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And PES staffers are continuing to raise the issue publicly. At the January 11 meeting of the Alameda County Board of Supervisors health committee, Nixon presented a graph showing that total annual visits by patients to John George PES jumped from 9,645 in 2007 to 16,116 last year, while staffing hasn't increased sufficiently to meet this explosion in admissions. "It's great that we are finally acknowledging these problems exist," Nixon told the supervisors and county health officials during a public comment period. "We need to set a maximum capacity at which we can safely, therapeutically manage things. Right now, there's simply no floor space, and we're being forced to free up space, and figure out who we can discharge faster. It's a tragedy." Nixon ended his comments by noting that John George PES is possibly the only hospital in the state without a cap on the number of patients who can be in the building.
I contacted the Alameda County Fire Department's fire marshal about Nixon's claim. According to spokesperson Aisha Knowles, John George Hospital's original building and permitting plans dating back to 1989 do not indicate an occupant load for the building housing the PES. State health and fire officials told the county fire marshal that a waiver was granted in 2004 to convert a building on the John George campus into the PES facility. The county fire marshal has requested records from the state related to this waiver, which should indicate if an occupant load was ever assigned to the PES by state fire and health officials. The county fire marshal, however, has yet to receive these records.
Nurses and other staffers say that last year, after they began demanding action on the issue of overcrowding, John George Hospital administrators became increasingly hostile, and that some staffers have been punished for speaking with state regulators and county officials.
"I have seen a lot of different administrations over my career," said BJ Wilson about the executives who run John George Hospital and other AHS mental health facilities. "The current group, which has been here for the last eight years or so, they have not been receptive to the staff's concerns. Some things, they do appear to be punitive, and when people have to work in a situation where they feel like their livelihood is jeopardized, it's working in fear." Wilson said fear has kept many AHS mental health workers from raising the issue of overcrowding with administrators. (In fact, all of the nursing staffers interviewed for this story declined to be photographed because of fear of retribution.)
Another nurse, speaking on the condition of anonymity, said many of the current AHS executives came to the system from private sector hospitals where nurses and other employees have fewer protections and work for less pay, and where the goal of increasing hospital profits often takes precedence over issues such as staffing and patient care. "In the private sector, if you piss off the boss, they get rid of you," said the nurse, who believes that many current AHS executives are bringing this mentality into the county's public health system.
Lucille Edwards was one of the speakers who addressed the AHS trustees at their board meeting last November about problems at John George PES. According to Edwards, after that meeting, her immediate supervisor called her into the office at least five times and reprimanded her for things like using an "irritated voice" in the workplace.
"We all know this stems from my going to the board of trustees with the other nurses and speaking about the problem. I was one of the main speakers," Edwards told me. "I had no problems from 2011, when I started working here, up until the trustees meeting. So the record speaks for itself."
Wilson told AHS trustees at their November board meeting that nurses used to only "fear being assaulted by patients, but now the fear is staff is being assaulted by the administration. ... If you talk, speak out, you're going to be reprimanded, hauled in, questioned, and your credibility is going to be on the line."
AHS spokesperson Schutz did not acknowledge my request to interview Judy Linn, director of nursing at John George, so I was unable to ask hospital executives about any recent disciplinary actions at the facility. Schutz also did not return my phone calls seeking comment about discipline issues.
Another nurse who spoke to me on the condition of anonymity said that PES workers who are injured on the job are sometimes treated as though their injuries are their own fault. "When you get assaulted by one of the patients, it's almost like you get another punishment afterward from the management," the nurse said. "They try to reassign you or keep you from being able to work again. They don't say it to you, but they do things to make it clear."
According to AHS records and other sources, John George administrators attempted last year to remove a PES manager who sided with nurses over the issues of overcrowding and the demand to establish a nurse-to-patient ratio. According to an open letter distributed publicly by PES nurses, Frederick Tatum, the nurse manager in PES, was placed on administrative leave after he communicated with state regulators about possible fire code violations and requested clarification regarding nurse-to-patient ratios from hospital executives and state regulators. According to the open letter, the hospital administration placed Tatum on administrative leave and investigated him for reasons that were not disclosed, but the administration found no evidence of misconduct, so AHS executives then offered Tatum a "hefty severance package" if he would agree to voluntarily resign.