Published: Sept. 02, 2012


Atascadero State Hospital has changed the way it discloses patient-on-staff attacks to the media, meaning scores of everyday acts of aggression inside the facility will go largely unreported.

Officials are now limiting the release of information about attacks on staff to acts resulting in only the most severe outcomes — hospitalization and arrest — as well as incidents of patient escape, murder and suicide.

Atascadero State Hospital is one of five in California.

Atascadero State Hospital is one of five in California.

That means the public won’t know about the hundreds of less severe attacks that occurred at much higher rates than more severe assaults.

Reporting everything, even the smallest incidents, “would give a more realistic picture of what the real situation is inside, because violence does occur on an almost daily basis,” said Paul Hannula, president of the California Association of Psychiatric Technicians’ ASH chapter.

It’s not clear whether the criteria change is a new policy or an existing procedure that was not followed until now. From January to June this year — the most recent data available — 222 attacks resulted in no treatment or first aid, while 24 attacks required medical treatment in the hospital’s urgent care. Only one assault required outside hospitalization, new data show.

Under the policy, because there were no homicides, suicides or patient escapes, the public would have only heard about the single attack that sent a staff member to the hospital.

Hospitalization refers to when an employee is formally admitted to a hospital but does not include trips to the emergency room or outpatient treatment. Further, employees aren’t required to notify their manager if they are admitted to a hospital unless it means they will miss work.

Data on assaults resulting in arrests were not immediately available.

The change followed The Tribune’s periodic checks for attacks as they happen. The Tribune began that reporting in December and continued it into June to provide the snapshot of daily violence inside the facility.

The media and citizens can still use the state’s Public Records Act to get information, but the information is typically 2 months old because of the time it takes the state to track and compile statistics.

Although the change doesn’t affect how ASH tracks staff attacks for its own records or for the Department of State Hospitals — which include all attacks — the shift in media access to real-time information has prompted some concern about transparency.

Unions that represent doctors and psychiatric technicians say all attacks matter — and the public should know about them.

A state senator working toward safety reforms at the hospital says the change may be too restrictive.

The shift in criteria of what to release to the media helps administrators assign the “proper framework” to define and share details on aggressive acts in order “to ensure the quality and integrity of information,” said Linda Persons, the hospital’s acting executive director, in a statement. Hospital administrators declined to be interviewed about the policy.

Keeping the everyday attacks out of the public eye ignores the confrontations that happen in between the more severe assaults, Hannula said.

As a facility with the highest level of security among California’s five state hospitals that treat mentally ill violent offenders, ASH is a place where hostility is common.

“A minor assault is still an injury, and it’s a real concern for the people who are out there with them (patients) all the time,” one doctor said.

The two doctors presented in this article were promised anonymity because ASH doesn’t allow its staff to speak to the media.

Daily dangers

On any given day, ASH staff can be punched, shoved and kicked by patients.

Sometimes, the violence worsens. Over the years, employees have been lunged at with pens and pencils, scratched in the eyes and subjected to beatings.

Injuries from such patient attacks have resulted in cuts, bruises and sprains. And, in more severe cases, broken bones and head injuries with lasting effects.

Portraying violence inside the facility as it happens helps give a better picture of what’s actually going on, another doctor said.

The number of assaults resulting in injury has more than doubled in the past seven years, state figures released this year show.

“You put in the newspaper that so-and-so got his nose punched, and that doesn’t seem newsworthy. But in cumulative results, it really does add up,” he said.

Last year, there were 409 aggressive incidents against staff. Of them, 151 resulted in injury, according to state data. Another doctor said limiting attack information to data and not real-life accounts leaves other effects, such as emotional and psychological scars, untold.

He recalled an incident in which one patient was kicked in the head by another patient, resulting in the bone cracking so loud that it was heard throughout the unit.

“That doesn’t leave you,” he said.

It’s important that the public knows about those incidents and others, he said, because the hospital is taxpayer-funded.

“The taxpayer is paying every time for treatment, (or) lack of treatment,” he said. “They don’t know that when we go to work, almost always somebody gets hurt, and that’s the reality of our workplace.”

The concern, for Sen. Sam Blakeslee, R-San Luis Obispo, is in the largely untold incidents in which patients use bodily fluids as a weapon.

He’s working to make the type of attack, known as “gassing,” a felony in state hospitals. It’s currently a misdemeanor offense in those facilities.

“If we are serious about changing the safety culture in our state hospitals, we must consider these types of assaults as serious incidents, and categorize and report them as such,” he said in an emailed statement.