LOCKDOWNS, BEAT DOWNS
Violent attacks increase at Trenton-based Ann Klein Forensic Center after ending of lockdown policy
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.”
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.”
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