[A] veteran nurse at the Vermont Psychiatric Care Hospital in Berlin was disciplined for abusive treatment of a patient in January, a Division of Licensing and Protection survey report shows.
The nurse, acting as shift lead, directed staff to conduct “planned ignoring” of a patient with severe obsessive compulsive disorder in an attempt to manage the patient’s “maladaptive” behaviors, according to the report.
Planned ignoring is a strategy sometimes used to reduce attention seeking behavior, the report states, but it was not part of this patient’s treatment plan. The treating psychiatrist later said planned ignoring is not recommended for patients with OCD and the nurse had no authority to instruct staff to implement it.
The nurse carried it further than just ignoring the patient, according to witnesses, by “taunting” the patient who became “visibly upset” and cried throughout the evening while begging for assistance. The episode left the patient so anxious that the person reported having thoughts of taking his or her own life, the report said.
A month later the patient and nurse went at it again, the report says. After the patient slammed a door, the nurse reopened the door 5 to 7 times while smiling and laughing. That left the patient “angry yelling and hysterical.” The nurse later told investigators they were creating a distraction to “deescalate” the situation.
Officials at VPCH reported the incident to the Division of Licensing and Protection, which performed an unannounced site visit on behalf the federal government. The inspection concluded that the abuse resulted from poor job performance “rather than from systemic processes and factors that require correction.”
At the same time, Adult Protective Services and the Department of Human Resources conducted their own investigations. APS, which investigates abuse or neglect of vulnerable adults, substantiated the alleged abuse in March, and the nurse was immediately placed on administrative leave. The finding was also reported to the Vermont State Board of Nursing.
The nurse in question was allowed to continue working at the hospital while those investigations unfolded because of “a positive work history with no record of having mistreated a patient.” The nurse has worked in state psychiatric facilities for nine years, a tenure dating back to the former Vermont State Hospital in Waterbury.
As of May 15, when Licensing and Protection approved the hospital’s corrective action plan for issues uncovered during the inspection, the nurse remained on administrative leave, according to Vermont Public Radio which first reported the incident.
The inspection also found VPCH was not properly documenting its use of restraint and seclusion, but not that restraint or seclusion was being used inappropriately.
The inspection report highlights the difficulty of cases that nurses at VPCH regularly confront. The combination of trying circumstances, low pay and lack of qualified nurses driving turnover and understaffing at VPCH — an issue at the hospital since it was opened last summer.
VPCH CEO Jeff Rothenberg told VPR that an Agency of Human Services working group is expected to deliver a report on state nursing salaries later this summer, and he was optimistic that could lead to higher pay.
