwater - Atascadero