My name is Michael Pantalone. I am a Mental Health Therapy Coordinator at Oregon State Hospital (OSH). I have been working at OSH for the past 29 years in many different programs including Forensic maximum security and medium security, Gero-psychiatric, Medical, Children’s and Adult Civil commit units. Clientele I have worked with has ranged from acute psychosis to chronic psychosis, sociopathic and antisocial personality types, borderline personality disorder and different types of depressive disorders. Each psychiatric type takes a particular intervention skill set and has inherent risk of injury to patients and staff.
Let me start at the
beginning. I started at OSH in December, 1986 as a 24 year old man that had the
desire to help people with psychiatric and behavioral issues. At the time I
worked in a program known as MaPL which housed two civil commitment units for
Marion, Polk, Linn and Benton counties. Both of these units took clients that
were called POH (Peace Officer Holds). These patients would come to OSH by police
escort with handcuffs and, sometimes, leg shackles on. The on call Physician
would interview them and then admit them based on certain criteria for psychosis
and dangerousness to self and others. I was working night shift at the time,
along with numerous overtime shifts, and we would often get from 1 to 4 admits
based on who the admitting Psychiatrist was for that night. The fear of
violence to myself, and the clients in my care, was constant as the instability
of many patients left staff wondering if they would be attacked or need to
protect other clients that were attacked. On many occasions I stepped between a
violent patient and his/her victim, taking the brunt of the attack to keep the
victim from being hurt. Many times the fears were realized with patients
hitting, scratching, biting and throwing objects, such as chairs and tables, at
other patients and staff. Taking clients down was not only a daily occurrence
but was, at times, something that happened more than one time on a shift. I
spent a great deal of time going down onto my knees on concrete floors, as well
as landing on my hips and back to physically control persons that were “out of
control” and out to hurt others. We would place them in a restraint bed while
they were trying to spit, hit, kick and bite staff. Many times they succeeded
in tearing flesh, breaking facial bones and noses, causing concussions and
hematomas to the staff attempting to help them.
In July of 1987 I was offered
a position in the Forensic Evaluation and Treatment Services, otherwise known
as Forensics, in the Maximum Security Wards, 48B and 48C. We were to provide
treatment for patients that had been found Unable to Aid and Assist in their
own defense in court or found Guilty except for Insanity in the commission of a
crime. Ward 48C also had 5 beds that were allocated for corrections clients
that would come from the Special Management Unit at the Penitentiary when the inmates
had become unstable after refusing medications. Patient crimes range from small
property crimes to domestic violence, menacing, murder, rape, arson, child
molestation and so many others. We were, to best of our abilities, expected to
set aside personal prejudices and provide treatment with the goal to have these
clients ready to return to the community with a reduced risk of danger to self
and others. It was on these units that I received numerous blows and the
aforementioned eye gouge experience. This is also where I dealt with patients
that were adept at making weapons out of things such as chicken bones, pieces
of plastic, tooth brushes and the like and received numerous threats to myself
and my family if I did not do as the patients demanded. Across the hall from
48B was the sex offender unit, 47B, which was part of the Corrections Treatment
Program. Staff were sometimes floated to this unit and became familiar with the
Penile Plethysmograph and its use in aversion therapy as well as the grotesque
photos and films that were used during “Therapy” sessions. I don’t believe a
person works with this type of clientele with any regularity in that they do
not themselves become affected.
There was always a sense of
tension in the air as staff waited for something to happen. 48B and 48C often ran
with 4 staff minimum on each unit, not including suicide and behavior
constants, while dealing with approximately 25 patients. The word ‘sucker punch’
was a common phrase as it happened often when the opportunity presented itself
to clients. Patients on these units were “locked down” at 2200 hrs and doors
opened at 0700 hrs. If the Unit began to go out of control it could be locked
down with a Doctors order.
As the Psychiatric Security
Aide 2, I was once informed of a planned escape attempt in which patients had
been digging through the 4 layers of bricks in one of the outer walls in order
to escape during an upcoming evening. When I found the hole in the wall, they
had already dug through 3 layers of bricks. I called the Physician on duty and
asked to lock down the unit because of the possibility of makeshift weapons and
threatening behaviors from the patients. Upon locking down the unit the
patients tore porcelain sinks and toilets out and tore holes through walls
between rooms. The halls of the unit were flooded and the threat of potential
weapons was extremely high with pieces missing out of the walls and shards of
porcelain all over the place. It took 30 days to restore this ward to working
order by replacing all of the broken walls with cinder block and replacing the
broken toilets and sinks. The unit was searched repeatedly looking for sharp
items that might still be available from this riot. During this lock down it
was not uncommon to have urine or feces thrown at the staff that were trying to
serve meals and meds, and meet patient needs. Besides being degrading there was
a continuous concern of contracting hepatitis or some other disease from the
excrement that was being flung at staff as they performed their duties.
When I promoted into the
position of Psychiatric Security Aide 3, later Mental Health Therapy
Coordinator, I became more aware of the need for security in order to have a therapeutic
environment. It is impossible to provide an environment that allows clients to
thrive and grow if they are in constant fear of unprovoked attacks from other
patients. This is even truer if you consider that staff has not been feeling
safe in this environment since I had started working in Forensics. Firm
boundaries come with the price of heightened vigilance of staff and continual
testing of the boundaries by patients that want to control the environment.
Threats of violence and attacks on staff continued, sometimes with drastic
results. Being in a continuous pressure cooker takes its toll on a person both
mentally and physically, and can only be endured for so long before the results
become destructive. Different people have different thresholds but the fact is
this type of environment is one that wears everyone out over time. For me
personally, I have had a laminectomy of my lower back and bilateral hip
replacements. I’m told I am very young to have this happening to me already.
While working in maximum
security I interviewed for and was blessed to be accepted into the Marion
County Sheriff’s Office Reserve Academy. I graduated in June of 1992. I decided
I wanted to go into the law enforcement direction because I really saw the job
I did in maximum security closely resembling police work. I was constantly
breaking up fights, stayed wary of the concern of assault and had to
continuously scan the area and search for possible weapons materials.
I transferred to the medium
security drug and alcohol unit in approximately 1990 in the Position of
Psychiatric Security Aide 3. The Position title changed to Mental Health
Therapy Coordinator but the job, otherwise, stayed the same. On this unit there
was a focus on treatment for substance abuse.
For every serious client there were 3 or 4 that were trying to play the
system. Though the violence did not happen as often it still happened and was
still just as devastating. There was, during this time, an incident in which a
patient had taken some pieces from the wall ventilation system and had
fashioned some talons for his hands. It was with this weapon that he attacked a
seasoned staff member’s face during a psychotic episode. This left the staff
member off duty and on medical leave for quite a few weeks to recover. It is a
constant reminder that security and safety are needed in order to maintain a
therapeutic environment.
I was soon bumped from this
position due to Hospital downsizing and took a position on the medical ward,
34B, of the Gero-psychiatric/Child and Adolescent Program. I became an
instructor of Prevention and Management of Aggressive Behavior (PMAB) and
worked to teach employees about ways to prevent and manage aggressive behavior.
How to implement verbal intervention techniques to exerting physical control
and the restraining of dangerous and out of control patients. It was also on
the medical unit that I learned how easy it is to get punched in the face or
bitten while trying to feed someone or covered in feces while attempting to
clean up a patient that was being violent. No matter what program I ventured to,
the prospect of being assaulted and degraded remained an inherent risk. No
matter how hard we work to mitigate the risk involved with our client base the
fact was, and remains to this day, that this job comes with risks that are not
common in daily private sector jobs. Even the elderly clients that are sent to
OSH from the community usually come because they are too dangerous to deal with
in Nursing homes, adult foster care or group homes.
While working on the medical
unit, 34B, for my regular shift I often worked overtime in the children’s unit,
40C in particular, since it was considered part of the same program. In this
program I had chairs thrown at me and large teenagers rush me while I was
trying to perform the duties assigned to me. There were threats of violence and
wishing for me to get in a car wreck on the way home from work. There were
allegations of inappropriate behavior and overtly suggestive statements by the
patients. I had 4 year olds that pinched and bit at me and yelled obscenities I
never thought I would ever hear from a little child. This program, too, showed
that no matter how hard you attempt to mitigate risk there continues to be an
inherent danger to doing this job.
During this time I was also
on loan to the program that became Adult Treatment Services. These were the
units that were relocating from Damasch State Hospital as it was closing and I
was there to help with the transition. On 35A there was a staff that was
working an overtime shift and he was watching a patient that was on a constant
watch. While he was doing so another patient came up behind him and started
beating him until he went to the floor and then the patient kept beating and
kicking him. I never saw this staff person again but was told that he had brain
trauma from the injuries and was unable to think clearly anymore and, so, was
unable to make a living working at the State Hospital anymore. Quite a high
price to pay for an income to take care of yourself and your family and really
something that no person in a public service industry should have to endure
without the support of the division.
In approximately 1996 I was
moved into the position of Mental Health Therapy Coordinator for Ward 50E. Ward
50E was a medium security unit that specialized in MR/DD services. I worked on
this unit until the new hospital was opened in 2010. I enjoyed working with
MR/DD clients but it still came with the same unpredictability and risks. When
I first started on 50E patient fights were a daily occurrence and patients
would throw property, throw pool cue balls and outright assault staff when they
did not receive the answer they wanted. While on this unit I was kicked,
attacked from the front while sitting in a chair, had a chair slammed on top of
my head (I received 5 staples in the top of my head and a slight concussion for
this).
I also had a patient break a plastic garbage can and threaten to stab me
with the sharp shard that remained. We had to use the shield to enter and
remove the shard from him (something that would not be done in corrections,
they would spray or taze the client before entering into the area to remove the
dangerous object). Staff are placed on 1:1 constant watch, on a regular basis,
with patients that are known to act out aggressively toward themselves or
others with the knowledge that we are not to physically intervene unless there
are 2 staff present. At the same time we risk discipline if we allow the
patient to hurt themselves or others. It is a catch 22 that is highly stress
inducing.
I could continue on with
numerous examples of staff injury and loss of livelihood. I have seen far too
many people lose their health due to the violence of patients and the limited
rules of engagement for staff. I myself have had a laminectomy for an extruded
disc, bilateral hip replacements and bilateral injections and physical therapy
on my knees and shoulders. This does not include the numerous hits, bites and
scratches that occur quite frequently as well.
I stand committed to
providing the best care possible to the clients we serve and to protect the
public as we are called to do. I would ask the great State of Oregon to look at
the duties we perform and realize that our roles fall under that of Police and
Fire.
I spent 5 years as a Solo
Reserve Deputy Sheriff for Marion County Oregon. I have sworn to uphold the
Constitution of the United States and the Constitution and laws of this great
State. I have been first in on drug busts and responded to domestic violence
situations in which I wasn’t sure if the significant other would turn on me or
not. I have also been involved in high risk stops of drive by shooters and
searched residents for burglars while the alarms were blaring. I tell you this
to emphasize that while a Police Officer faces real risks daily it is not far
from the constant stressors and possibility of assault that faces all of the
direct care staff that work at OSH. Daily we come to work not knowing what the
day will bring and not knowing who is going to be assaulted today.
In my personal life today I
stay aware of my surroundings. I have run into past clients at the 7-Eleven,
the Doctor’s office, immediately after a sinus surgery at McDonalds and at the
shopping mall while carrying my baby girl in my arms, as well as numerous other
public settings. When I have these interactions I am never sure how things will
go. I have had past clients threaten to harm me, I have had clients ignore me
and I have had them thank me. The point is that not knowing how things will go
is a big portion of my experience away from work and it leaves me in a position
of being constantly on guard. When I go to restaurants I always sit in a seat
that allows me to see the door because I have a fear of ex-clients sneaking up
on me or my family, and accosting us. This concern in real and is not something
that leaves or that I can just turn off.
Injuries I have suffered have
ranged from black eyes and bruised face, torn lips, scratched face, pulled
shoulder muscles, bursitis, swollen and painful knees, back injuries, hip
injuries, sliced open scalp, neck aches, bites on my arms, numerous torn
clothing, busted nose, numerous cuts, abrasions and exposures to possible
lifelong diseases from being spit on and patients grabbing my face and getting
their finger in my mouth while covered in feces.
The stories I have told in this article are but a small portion of the things that have happened to me over the past 29 years. Along the way there were other injuries and accusations of wrong doing that were absolutely ludicrous. I have given a simple glimpse into the life of a person that dedicates themselves to a lifetime of working in this environment. These patients are the forgotten of Society and we, the staff that care for them, are the forgotten of the Law Enforcement and Medical Fields. Please give us the dignity we deserve for doing the job that many others cringe at the thought of doing.
I ask that you consider that
tasks we are given and the limited tools we have at our disposal to use with
this protected class of people. We are, indeed, here to help people but it does
come at a high cost to our own personal well being physically, mentally,
emotionally and financially.
Sincerely,
Michael Pantalone
