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Staffers said during a series of recent interviews that it's especially common for male patients to explode in anger at nurses and other patients when they feel that their personal space is being invaded, or when they're asked to make room for people with disabilities or health problems who need to lay down.
"The stronger people sleep on the couch," explained Johnson, referring to one of the few pieces of full-length furniture in the main room where a patient can comfortably recline. "We recently had a little lady with arthritis who needed to lay down, and we wanted to put her on one of the few couches that we have, and a man who was sleeping on the couch, when we asked him to please let the lady have it, he began yelling, 'Hell no!' and got very angry." Johnson said they had to back off and find another spot for the woman for fear that the situation would escalate.
Nurses and other staff members say that while the problem of overcrowding is not new at John George, the situation is growing increasingly dangerous. And they blame hospital administrators not only for management decisions that they allege have made matters worse but also for creating a culture of fear in which speaking out could cost nurses their jobs.
Ruby Sloan, a mental health specialist who has worked at John George Hospital since it opened in 1992, and who previously worked in the psychiatric ward at Highland Hospital, has seen lots of fights break out, but in recent years the problem has intensified, and the hospital administration has been unresponsive to pleas from nurses and other staffers, she said. "The PES has been overcrowded for more than ten years now," said Sloan in an interview. "I've seen people bitten and stomped. I've had two concussions myself."
In 2006, Sloan was working her shift at PES when a male patient became agitated and began lashing out at staffers. Sloan was standing nearby when the man threw a wild punch that landed square on the side of Sloan's head, behind her ear, causing a concussion. Then in 2014, another male patient struck Sloan in almost the same spot with his fist, causing a second concussion. Both injuries forced Sloan to go on medical leave while she recovered. Sloan believes that her injuries, along with similar wounds sustained by her co-workers and other patients, could have been prevented if there were fewer patients crowded into PES and more nurses to look after them.
Overcrowding also results in critical gaps in patient care, said several other PES staff members whom the Express has agreed not to identify because they fear retaliation by hospital management. According to several accounts, last year nurses had difficulty providing care to a patient experiencing a life-threatening medical emergency inside PES. "We had to try to help this person right there on the spot," said a PES staff member. "This was a lady who was in serious trouble, but because it was so overcrowded, and because some of the patients don't know any better, we had people interrupting us the whole time, coming up behind us, asking for snacks, for cookies, or if they could go to the bathroom."
In multiple emails and phone messages, I repeatedly asked the Alameda Health System's communications director Jerri Randrup and agency spokesperson Jennifer Schutz about recent events in PES, but neither responded to my questions. Instead they emailed me the same undated, unresponsive one-page statement three times.
Edwards, Johnson, and Sloan all said that frequent overcrowding inside John George PES also means that many patients have to eat their meals — which are served in Styrofoam trays with plastic utensils — while sitting on the tile floor, and that at night, some of the patients are expected to sleep on the hard floor with only a pad and a blanket to insulate them. According to the Alameda County Mental Health Board, a public committee that advises the county board of supervisors on mental health services, there are frequently upwards of twenty patients sleeping on the floor at night in PES because the facility is overcrowded.
"There's nothing therapeutic about this," said Johnson. "We're going backward."
"The floor is cold, and there's no good ventilation in the PES," added Edwards. The room is normally pungent with the smell of soiled clothing. Because the toilets are locked, and a nurse must accompany a patient when they need to use the toilet, patients frequently urinate on themselves. "A lot of people end up leaving the hospital more traumatized than when they came in," said Edwards.
On November 24, 2015, Edwards, Johnson, Sloan, and about forty other nurses and staffers went to the meeting of the Alameda Health System Board of Trustees, which oversees the John George Psychiatric Hospital, and implored the board to find a solution to the overcrowding. The public appearance of so many hospital staff at a board of trustees meeting — effectively going over the heads of their own hospital's administrators — was unprecedented.
"Overall morale at John George is at an all-time low," said BJ Wilson, a nurse who has worked for many years at John George's PES, during the public comment period. Wilson added that in the months leading up to the trustees' meeting, PES had exceeded its capacity on multiple days, and that if the conditions are allowed to continue, violence will ensue and the quality of patient care will further decline. "Sooner or later," Wilson warned the trustees, "something bad is going to happen."