HELENA — The Montana State Hospital has changed some policies and plans to increase staffing and improve training after an investigation found a unit was locked down in November due to a lack of staffing and that two patients were unnecessarily held in seclusion for a week.
Disability Rights Montana filed the complaint over a November lockdown at the Forensic Mental Health Facility in Galen, whose patients include those committed to the hospital after being convicted of a crime. Attorney Bridgitt Erickson argues the new policy doesn’t adequately address staffing shortages.
“Whenever these facilities are caught in a violation, they fix it with a policy and then another policy,” Erickson said. “You’re still stuck with the fact that if nobody follows the policy, nothing has changed.”
Jon Ebelt, spokesman for the Department of Public Health and Human Services, said hospital staff have to weigh a patient’s right to be free from restraint against the rights of patients and staff to be safe in an emergency situation.
It’s a “very difficult balance,” Ebelt told Lee Newspapers of Montana, adding that patients are secluded when they are repeatedly a danger to themselves or others.
The issue began Nov. 1 when a patient pushed a button to access a sally port between two units. Control room staff opened the port without verifying who pushed the button, according to the investigation by the health department’s Licensure Bureau.
A review of video showed the employees made no effort to encourage the patient to return to her wing. Instead they called a “code green.” A responding staffer entered the sally port through another door and used a body shield to push the client about 4 feet (1 meter) across the hall and into a wall, the investigation found.
The client was restrained and a staff member was injured, which was used as a reason for an overnight lockdown. Staff had restrained and secluded another patient that day.
The facility-wide lockdown was “initiated for the convenience of staff,” in violation of state statute, the February investigation found.
Management said current staff were exhausted and security at the nearby Montana State Hospital in Warm Springs initially refused to respond to the Galen facility, the report said.
“The facility does not have a sufficient number of qualified staff on duty 24 hours a day to meet the scheduled and unscheduled needs of each client or to respond to emergency situations,” the investigation found.
The lockdown was lifted on Nov. 2 but reinstated later that day after an employee reported hearing rumors about a patient riot. Beginning on Nov. 4, patients were gradually released from seclusion. They were released for a few hours and returned to seclusion.
The investigation found the patient who accessed the sally port was noted to be calm the morning of Nov. 2. But the patient was held in seclusion until Nov. 7, as was the second patient who was restrained on Nov. 1. State law requires restraint or seclusion to be discontinued at the earliest possible time.
Patient charts contained no documentation from a professional staffer stating the reason for the facility-wide lockdown or continued seclusion, the investigation found.
The state health department will conduct an analysis and work to make sure the required staffing level is met. A security analysis is planned, and traveling nurses will receive specific training before caring for clients at the Forensic Mental Health Facility, the agency said.
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