Editor’s Note: Workplace violence, often associated with unsafe staffing
levels, and official complacency have contributed to the current profound and
growing nurse shortage. Here’s news coverage of one such horrible case. The
Massachusetts Nurses Association has organized a task force on workplace
violence, introduced legislation to address it and begun an educational
program to prepare nurses to tackle and defeat this plague.

St. Lucie mental patient kills nurse, injures two patients

Associated Press

April 10, 2001

PORT ST. LUCIE, Fla. - A psychiatric hospital nurse was beaten to death and
two elderly patients were injured early Tuesday in an attack by a man who was
being checked in, authorities said.

Alberto Serrano, 33, was charged with first-degree murder in the death of
Alda Ellington, 47, a nurse at the private Savannas Hospital.

Serrano also was charged with two counts of attempted murder in the beatings
of two female patients. One, 75-year-old Olive Simpson of Wellington, was in
critical condition at St. Lucie Medical Center. The other patient,
64-year-old Elizabeth Scott of Port St. Lucie, was treated and released back
to the mental facility.

"I was shocked because I thought she was safe in a situation like that," said
Elizabeth's husband Raymond Scott. "I felt so good that she was secure.
Undoubtedly she wasn't."

In a separate incident, Serrano was arrested last Friday on a misdemeanor
battery charge for punching a man in the face and back in the waiting room at
New Horizons mental health center in Fort Pierce. He was released from the
St. Lucie County Jail the same day on $500 bond.

Serrano's girlfriend, Nidia Pena, said he was taken to New Horizons by police
after attacking on his family in the middle of the night.

"Not again," she told police when she learned of the latest incident. "He
just did this at New Horizons and was arrested for battery two days ago."

While being processed, Serrano was alone with Ellington when he attacked and
beat her to death at about 2 a.m., said Mark Weinberg, spokesman for the St.
Lucie County Sheriff's Office. Serrano then attacked the patients, whose
rooms were nearby, he said.

Ellington was found unconscious lying in a pool of blood. Simpson and Smith
were lying in their beds with bloody faces.

"With his own bare hands and with no apparent provocation he committed these
acts," Weinberg said. "We do not know of any precipitating factors."

Serrano was brought to Savannas after voluntarily admitting himself into the
emergency room of Martin Memorial Medical Center in nearby Stuart at about
12:30 a.m., said hospital spokeswoman Pat Austin.

He was taken to Savannas under the Baker Act, which requires a person
determined to be a threat to others to spend three days in a psychiatric
facility for an evaluation, Weinberg said.

Serrano was arrested without incident after deputies found him sitting in a
chair outside the building. He was drenched in water and his hands were
swollen and cut. Detectives believe he may have washed himself in a pond on
the property after the alleged attacks, the report said.

He was taken back to the county jail, where he was being held without bond in
a medical cell until a Wednesday morning court appearance. He talked about
the attacks during an interview with detectives after his arrest, Weinberg
said.

Copyright 2001 Associated Press.

----------------------------

Police: Error delayed suspect's treatment

by Teresa Lane, Palm Beach Post

April 12, 2001

PORT ST. LUCIE -- Four days before a mental patient fatally beat a nurse at
Savannas Hospital, mental health workers at a second facility ignored a
"routine procedure" that would have ensured immediate psychiatric care for
the patient, law enforcement officials said Wednesday.

Although police took Alberto Serrano to New Horizons of the Treasure Coast
early Friday for treatment, he never received any, records show. A punch to a
fellow patient instead meant a trip to the St. Lucie County jail, where
Serrano, 33, spent the night on a misdemeanor battery charge before his
girlfriend posted $500 bond.

St. Lucie County Sheriff's Office spokesman Mark Weinberg said while it is
routine for psychiatric hospitals to place a mental health hold on patients
who commit crimes, allowing them to receive treatment after jail, that was
not done in Serrano's case. Serrano's estranged wife says he is
schizophrenic.

Three days after his jail release, the 6-foot-2, 250-pound Serrano began
hearing voices again. This time, police say, 47-year-old Savannas Hospital
nurse Alda Ellington and two elderly patients were the targets of his fists.
Ellington, who was 5-foot-4 and weighed 135 pounds, died of massive head
injuries. Olive Simpson, 75, remains in critical condition at St. Lucie
Medical Center. Elizabeth Scott, 64, escaped with a broken nose, cut lip and
broken dentures.

"We are not a psychiatric organization; we're a criminal justice agency,"
Weinberg said. "New Horizons is well familiar with the mental health hold
procedure, and it has been done many times in the past. I don't know why they
didn't in this case."

An employee of New Horizons, a state-supported psychiatric treatment center,
said he was unaware of the hold procedure and said his staff prefers to treat
violent patients in jail. Unlike Savannas Hospital and a second private,
for-profit psychiatric hospital in St. Lucie County, New Horizons can't turn
away poor patients.

"I have a non-tolerance procedure for violence," said Ed Stein, director of
nursing and emergency services at New Horizons. "If someone is actively
assaulting people, I can't put my staff and patients at risk. Our psychiatric
staff treats violent people in the jail."

Diagnosed as a paranoid schizophrenic, Serrano had been admitted to mental
hospitals at least 10 times over the past decade, usually because he had
stopped taking his medication, said estranged wife Kimberly Serrano, 31. He
was sometimes admitted for two weeks at a time to New Horizons, but he had
also been admitted to Savannas at least twice, she said. He also had been
hospitalized once in Palm Beach County and at least once in his native Puerto
Rico.

Serrano was committed to New Horizons under the state's Baker Act Friday
after he punched three adults and an 8-year-old girl and kicked down a
bedroom door, a police report said. The four were residents of the JCAHO
Boulevard home in Port St. Lucie where Serrano was staying in the garage.

He had attacked hospital workers before, his wife said. A bodybuilder with
rippling muscles, the former roofer didn't like to take psychiatric
medication because it made him tired. Twice he had to be restrained by staff
members who were punched while trying to give him medicine, Kimberly Serrano
said. Neither incident was so severe it ended in arrest, she said.

"He never hit me or my children," she said.

Although Savannas Hospital has refused to comment on whether staff members
followed written procedures in allowing Ellington to interview Serrano alone,
another area treatment center said it never allows nurses to be alone with
incoming patients. A Savannas nurse on duty during the attack said staff
members have complained of lax security, to no avail.

An orderly left the two in a room alone for an initial interview, and a
technician who was supposed to assist was on break, said the nurse, who asked
that her name not be used.

"Somebody called me over to do CPR (on Ellington) and I couldn't ... I mean,
I had to stay at (my) unit," the nurse said. "It was just me. Plus, he
(Serrano) was on the loose."

Serrano confessed to attacking the women, saying he "killed the people by
breaking their necks and backs and beating them in the face," sheriff's
Detective Elmer MCP wrote in a report.

The state Agency for Health Care Administration is investigating the
incident. The Department of Children and Families, which state law designates
as the "mental health authority" in protecting patients, said it would not
take any action until ACHE reports its findings.

Savannas Hospital stumbled on its last survey by the Joint Commission on
Accreditation of Healthcare Organizations, the private not-for-profit agency
designated by the state to inspect hospitals every three years for compliance
with its standards.

After receiving an excellent rating in 1996, the hospital was told to make
improvements in 1999, the last time a full survey was completed. The
hospital's psychiatric services fell short in three areas: initial assessment
procedures, implementing plans "to provide a safe ... environment of care"
and use of medicines.

Of the 574 psychiatric facilities reviewed by the agency in 1999, fewer than
15 percent were deficient in initial assessments and safety plans, and only 8
percent were deficient in use of medicines. Overall, the hospital's
psychiatric services scored 95 out of 100, placing it among 459 facilities
that scored in the same bracket.

Charlene Hill, a JCAHO spokeswoman, said it has asked Savannas to submit a
confidential report within 45 days on the circumstances and causes of the
nurse's killing and patient attacks. If the agency finds the report "thorough
and credible," and the hospital takes the proper actions to prevent the
incident from recurring, it's unlikely the agency would revoke the hospital's
accreditation, Hill said.

The report is kept confidential so the hospital does a thorough
investigation, she said. "We've learned over time it's a systems error, not a
people error." But the agency also accepts information from the public on its
complaint hot line, (800) 994-6610.

The state has different staffing requirements for psychiatric hospitals than
nursing homes and acute care hospitals. The standard simply requires at least
one qualified staff person on each floor at all times, according to state
officials.

Although Stein said New Horizons workers are sometimes left alone while new
patients are being screened, Lawn wood Pavilion spokeswoman Beth Tutee said
that's a cardinal safety sin at her 36 bed psychiatric facility in Fort
Pierce.

Savannas executives have refused to comment since the killing, instead
issuing a release that said "Even in the most restrictive settings, forensic
hospitals, jails and state hospitals, incidents such as this can occur." The
facility has treated more than 15,000 patients since opening on Walton Road
in Port St. Lucie in 1987 and said it will evaluate the tragedy in the coming
weeks "to assist us in learning from this traumatic experience."

Serrano was being held without bail in a medical cell Wednesday on charges of
first-degree murder and two counts of attempted murder.

Staff writers Colleen Mastery, Molly Hennessy-Fiske, Jill Taylor and Snaggy
Beat contributed to this story.

----------------------------

SBA 501, An Act Requiring Health Care Employers To Develop And
Implement Programs To Prevent Workplace Violence (new)

This bill would mandate a comprehensive workplace violence prevention
program, along with counseling program for victims of workplace violence who
work in the delivery of health care. It would also address the risk of
violence and the appropriate retirement compensation for those professionals
who care for these populations in public sector settings. (Sen. James Jejuna,
Methuen and Rep. David Donnelley, Dwelt Robbery)

Text of Actual Bill ...

The Commonwealth of Massachusetts
------------------------
In the Year Two Thousand.
------------------------

AN ACT REQUIRING HEALTH CARE EMPLOYERS TO DEVELOP AND
IMPLEMENT PROGRAMS TO PREVENT WORKPLACE VIOLENCE

Be it enacted by the Senate and House of Representatives in General Court
assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 149 of the General Laws, as appearing in the 1998
Official
Edition, is hereby amended by inserting after section 129 D, the following
new section:-

Section 129E. (a) As used in this section, the following words shall
have the following meanings: -
"health care employer" shall mean any individual, partnership, association,
corporation or, trust or any person or group of persons employing five or
more employees.
"employee" shall mean an individual employed by a health care facility;
including any hospital, clinic, convalescent or nursing home, charitable home
for the aged, community health agency, or other provider of health care
services licensed, or subject to licensing by, or operated by the department
of public health; any state hospital operated by the department; any
"facility" as defined in section three of chapter one hundred and eleven B;
any private, county or municipal facility, department or unit which is
licensed or subject to licensing by the department of mental health pursuant
to section nineteen of chapter nineteen, or by the department of mental
retardation pursuant to section fifteen of chapter nineteen B; any "facility"
as defined in section one of chapter one hundred and twenty-three; the
Soldiers' Home in Holyoke, the Soldiers' Home in Chelsea; or any "facility as
set forth in section one of chapter nineteen or section one of chapter
nineteen B.

(b) Each health care employer shall annually perform a risk assessment, in
cooperation with the employees of the health care employer and any labor
organization or organizations representing the employees, all factors, which
may put any of the employees at risk of workplace assaults and homicide. The
factors shall include, but not be limited to: working in public settings;
guarding or maintaining property or possessions; working in high crime areas;
working late night or early morning hours; working alone or in small numbers;
uncontrolled public access to the workplace; working in public areas where
people are in crisis; working in areas where a patient or resident may
exhibit violent behavior; working in areas with known security problems and
working with a staffing pattern insufficient to address foreseeable risk
factors.

(c) Based on the findings of the risk assessment, the health care employer
shall develop and implement a program to minimize the danger of workplace
violence to employees, which shall include appropriate employee training and
a system for the ongoing reporting and monitoring of incidents and
situations involving violence or the risk of violence. Employee training
shall include education regarding reports to the appropriate public safety
official(s), body(s) or agency(s) and process necessary for the filing of
criminal charges, in addition to all employer program policies. The employer
program shall be described in a written violence prevention plan. The plan
shall be made available to each employee and provided to an employee upon
request and shall be provided to any labor organization or organizations
representing any of the employees. The plan shall include: a list of the
factors, which may endanger and are present with respect to each employee; a
description of the methods that the health care employer will use to
alleviate hazards associated with each factor, including, but not limited to,
employee training and any appropriate changes in job design, staffing,
security, equipment or facilities; and a description of the reporting and
monitoring system.

(d) Each health care employer shall designate a senior manager responsible
for the development and support of an in-house crisis response team for
employee victim(s) of workplace violence. Said team shall implement an
assaulted staff action program that includes, but is not limited to, group
crisis interventions, individual crisis counseling, staff victims’ support
groups, employee victims’ family crisis intervention, peer help and
professional referrals.

(e) The Commissioner of Labor shall adopt rules and regulations necessary to
implement the purposes of this act. The rules and regulations shall include
such guidelines as the commissioner deems appropriate regarding workplace
violence prevention programs required pursuant to this act, and related
reporting and monitoring systems and employee training.

(f) Any health care employer who violates any rule, regula