Employees raise concerns over incidents in Pueblo mental health hospital unit

Current and former employees of the Colorado Mental Health Hospital in Pueblo (CMHHIP) say there's a pattern of dangerous incidents between patients and staff in the Adolescent Behavioral Treatment Unit (ABTU).

News5Investigates first learned of a possible riot on the ABTU in mid-February after staff members reached out saying they were concerned about the safety of both patients and staff.

Hospital police case logs show there were three patient-to-staff assaults within a month on the unit: Feb. 17, March 1, and March 16. Assaults are common in the hospital, but employees told News5Investigates that these incidents should be a wake-up call for hospital management.

Brandon Bernal left his job as a clinical safety specialist at the hospital in October. Before his departure, Bernal said he was placed on administrative leave after what he called an "attempted riot" in the adolescent unit.

"I felt betrayed by the hospital, I felt like nobody had my back," Bernal said, who added his administrative leave lasted about four and half months. Shortly after his resignation, Bernal learned he was facing criminal charges that would later be dropped: Misdemeanor assault and two counts of misdemeanor child abuse.

After learning about the recent incidents, Bernal said he felt angry.

"I tried to tell 'em what was going on and it was pretty much like I got blew (sic) off and discarded," Bernal said. "They've proven time and time again that they can't handle these patients, not with the policies and procedures that they have," Bernal said.

Six current and former employees have spoken with News5Investigates on the condition of anonymity about the incidents.

Days before a Feb. 17 riot, employees say a shank was found on the unit. Employees say they believe patients were planning on using the shank during the incident. They also said that during the riot, patients stormed the nursing station on the unit.

Employees tell News5Investigates that during a March 1 incident on the unit, six employees went to the hospital with injuries of varying degrees, including a fractured hip.

News5Investigates reached out to the Colorado Department of Human Services (DHS) about the incidents and they sent the following statement. After following up to ask for an on-camera interview, CDHS said it couldn't grant an on-camera interview due to HIPAA and employee confidentiality.

STATEMENT FROM COLORADO DEPARTMENT OF HUMAN SERVICES

As far as the incidents on the Adolescent Behavioral Treatment Unit, we treat very acute patients, and it is important to remember that CMHHIP is a psychiatric hospital that serves patients with mental health and psychiatric needs. Patients are referred for treatment at the hospital either due to having criminal charges and as a result of a mental health condition are not able to participate in their own defense, or as a result of a mental condition are a danger to themselves or others or are gravely disabled. Sometimes there are situations that require emergency physical response and/or restraint. We as a hospital are very fortunate that we have an integrated law enforcement entity that works in collaboration and side by side with staff to ensure the safety of patients and staff.


As a result of serving this population, sometimes there are situations that escalate or are not ideal. When these incidents do occur, we come together as a hospital to ensure both the patients and staff are safe, provide training and support, conduct quality analysis, and if needed follow-up investigations. After an incident in which some staff were minorly injured, CMHHIP deployed additional staff to cover and support the staff that were involved in the incident. They also implemented additional actions to address any concerns identified by hospital leadership and staff to further ensure the quality of patient treatment, safety, and safety of staff.

CMHHIP staff told News5Investigates that moving forward, it will deploy staff with additional expertise and plans to provide coverage for staff so they could receive extensive training to provide them with additional techniques to mitigate these types of incidents, should they occur in the future. Additionally, CMHHIP has made environmental modifications to the unit with additional modifications underway.

These environmental modifications include:

• Adding tables and additional sitting areas to the day hall to foster group activities, increase positive interactions between staff and patients, and provide a more communal environment for patients to interact.
• Relocating the medication window to a different location to help reduce the general congregation around the doors to the nursing station.
• Improving lighting in the day halls and new windows in the nurse's station.
• Replacing the doors to the nurse’s station to provide an added level of safety and security to medications and unauthorized areas.

One employee told News5, "It doesn't make it safer, it makes it more dangerous. Staff got hit with those tables, the patients jump on those tables, the patients use those tables to jump back and forth and dodge staff members, that's not safe to us."
News5Investigates sent questions to CDHS asking for clarification on the statement as well as why the hospital was declining an interview.

1. Why is the hospital declining an interview for the ABTU incidents?
   
   1. Response: Since we can’t comment on staff injuries (due to HIPAA) or incidents at the hospital (due to HIPAA and C.R.S. 25-3-109), we wouldn’t be able to provide specifics for most of the questions you asked.
2. You said staff had minor injuries - I've been told 6 employees went to the hospital during the March 1st incident and at least one of them hasn’t returned to work because of a broken hip, is that a minor injury?
   
   1. Response: We can’t comment on specific injuries staff may have received, as that is part of their medical record, and disclosing that without their consent would violate HIPAA. However, it is hospital policy to encourage all staff involved in incidents to get checked out by medical professionals, even when they report their injuries are minor, to ensure they are safe and healthy out of an abundance of caution.
3. How many staff were added after that incident? Was hospital police put on the unit?
   
   1. Response: The Department of Public Safety at CMHHIP has Police Officers, Correctional Officers, and Security Guards. Correctional Officers have always been stationed on ABTU, even prior to this incident, as they manage the building security. In this case, Police Officers also responded to the unit during the incident to ensure both patients and staff were safe. Once the situation was de-escalated, one additional officer remained on the unit overnight to provide additional safety support. Additional support staff were deployed the night of the incident, but the permanent staffing numbers on the unit haven’t changed.
4. I’m told police were previously on all units at the hospital but that changed in 2021, is that true? If so, is the hospital reexamining that policy?
   
   1. Response: Police Officers have never been stationed on patient units. While they do conduct walk-through visits on occasion, they do not engage in patient management unless a situation requires the hospital to call for their assistance. Correctional Officers conduct patient clinical transports, and the management of the high-security buildings (including ABTU). Correctional Officers are stationed on high-security units, which includes ABTU, to manage the facility security. Clinical Safety Specialists are routinely stationed on ABTU and in the Hawkins building (adult population). They are also stationed on other units as needed.
5. On March 1, Jill Marshall sent an email about “possible negative media coverage” related to an incident on the ABTU what was that in reference to?
   
   1. Response: The hospital had received several media and CORA requests related to the ABTU incident, and we wanted to prepare staff for negative media coverage so they weren’t surprised or hurt by the potential coverage.
6. Can you explain the process for adolescents being admitted into the hospital? Is it similar to adult patients?
   
   1. Response: It is similar to adult patients – the adolescents on the ABTU unit are admitted because the issue of competency has been raised by a criminal court and they are placed at CMHHIP for competency restoration treatment. In some cases, we are able to admit civilly committed adolescents as well.