Vi­o­lent at­tacks in­crease at Tren­ton-based Ann Klein Foren­sic Cen­ter after end­ing of lock­down pol­icy

The Trentonian (Trenton, NJ) - - FRONT PAGE - By Su­laiman Ab­dur-Rah­man Su­laiman@21st-cen­tu­ry­media.com @sab­durr on Twit­ter

TREN­TON >> Talk about a cul­ture of vi­o­lence.

Un­ruly psy­chi­atric pa­tients have in­creas­ingly at­tacked staff mem­bers at Ann Klein Foren­sic Cen­ter, a state-run med­i­cal fa­cil­ity hous­ing dozens of crim­i­nal de­fen­dants with se­vere men­tal ill­nesses.

“It’s re­ally a jail,” an Ann Klein se­cu­rity of­fi­cer said of his work­place, “but you call it an in­sti­tu­tion or a hos­pi­tal.”

The Tren­ton-based fa­cil­ity houses about 200 in­pa­tients, most of whom come from county jails or state pris­ons. Ann Klein pa­tient Dwayne Hester, 51, has been in­dicted on ag­gra­vated man­slaugh­ter charges on al­le­ga­tions he killed pa­tient Daniel Ro­driguez, 55, in a vi­cious at­tack ear­lier this year.

At least five pa­tient-on-pa­tient as­saults have oc­curred at Ann Klein dur­ing the first six months of 2018, ac­cord­ing to sub­stan­ti­ated data re­ports, but em­ploy­ees who work at the fa­cil­ity say they are in­creas­ingly be­com­ing vic­tims of pa­tient-fu­eled at­tacks.

“We were deal­ing with a hos­tile pa­tient and he had be­come com­bat­ive and punched me a cou­ple times,” an Ann Klein med­i­cal se­cu­rity of­fi­cer said of a re­cent in­ci­dent. “He was kick­ing of­fi­cers. He spit blood in of­fi­cers’ faces.”

The Tren­to­nian has in­ter­viewed mul­ti­ple Ann Klein Foren­sic Cen­ter em­ploy­ees for this story. They spoke on the con­di­tion of anonymity for fear of retri­bu­tion. The news­pa­per learned of re­cent at­tacks on staff, in­clud­ing a doc­tor be­ing knocked un­con­scious and a se­cu­rity of­fi­cer suf­fer­ing a brain bleed at the hands of a vi­o­lent pa­tient.

“You are not sup­posed to work and feel like a punch­ing bag,” an Ann Klein se­cu­rity of­fi­cer said. “It’s bad. The aver­age day is gear­ing your­self up men­tally to ex­pect the un­ex­pected. You don’t know what to ex­pect from the ad­min­is­tra­tion or pa­tients.”

“Peo­ple in hos­pi­tals don’t have mur­der charges or kid­nap­ping charges,” an­other em­ployee said. “The pop­u­la­tion we have, they are very dan­ger­ous.”

David Kensler, CEO of Ann Klein Foren­sic Cen­ter, sent an email on Oct. 17 ac­knowl­edg­ing “re­cent as­saults” at the fa­cil­ity, which re­sulted in a “mod­i­fied re­hab sched­ule” be­ing put into ef­fect. “Al­though we can­not elim­i­nate vi­o­lence com­pletely,” Kensler said in his email, “we hope to tighten up ex­ist­ing pro­cesses and com­mu­ni­ca­tion to re­duce our risk.”

A New Jer­sey Depart­ment of Health spokesper­son con­firmed Kensler has mod­i­fied sched­ul­ing while DOH “in­ves­ti­gates re­cent in­ci­dents in­volv­ing prob­lem­atic pa­tients.”

Lock­down ends

An in­de­pen­dent or­ga­ni­za­tion known as The Joint Com­mis­sion was not im­pressed with Ann Klein Foren­sic Cen­ter when it vis­ited the fa­cil­ity nearly one year ago. The Joint Com­mis­sion, a non­profit also known as TJC, ac­cred­its and cer­ti­fies nearly 21,000 health care or­ga­ni­za­tions and pro­grams in the United States.

The Joint Com­mis­sion vis­ited Ann Klein Foren­sic Cen­ter in De­cem­ber 2017 and cited the fa­cil­ity “for mul­ti­ple find­ings in qual­ity of care and pa­tient safety,” ac­cord­ing to a state re­port. The Gov. Phil Mur­phy ad­min­is­tra­tion had to re­solve the prob­lems and im­ple­ment sig­nif­i­cant changes at Ann Klein in or­der for the state-run fa­cil­ity to re­ceive full ac­cred­i­ta­tion from TJC.

“Joint Com­mis­sion ac­cred­i­ta­tion and cer­ti­fi­ca­tion is rec­og­nized na­tion­wide as a sym­bol of qual­ity that re­flects an or­ga­ni­za­tion’s com­mit­ment to meet­ing cer­tain per­for­mance stan­dards,” ac­cord­ing to TJC’s web­site.

Ann Klein had a for­mer lock­down pol­icy that helped main­tain or­der, em­ploy­ees say. Un­der that for­mer pol­icy, Ann Klein in­pa­tients would typ­i­cally be locked in­side their rooms for op­er­a­tional and ad­min­is­tra­tive rea­sons dur­ing three shifts on a daily ba­sis, with the long­est lock-in tak­ing place overnight from 9 p.m. through 6:30 a.m. the fol­low­ing day.

The foren­sic cen­ter on other oc­ca­sions would ad­min­is­tra­tively lock pa­tients in­side their rooms dur­ing any time when the fa­cil­ity was short-staffed. The state elim­i­nated the ad­min­is­tra­tive lock-in pol­icy on all shifts as of June 25, ac­cord­ing to a state DOH re­port dated Aug. 22.

“TJC as­serted that any­time a pa­tient is locked in their rooms and can­not freely leave, it is con­sid­ered seclu­sion,” ac­cord­ing to DOH, which ended the lock-in pol­icy as a con­di­tion of main­tain­ing its sta­tus as a cred­i­ble, prop­erly run in­sti­tu­tion.

“This pol­icy change was re­quired in or­der for Ann Klein to main­tain its 20-year ac­cred­i­ta­tion,” Dawn Thomas, a DOH spokesper­son, said Wed­nes­day via email. “Two weeks be­fore the Mur­phy ad­min­is­tra­tion be­gan in Jan­uary 2018, the Joint Com­mis­sion in­formed AKFC that it could lose its ac­cred­i­ta­tion if it did not end a long-stand­ing ad­min­is­tra­tive lock-in pol­icy in place on cer­tain shifts. AKFC re­tained its ac­cred­i­ta­tion by end­ing ad­min­is­tra­tive lock-ins, hir­ing 90 med­i­cal se­cu­rity of­fi­cers and mak­ing an­tili­ga­ture im­prove­ments to pre­vent pa­tients from harm­ing them­selves.”

Ann Klein em­ploy­ees say the work­place has be­come more hos­tile ever since the lock-in pol­icy ended, but the DOH spokesper­son sug­gested there is no cor­re­la­tion be­tween the re­cent in­crease in pa­tient-fu­eled as­saults and the abo­li­tion of ad­min­is­tra­tive lock-ins.

“Spikes in as­saults are of­ten at­trib­uted to flu­id­ity of the pa­tient pop­u­la­tion and the prob­lem­atic be­hav­ior of just a few pa­tients,” Thomas said. “I am in­formed that most re­cent as­saults are un­re­lated and oc­curred in places that would not have been sub­ject to a lock­down any­way. In­ci­dent data fluc­tu­ates pe­ri­od­i­cally due to the flu­id­ity of the pa­tient pop­u­la­tion and the abil­ity of a few par­tic­u­larly prob­lem­atic pa­tients to skew the data. The tran­si­tion from a cus­to­dial to a ther­a­peu­tic en­vi­ron­ment takes time.”

Adam Hard­wick, a DOH su­per­vis­ing of­fi­cial, ac­knowl­edged in a re­cent steer­ing com­mit­tee meet­ing that Ann Klein’s “in­crease in vi­o­lence ap­pears to al­ways in­volve a select group of toxic pa­tients who now have the time to plot and con­spire with one an­other to act out in in­ap­pro­pri­ate ways” and he sug­gested the “lack of struc­ture on the units and bore­dom could pos­si­bly be the rea­son” those pa­tients are be­com­ing more vi­o­lent.

“I don’t go in there fear­ing for my safety,” an Ann Klein se­cu­rity of­fi­cer said of the foren­sic cen­ter, “but at the same time I do. Maybe to­day is the day I’m get­ting as­saulted. You just don’t know. It plays a part in your mind. You worry about how you are go­ing to re­act. It’s def­i­nitely stress­ful.”

Staff safety

Ann Klein se­cu­rity of­fi­cers feel dis­re­spected and pow­er­less, ac­cord­ing to the rank-and-file staff. They say Ann Klein pa­tients com­monly file bo­gus com­plaints in an at­tempt to get se­cu­rity of­fi­cers in trou­ble. They of­ten re­fer to them­selves as “punch­ing bags,” say­ing the state will quickly dis­ci­pline any se­cu­rity of­fi­cer who uses body force to sub­due an un­ruly pa­tient.

“As of­fi­cers, we need a lot more than they have of­fered,” an Ann Klein em­ployee said. “We need job se­cu­rity, job pro­tec­tion, all of that.”

DOH con­sid­ers staff and pa­tient safety to be a “top pri­or­ity” at the Tren­ton-based foren­sic cen­ter. “In ad­di­tion to the 90 med­i­cal se­cu­rity of­fi­cers hired over the sum­mer, 34 part-time po­si­tions were just made full time. In ad­di­tion, the fa­cil­ity is hir­ing nine more full-time and eight more part-time med­i­cal se­cu­rity of­fi­cers,” said Thomas, the DOH spokesper­son. “The depart­ment and the hos­pi­tal’s lead­er­ship con­tinue to work with staff to en­sure a safe en­vi­ron­ment while meet­ing stan­dards of in­pa­tient psy­chi­atric care.”

“Med­i­cal se­cu­rity of­fi­cers can in­ter­vene, de-es­ca­late and put vi­o­lent pa­tients in a tem­po­rary phys­i­cal hold to re­store safety,” Thomas added, “but only a nurse can ini­ti­ate a me­chan­i­cal re­straint.”

The Ann Klein Foren­sic Cen­ter serves 199 clients who have been de­ter­mined by the courts to be “not guilty by rea­son of in­san­ity” or “in­com­pe­tent to stand trial” or who re­quire spe­cial se­cu­rity mea­sures due to the na­ture of their ill­ness, ac­cord­ing to the New Jer­sey Divi­sion of Men­tal Health and Ad­dic­tion Ser­vices.

State law re­quires the Ann Klein Foren­sic Cen­ter to re­port any as­saults on site that re­sult in ma­jor or mod­er­ate in­juries. It could take DOH months to sub­stan­ti­ate each as­sault that oc­curs at the fa­cil­ity. Con­sider the as­sault data from re­cent years:

• In 2014, there were 351 sub­stan­ti­ated as­saults at Ann Klein, which in­cludes over 250 in­ci­dents that re­sulted in mi­nor in­juries or no in­juries.

• In 2015, there were 78 sub­stan­ti­ated in­ci­dents of a staff mem­ber suf­fer­ing a mod­er­ate in­jury at the hands of a pa­tient.

• In 2016, there were 23 sub­stan­ti­ated in­ci­dents of a staff mem­ber suf­fer­ing a ma­jor or mod­er­ate in­jury at the hands of a pa­tient.

• In 2017, there were nine sub­stan­ti­ated in­ci­dents of a staff mem­ber suf­fer­ing a mod­er­ate in­jury at the hands of a pa­tient.

The goal of Ann Klein Foren­sic Cen­ter is to “de­liver the high­est qual­ity, ther­a­peu­tic and ev­i­dence-based psy­chi­atric ser­vices to its clients,” the DOH spokesper­son said. “A psy­chi­atric foren­sic cen­ter is in­tended to treat peo­ple with se­vere men­tal ill­nesses and re­duce risks of vi­o­lence.”

Ann Klein’s pa­tients, also known as clients or ser­vice re­cip­i­ents, are of­ten­times deemed “in­com­pe­tent to stand trial.” Even so, all pa­tients at Ann Klein are con­sid­ered com­pe­tent to give state­ments and make com­plaints.

“A court de­ter­mi­na­tion that a per­son is un­fit to stand trial,” Thomas said, “does not re­move the hos­pi­tal’s re­spon­si­bil­ity to in­ves­ti­gate al­le­ga­tions of pa­tient abuse.”

Ann Klein Foren­sic Cen­ter in Tren­ton

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