Wednesday, November 9, 2016

A Bergen Regional Medical Center nurse who was brutally assaulted in 2015 by a patient known to be violent won a grievance case against the Paramus facility

Bergen Regional Medical Center
The Record

Wednesday, November 9, 2016, 6:33 PM
Nurse who was brutally assaulted by a patient wins grievance case against Bergen Regional 

  A Bergen Regional Medical Center nurse who was brutally assaulted in 2015 by a patient known to be violent won a grievance case against the Paramus facility, which must cover some medical expenses and back pay, an arbitrator has ruled.

Details of the legal case, which triggered a federal investigation last year, were made public this week by the union that represents more than 400 nurses at the state’s largest hospital.

The attack was also detailed in a report in The Record in May — one of hundreds of alleged assaults logged by police at the hospital. As a result of questions raised about patient and staff safety in the report, Governor Christie signed into law last month a measure creating an 11-member panel to oversee the hospital.

On Wednesday, the Bergen County Board of Freeholders overwhelmingly approved the introduction of an ordinance to create the panel, which will have sweeping powers over the hospital and replace the Bergen County Improvement Agency which currently has oversight.

The hospital maintains that it meets all standards to prevent work place violence and maintains that the rate of episodes is lower than that of state psychiatric facilities, yet it has declined to provide the number of assaults. A private consultant, which Bergen County Executive James Tedesco ordered the hospital to hire, recently concluded that staff over-reported episodes to police and meets all state regulations.

Nurse Sandra Giancarlo testified about a harrowing attack Jan. 11, 2015 and the 11 “violent” and “aggressive” episodes triggered by the same patient in the four months prior to the assault.

Staff repeatedly asked that the 350-pound 6-foot woman be forcibly medicated because she refused anti-psychotic drugs to prevent violent episodes, the ruling noted. Staff also noted that the woman languished in a unit without improving and refused showers for more than a year before she was forcibly bathed, the ruling noted.

The attending physician in the psychiatric unit said she spoke with Dr. Gabe Kaplan, medical director of psychiatry, who would not write an order to forcibly medicate the patient, despite the violent episodes.

At the start of her shift, Giancarlo requested a male staff member to the psychiatric unit because the prior shift found the patient “unpredictable and aggressive.” The assistant director of nursing declined the request, claiming no male assistants were available, according to the ruling.

The patient, identified as M.B., attacked Giancarlo at the end of her shift, scratched her face, ripped out some of her hair and damaged her knee, according to the ruling. Giancarlo, 5-foot 4 inches and 107 pounds, crawled away after two employees pulled the woman off of her, but collapsed because of pain in her left leg.

She suffered a torn ligament that required surgery, suffered a back injury, used crutches and a knee brace for months. She attended physical therapy and took pain medication for months and continues to see a psychiatrist and psychologist for post-traumatic stress disorder, according to the ruling.

The 1070-bed hospital “did not take the appropriate action to mitigate a known threat,” Arbitrator Lisa C. Charles determined. The hospital also acknowledged that it did not have a plan to determine when to administer anti-psychotic medications when patients refused treatment, Charles noted.

Bergen Regional, which provides long-term care, acute and behavioral health services, previously had a policy where a physician could write a standing order to inject medications if necessary. The policy changed after a New Jersey court ruled that such regulations are illegal. The court then ordered each institution to create guidelines, the ruling noted.

In testimony, Kaplan said psychiatrists cannot always predict when a patient may become violent and the physicians must “balance the patient’s civil and human rights against the benefits of medicating them.” But he acknowledged that “the hospital had not formulated an alternative policy’’ after New Jersey courts mandated one, according to the ruling.

“It was incumbent upon the hospital to address the known risks of violence, and to comply with the court order, but there was no evidence presented that it did either,” Charles concluded.

In a statement the hospital released Wednesday, a spokeswoman said “there are factual inconsistencies in the arbitration document.

“There is and has been a policy in place for the administration of emergency involuntary medication and the policy outlines the procedures to follow,’’ said spokeswoman Donnalee Corrieri.

Giancarlo, who returned to work in May after an 18-month absence, declined to comment.

“BRMC has and will be supportive of Ms. Giancarlo in the aftermath of her ordeal,’’ Corrieri said. “The breadth of that support extends well beyond, and is irrespective of, the full compensation and expressed coverage addressed within the award.’’

Bernard Gerard, an official with Health Professionals and Allied Employees, filed a complaint with the federal Occupational Safety and Health Administration in Feb. 2015 after he learned of the attack. OSHA issued a citation six months later and imposed a $13,600 penalty. The hospital is “vigorously contesting’’ the ruling, which marked the second time that OSHA urged the hospital to better protect staff.

Giancarlo wasn’t the only nurse attacked by M.B., the ruling noted.

A nurse who retired in Dec. 2014, Mary Ann Grieco, said M.B. threw a tray at her and charged her. Grieco said she called for a male attendant to help escort M.B. to a seclusion room where she was put in leather restraints. The nurse testified at hearings that she talked to physicians several times about M.B.

Another nurse, Jeffrey Peck, who testified as president of the local union, said he received calls from union members complaining about understaffing. Peck testified that M.B.’s length of stay was “unusual,” that she was not improving and had had three admissions since 2011, according to the ruling.

Djar CQ Horn, a union staff member testified that she investigated the assault on Giancarlo, watched a video of the episode, reviewed OSHA guidelines and determined the hospital violated federal regulations and the collective bargaining agreement between HPAE and Bergen Regional.

“The hospital knew that the patient who attacked Ms. Giancarlo was violent, that the patient had attacked and threatened other staff members, and the hospital ignored the known risks,” Horn testified.

Horn also testified that the hospital “did not provide the appropriate staff to Unit AG… and that it had not followed its own polices.”

Corrieri said “the arbitrator unfortunately predicated her determination on the allegations from OSHA that BRMC is vigorously contesting.’’