New York State

Occupational Safety & Health

Hazard Abatement Board

Public Hearing on

“Proposed Standard for Safety and Security in the Public Sector throughout New York State”

Testimony of Ricardo K Fernandez, RN

Psychiatric Nurse, Capitol District Psychiatric Center

on behalf of the New York State Public Employees Federation, AFL-CIO

June 16, 2003

Good morning, my name is Ricky Fernandez and I am a registered nurse and a member of PEF. I have been working as a psychiatric nurse at Capital District Psychiatric Center for 6 years. I work in the Intensive Care Unit that deals with high risk patients who are in danger of harming themselves or others.  These patients typically have a decrease in their mental status that requires that they be closely monitored. Some of these patients may have refused to take medications, and have become psychotic, threatening, and aggressive. We have a maximum of twenty patients on this locked unit and generally we have greater staffing than the other units.  Our unit has a minimum of six staff, including two nurses and four mental health therapy aides. Intensive care patients are more susceptible to  self-abusive behavior and physical confrontations with other patients and staff. Every staff person must be super vigilant to avoid patient manipulation and assaults.

Just last week a therapy aide was kicked by a patient in the knee.   Fortunately this incident did not cause a lost time injury, however, if the  force had been sufficient the staff person would have been seriously injured. Staff are injured on almost a daily basis. Most of the injuries are minor and never get reported. In the six years that I have been at CDPC, staff have been bitten, scratched, punched, and kicked. They have had their hair pulled out, urine and feces thrown on them as well as food and  scalding hot beverages. Injuries have ranged from minor scratches and bruises and burns to major hemeatomas, sprains, strains, and fractures.  In the truly psychotic patient, actions such as these are usually expected and  forgiven. Staff must suffer the healing.

 In a small group of patients with a specific diagnosis these actions are learned from years in the mental health system and are fine tuned to be inflicted to staff without fear of reprisal. These patients are battle hardened by the system, and staff must suffer the healing.

On August 9, 2000, I was punched on the left side of my face. I never saw it coming. My nose was displaced to the right. It happened so fast it stunned me. I saw stars. The force of the blow spun me around.

My nose began to bleed profusely and an Officer from Safety rushed me to St. Peter’s Hospital Emergency Room. It was determined that my nose was fractured. My nose was bent over to the side from the blow and I had a large bruise under my left eye.  Cartilage was displaced and I was referred to a plastic surgeon. I was scheduled for surgery under general anesthesia and had a closed reduction to straightened my nose. I was able to go home the same day post surgery, with a splint on my nose and and my nares full of packing  feeling quite miserable. I could not breathe through my nose.

I serve my country as a Captain in the United States Army Reserves, working as an Army Nurse, and I was scheduled and had orders to go to Fort Gordon, Georgia for two weeks of annual training. That had to be postponed and rescheduled as a direct result of the assault.

 Trying to recuperate at home was very uncomfortable. I did not enjoy the three weeks at home. I couldn’t breathe through my nose for three weeks. I had to mouth breath. I was put on a soft diet and couldn’t have hot beverages or eat anything crunchy. I was exhausted. I couldn’t sleep at night because I had to sleep sitting up with my mouth open. I’d wake up with my tongue stuck to the roof of my mouth. I was prescribed pain medication as well as an antibiotic which I had to take for seven days.

My co-workers were very supportive, including my supervisors.  I was offered trauma counseling and I spoke with the Employee Assistance Counselor. I decided to press charges against the patient. I had to go to the police station on my own to file the police report. The magnitude of my injury was great enough to be classified as an assault second degree, a felony.

  I had to spend time on my own to go to the police court and speak with the District Attorney. I had to make three trips on my own time from Schoharie county. I feel if I hadn’t met with the criminal justice authorities, the charges would have been reduced or dropped. Neither the facility nor the court notified me of the court date. I had to find that out on my own initiative. I told the court that I did not want the charge reduced. and agreed to an “Adjournment on Contemplation of Dismissal”. The patient was put on probation for a year. The patient had been previously charged with an assault and was already on probation at the time he assaulted me.  The patient was subsequently  transferred to a different facility, but I had to suffer the healing. The thing that was most upsetting to me was the loss of wages. I lost  3 weeks of work and had to deal with the workers’ compensation bureaucracy.

A lot of the elements of a security and safety standard are in place at CDPC such as a written violence prevention policy, staff training, and environmental rounds. At the same time, OMH has been pushing to decrease the use of restraints and seclusion. Patients have rights to protect them from undue abuse, and staff supports the elimination of unnecessary restraint and seclusion. But patients who are constantly combative and assaultive should not be allowed to continue to pose a risk to other patients and staff. OMH needs to come up with strategies to address the small group of patients that are causing so much harm.

I encourage the Hazard Abatement Board to recommend that the Commissioner of Labor promulgate a standard on workplace safety and security. The incredible harm caused by workplace assaults must become a high priority to all parties concerned with occupational safety and health: the Department of Labor, Public Employers, and the Unions. In my case, my employer has some elements of a security and safety program already in place: a written policy, staff training, and environmental rounds. However, there is one key element that is not in place, developing a means of containing patients who are repeatedly violent.