KANEOHE, OAHU (HawaiiNewsNow) - Severe assaults on employees at the state's only public mental hospital have resulted in some of them being out of work for months and even years, a Hawaii News Now investigation revealed. Four employees came forward to say the State Hospital is understaffed and they don't feel safe going to work.
The recent wars in Iraq and Afghanistan have left many U.S. military personnel with traumatic brain injury and post traumatic stress disorder.
But employees at the state hospital are suffering from those conditions as well, just from going to the office.
In December 2009, psychiatric technician Emelinda Yarte was leading a group of mental patients at the State Hospital up some stairs when she saw a patient start punching another staffer.
"I went back to help and then he slammed me on the wall and that's when my jaw got dislocated," Yarte said.
Her physician, Dr. Scott Miscovich, said Yarte suffered repeated blows to the head, jaw and neck when the patient, who was a mixed martial arts fighter, attacked her.
"I can't send these people back knowing the work environment is still very dangerous and nothing is being done to stop these assaults from happening again," Miscovich said.
Yarte has been out of work for nearly four years because of the attack. She returned to a part-time light-duty assignment doing clerical work at the state Health Department headquarters at Kinau Hale, across the island from the State Hospital, this fall.
"When I eat, I can't chew. And I had a hard time chewing. I had a hard time sleeping. Continuous headaches," she said.
Yarte said she suffered panic attacks when she tried to go back to the hospital.
"My kids cried because I wasn't myself anymore. I wasn't myself and as my son said, 'Whatever happened to you at the state hospital, we don't know, we don't understand you anymore,'" a tearful Yarte told Hawaii News Now.
Her psychologist has diagnosed her and other state hospital workers with Post Traumatic Stress Disorder.
"Nobody should have to go to work and not know if they're going to get kicked in the head or punched or have to get surgery for their shoulder when they walk out that day," said psychologist Mary Horn, who is treating about seven state hospital employees who have been hurt on the job.
"In order to be there, you need to be on your game. And after a while, when the risk is really high and your life is in jeopardy or you feel that your life is in jeopardy, you're not on your game," Horn said.
Another State Hospital employee, registered nurse Josh Akeo, said, "It's quite dangerous up there."
Akeo has been out of work for three months, since he stepped in to try to separate two mental patients fighting and was repeatedly kicked in the head by one of them. He suffered a severe concussion and jaw injury.
"I've lost a little over 30 pounds. I can't eat. I have a hard time opening my mouth. Causing a lot of headaches. I also got a neck injury," Akeo said.
"After what the doctor told me, he said the next kick in the head, the next punch in the head could end my life. That kind of stunned me. Because in that respect, I'm afraid to go to back to work."
Miscovich is treating about a half dozen State Hospital employees in what he calls a "cluster" of injuries in the last eight months.
Speaking about Akeo's medical problems, Miscovich said, "The most serious part of the injury that we're seeing is traumatic head injury. This is minimally a severe concussion. The whole way up to a patient with a traumatic brain injury."
Mark Fridovich is the adult mental health administrator for the state Health Department and oversees the State Hospital, which he used to run as its administrator for nearly seven years until this past March.
"Assaults do occur. We take each and every one of them very very seriously," Fridovich said. "The problem with assault is even a single incident of it can cause incredible harm to the worker and traumatic experience."
The state reported 90 assaults by patients on staff as of the end of August of this year. Last year, there were 120 reported staff assaults by patients, equating to roughly one every three days. In 2011, employees reported 132 assaults attributed to patients. Over the last three years, 16 of those assaults resulted in medical treatment and time away from work for employees.
"Each assault is assessed with respect to are there policy changes that need to occur?" Fridovich said. "When an incident occurs, we follow up immediately, provide support to the individual who's been hurt. We follow up in figuring out if there are patient factors, staff factors, policy changes, technical changes, environmental changes that might be used to make the situation more and more safe."
But employees who came forward to speak exclusively to Hawaii News Now said many of them don't bother to report routine assaults, such as a quick punch or a slap by a patient. So they estimate the true assault numbers could be as much as 50 percent higher. They said some supervisors discourage reporting assaults and other staffers are influenced by a "take one for the team" atmosphere in which they don't want to let down fellow members of their shift by going out on injured leave.
They blame under staffing for contributing to the assaults. Akeo is a charge nurse, who ran his unit during a shift.
"I can't even tell you how many times I've called to try to get extra staff and the response is 'We just don't have staff,'" Akeo said.
The state said there's a 34 percent vacancy rate for para-medical assistants, meaning as of last week there were 19 openings for those key employees who can help subdue unruly patients. The state reported 11 percent of the hospital's key front-line positions, including doctors, nurses, psychiatric technicians and para-medical assistants, are unfilled.
The state relies on overtime and temporary staff from agencies to fill the gaps, something Fridovich admitted is less than ideal.
"Those are adequate but sub-optimal. We would rather have full-time state workers in our open blocks," Fridovich said. "We'd much prefer to have the hospital staffing be more and more substantially permanent employees."
Employees said less-experienced agency or temporary staff can make difficult situations worse, because some of them are not used to dealing with dangerous, acutely mentally ill patients.
Some psychiatrists at the hospital's two wards with the most troubled patients sometimes have remained on the job for only a few days, weeks or months before leaving, employees said. One doctor who was an expert with child mental illness was not used to dealing with adults, and on-the-job injuries in his unit spiked during his brief tenure, employees said.
The facility is also very close to its legal capacity of 202 patients -- at 197 patients last week -- roughly 25 more than what the state calls its "target census," Fridovich said.
"We've raised that concern with the department, the governor's aware. We've briefed legislators on it. And we're making attempts to try to move ahead with more long-term interventions that will alleviate that census crunch," Fridovich added.
Another staffer, psychiatric technician Ryan Oyama, said he has endured about 60 assaults during his nearly 11 years on the job at the State Hospital. He said he went back to work the day after a patient attacked him without warning a couple of years ago.
"And he started punching. So I started trying to kind of duck the punches and he was catching me at my temple. And I think I blacked out because I don't remember what happened," Oyama said.
Oyama said the day after he and the other employees were interviewed on-camera by Hawaii News Now, his supervisor threatened him with termination for speaking out about problems there.
Fridovich responded to that situation by saying, "We take extremely seriously any allegation of staff intimidation. If that's occurred, we will look into it, it will be investigated. If the allegation is substantiated, we will follow through, I will follow through to ensure that appropriate discipline, or personnel action is taken."
A fourth employee who has worked at the hospital for more than five years asked to remain anonymous, but said repeated assaults by patients have taken their toll.
"Those people making the decisions to staff us aren't the ones at risk. They are not there with us. I'm sure if they were, they'd be requesting for extra staff too," the anonymous employee said. "It just affected every part of my life to the point where when I think about it, it's just overwhelming."
Even when all the spots on a shift are filled, some staffers are pulled off the wards because they have to watch the most dangerous patients one-to-one, sometimes leaving few staff to mind the rest of the population, employees said. They said a lot of the injuries happen when other employees are on meal breaks or have been pulled off the unit for one-to-one observation duty.
The employees said some patients are experienced boxers or mixed martial arts fighters, posing new physical risks to the staff, who are unarmed. Other patients, they said, are still experiencing the effects of using drugs such as crystal methamphetamine, causing them to be extra powerful and prone to assaulting patients and staff.
Fridovich said about 85 percent of the patients at the State Hospital have been committed by the courts. The hospital, he said, is having trouble keeping up with massive increases in admissions that have jumped 30-, 50- and even 100 percent as judges commit more people to the hospital or assign defendants in crimes to the hospital for a mental evaluation.
The Department of Health has a contract with private mental hospital Kahi Mohala in Ewa, which handles about 40 patients for the state, Fridovich said.
The state also has $150,000 to restore the Hawaii State Hospital Master Plan that was begun in 2005. The plan will help determine what improvements need to be built on the Kaneohe campus of the hospital, deciding whether old units should be renovated or new facilities are built from scratch, Fridovich said.
Para-medical assistants, who have the highest vacancy rate of 34 percent, are paid in the range of $34,000 to $43,000 a year. Psychiatric technicians, who have a 5-percent vacancy rate at the hospital, have an annual base pay in the range of $35,000 to $43,000. Both classifications of workers are represented by the United Public Workers union.