Violence on Rise at Maples Teen Treatment Centre

A nurse who intervened in the brutal attack on a co-worker by a patient at the Maples Adolescent Treatment Centre remains on long-term disability and may never return to her job, according to an official with the Union of Psychiatric Nurses of British Columbia.

Three workers were injured, including a childcare counsellor who suffered "swollen and sore jaw, pain in back, right shoulder and arm" on May 17, 2011 at the provincial government's Burnaby institution for troubled 12 to 17-year-olds. The patient, whose identity was withheld by government, charged at an unnamed staffer "from the back with fists drawn, punching her twice in the face causing her to fall to the ground."

The patient also "smashed staff #2 head against the wall" and "threw the computer at staff #2."

The heavily censored Joint Accident Investigation Form about the incident offered few details about the outburst and physical injuries. Nor did it answer how the melee started and why it happened.

"The patient involved had a history of violence directed towards staff," said UPN occupational health and safety chair Prentice Geary. "One staff member was severely injured and could have been killed had our member not intervened, and our member is still off due to the psychological impact of that incident."

The only visible line on the form under "basic cause (and contributing factors)" said, "staff voiced concern about working with an all female team." Geary said female staff members can have a calming effect on a ward, but admitted some patients could have a "hate-on" for women.

"We can't staff units based on gender, it's not appropriate, [but] we do have to be cognizant of the mix," Geary told The Tyee. "If we have a lot of violent males, maybe we need to have security in place. It's not about having male nurses on the ward."

Violence weekly at Maples

Violent incidents happened more than once a week in 2012 at the 1969-opened Maples and Geary is frustrated. It is a healthcare facility, not a jail, where the frontline workers are paid only to be caregivers.

"If you had more staff, you'd be able to spend more time with your assigned patients one-on-one to have the therapeutic conversations," Geary said.

The Maples operated on a $9.14 million budget in 2012 for residential, non-residential and outreach services to youths who have suffered physical and sexual abuse, fetal alcohol syndrome, addiction and/or mental illness.

Combine the emotional and mental challenges faced by the youths, some of whom are on prescription medication, with their natural adolescent distrust of authority and the result can be aggression and violence.

"They are trying to prove themselves to others so they don't get victimized again," Geary said. "The nurse is seen as someone in an authority figure, even though with the attachment model you're not trying to have that happen, you want them to see you as a trusted figure. They still make you akin to the person who abused them, perhaps they have been abused in care in a foster home and they don't have the trust."

The three-building complex, with between 6,000 and 8,000 square feet each, has 10 staff total in the three residential units. A 22-bed facility served 191 youth over 2012. Their average stay was between 30 and 90 days. At any time, there may be up to five residents under treatment for being unfit to stand trial or not criminally responsible by mental disorder for a crime.

According to the Ministry, there is supposed to be one frontline staffer for every two youths: a shift supervisor (psychiatric nurse) for every four staff plus a shift supervisor for each residential unit.

Documents released via Freedom of Information about the Maples indicate 56 client-on-staff incidents of violence happened between Jan. 1, 2012 and Nov. 30, 2012. There were also 30 client-on-client violent reports. The Ministry claimed that the year ended with no further client-on-client violence and that only one more client-on-staff incident happened in Dec. 2012 -- despite evidence otherwise.

Key form often not filled out

In 2009 there were 39 client-on-staff incidents and 45 client-on-client incidents, but the numbers fell in 2010 and 2011 before the 2012 spike.

"Violence related incidents are not sufficiently explored, documented or communicated and that actions arising from them are inadequate," said a damning March 21, 2011 WorkSafeBC report after a B.C. Nurses Union regional safety advocate complained. "It was stated that there are unresolved issues re: insufficient risk reduction to minimize violence in the workplace, particularly with staff in the Crossroads program, but also Response."

"For those violence-related incidents reviewed, cause is frequently ascribed to assault, but the investigations do not thoroughly identify unsafe conditions, acts or procedures that may have contributed to the incident, nor recommend corrective action to prevent similar incidents," said the WorkSafeBC report.

The list of 2010 incidents included danger to self and/or other (72), medical (51), property (31), restraint (31), other (31), illegal substance, (25), and injury matters (25). Twenty-two incidents resulted in 26 injuries to staff, eight of whom required more than one day's time off each.

WorkSafeBC analyzed a dozen incidents, half of which were violence-related, but none had the Joint Accident Investigation Form completed. The form, also known as PSC 38, is the ministry's key "root cause analysis form."

The report said a manager stated only 10 to 15 per cent "of all of the packages had a completed PSC38." No site-wide violence in the workplace risk assessment had taken place "for some time" and the joint management/union health and safety committee met eight times, instead of monthly, in 2010. Minutes for March, April, June and August were unavailable.

Geary said threats and posturing count as violent incidents and should be documented, but the challenge of juggling additional paperwork with frontline care to patients is unwieldy.

"For me, as an occupational health and safety rep for the union, I want to encourage all my members to do that, but it's got to be not just me doing that," he said. "Are we going to provide you time away from the front line and cover you so you can get off the front line? Is a manager going to come and cover you while you take the half hour to fill out your paperwork? Who's going to cover me when I'm away from the frontline, otherwise I make my colleagues more vulnerable to attack or injury or to throatiest. We have to change the culture in healthcare, so that we don't normalize the abnormal."

'One or two very challenging youth': Ministry

In a statement from the Ministry of Children and Family Development, the 2012 increase was blamed on "one or two very challenging youth." The Ministry claimed to be unaware that incidents went under-reported or unrecorded in previous years.

The investigation said the attachment care model used at the Maples to foster relations among staff and residents "has placed [healthcare workers] at excessive risk because it doesn't provide effective controls. It permits too wide a range of resident privileges that are subject to individual risk tolerance. Further it sets up expectations with the resident that may not be deliverable on a given shift because of the shift staff profile, and this in turn raises frustration, volatility, unpredictability and violence in the workplace risk."

The perpetrator of the May 2011 incident was involved in a Sept. 13, 2011 incident in which a nurse and two childcare counsellors were injured. Two staffers were punched in the face several times. Another's head was knocked into a wall. Injuries included "bruising and swelling to bridge of nose" and "back of head sore, loss of consciousness for approximately 10 seconds, sore arms and neck."

UPN, BCNU, B.C. Government and Service Employee's Union, a B.C. Public Service Agency-assigned safety specialist and WorkSafeBC met on Sept. 22, 2011. The violence in the workplace risk assessment was insufficient. A July 24, 2012 report said near-miss incidents with the potential for serious injury were not being investigated.

The year ended with a trio of post-Christmas incidents.

A patient grabbed a victim "around the neck and stated 'I'm going to choke you till you're blue,'" according to a Dec. 26, 2012 incident at 6:30 p.m. Two days later, a pair of incidents happened in less than 90 minutes.

The first, at 5:30 p.m. involved a youth "in a highly agitated state, after being restrained earlier in the shift and seemed unable to bring down her affective response.

"Youth wound up lunging at a staff in the staff office and started punching her in the head necessitating her restraint," said the report.

At 6:45 p.m., a patient turned and began punching a person "numerous times in the head." A worker lost four days of work after suffering unspecified injuries to the upper head, arms and hands.

A request to interview Stephanie Cadieux, the fifth Children and Family Development Minister in the last six years, was not fulfilled.

UPN president Dan Murphy said the BC Liberal government owes patients, healthcare workers and the public more than platitudes.

"I don't like scapegoating the patients; they are who they are," Murphy said. "We're victimized by the system, just as they are. It's got to change for the patients and us. Otherwise, nobody wins."