Safety And Suicide At Western State Hospital

Sep 7, 2012

The main entrance of Western State Hospital in Lakewood, Wash.
What happens behind this door -- the main entrance of Western State Hospital in Lakewood, Wash. -- is hard to find out.
Credit John Ryan / KUOW

Editors' Note: This story contains graphic descriptions of suicide. If you or someone you know might be suicidal, visit the National Suicide Prevention Lifeline or call 800.273.8255 (800.273.TALK).

Western State Hospital in Lakewood is the largest psychiatric institution in the Pacific Northwest. Its mission statement says the hospital:

... provides a healing environment free from danger, fear, hurt, injury, coercion, or intimidation for people with psychiatric disabilities. ... Through vigilant attention and effort, WSH ensures a safe haven.

One week in April, Western failed to live up to those words, and the consequences were dire. Attention was less than vigilant, and two patients wound up dead. Part one of this KUOW investigation examined the case of one of those patients. She committed suicide. Now we look at the safety improvements Western has, and hasn't, made since April.

Safe Rooms — And Unsafe Rooms

Western State Hospital nurse Eric Biscocho shows off the features of one of the hospital's brand–new safe rooms.

"They just fixed this like about two, three days ago," he says. "They changed the fixtures of this room. They changed the nightstand. They changed the bed. They made it plastic. Before, it was metal. It's bolted to the floors."

The bed is bolted down to keep patients from turning it upright and hanging themselves from it. A patient did that in 2008.

"We don't want that thing to happen here," Biscocho says.

A safe door handle
A newly installed 'anti-ligature' door handle at Western State Hospital.
Credit John Ryan

Suicide is one of the greatest safety risks at any mental hospital. Hanging is the number one method. In this safe room, anything that a patient could tie a makeshift noose to has been replaced: hinges, door knobs, door–closing mechanisms and more.

"There's nothing for the patients to hurt themselves with," Biscocho says.

The new safe rooms come in the wake of a suicide and a murder at Western State Hospital in April. The unusual, back–to–back deaths led to outside investigations and internal reviews. Western unveiled a flurry of new or sped–up safety initiatives — everything from new hardware to new procedures and training for suicide prevention.

"Any death here, any injury to patients, is a tragedy," says Marylouise Jones, the hospital's director of clinical operations. "I think everybody is committed to making sure that that doesn't happen. When we fall short of that, we can't go back to change the past but, boy, we are going to make every effort to make sure that it doesn't happen again."

All patient rooms are getting safer door handles this summer. But only two rooms on each ward are getting the full–on safety treatment. Most rooms at Western still have door–closing mechanisms and moveable furniture that patients could use to hang themselves from, just like 20–year–old Megan Templeton did in April. The hospital plans to ask the legislature for $2.1 million next year to address remaining safety risks.

"We do make every effort in every patient bedroom to have only safe furniture," says Jones. "We certainly have to prioritize what needs to be done, what is most unsafe, with the resources that we have while we're still asking for money from the legislature."

We can't go back to change the past but, boy, we are going to make every effort to make sure that it doesn't happen again.

Hospital Hazards

Whether for lack of money or other reasons, Western State Hospital has left its patients exposed to hazards that other hospitals addressed years ago.

Hospital doors at Western have been a hazard for at least nine years. A patient hanged himself there in 2003. KIRO–TV reported that he used a bathroom door handle. Western officials did not respond to our requests for details on that death.

In 2010, two patients tried to hang themselves on their doors, and the hospital determined that the door closers were a hanging risk.

At the Seattle VA hospital, a psychiatric patient committed suicide in 2006. Afterward, the veterans' hospital flunked an inspection and was in danger of losing its accreditation. The VA mental ward quickly made top–to–bottom safety upgrades, focused especially on reducing the risk of hangings.

"We have done all kinds of things to get rid of attachment points," says Robert Barnes, the head of mental health services for the VA in Puget Sound.

And those door closure devices that Western is seeking money to replace next year?

"Oh, we got rid of all those," Barnes says. "We do have doors that close automatically, but any area a patient can get into, they do not have that closing mechanism on the door."

Disability Rights Washington investigator Emily Cooper says she sees Western State Hospital taking steps in the right direction. Her group advocates for the mentally ill and other disabled people. The steps may be right, but Cooper adds:

Do changes happen as quickly as we would like them to? No. When it comes to changing systems to make them more safe for people with disabilities, it's sometimes infuriatingly slow because there are lives that hang in the balance in the meantime.

Shame And Secrecy

Across the street from Western State Hospital, most of the gravestones in a large, nondescript graveyard have no names, only numbers. For the better part of a century, thousands of Western State Hospital patients were buried there anonymously. There was such a stigma, such a sense of shame, attached to mental illness that the hospital kept its patients' identities a secret — even after they died.

An anonymous grave near Western State Hospital
One of more than 2,000 anonymous graves at Fort Steilacoom Park, across the street from Western State Hospital.
Credit John Ryan

In 2004, Gov. Gary Locke signed a law that allows the state's mental hospitals to release patient names so their graves won't have to go unmarked. Volunteers have managed to put names on about a third of the 3,200 graves there. But even today, the law only allows the hospitals to name names if the patients have been dead at least 50 years.

Today, information about the inner workings of any hospital is hard to come by. Patients' privacy is carefully guarded by state and federal laws. At psychiatric institutions like Western State Hospital, the privacy measures are even stricter. Cameras aren't even allowed on the grounds at Western.

Other hospitals in Washington have to report their mishaps to the Washington State Department of Health. With long lists of surgical errors and other problems posted on the department's website, you can judge for yourself which hospitals are safe to use. But you won't find anything about Western State or Eastern State Hospital. They are exempt from reporting their mishaps to the state.

"I don't know why we're exempt from that," says Brian Waiblinger, Western State Hospital's medical director. "We already report to our accrediting agency."

"A lot of people who are admitted to Western State Hospital report that they feel invisible once they go through those doors."

That agency, called the Joint Commission, generally doesn't release information on individual hospitals' mishaps. (KUOW filed a public records request with Western State Hospital to get the Joint Commission's investigation.)

"A lot of people who are admitted to Western State Hospital report that they feel invisible once they go through those doors," says Emily Cooper with Disability Rights Washington. Cooper says mental hospital patients would probably get better treatment if they were more visible. On the other hand, she says,

Folks in there, they have to go back out into their life and back to work. They don't want to get the scarlet "MH" on their chest. They want to be able to go back into their lives as seamlessly as possible because they fear being treated differently the rest of their lives or their families being treated differently.

Privacy laws let Western State Hospital avoid scrutiny. But they also put the hospital at a disadvantage. If a patient's family complains about conditions there, Western can't publicly defend itself, except in the most general terms.

Before Megan Templeton was committed to Western State Hospital for her own safety, she spent a couple weeks at Southwest Medical Center in Vancouver. Mike Kuhns says the Vancouver hospital did a great job of keeping his suicidal stepdaughter safe from herself.

"A lot of times, she was under 24–hour supervision with somebody sitting in a chair, watching her even sleep," Kuhns says, "just so they could keep her safe."

Megan Templeton sitting outside
Megan Templeton on an outing away from Western State Hospital for her 20th birthday. She died four days later.
Credit Suzanne Kuhns

That same kind of constant observation — a staffer within arm's reach at all times — was also the policy for high–risk patients at Western State Hospital. But that policy wasn't followed with Megan Templeton. She was left alone for nearly an hour before she hanged herself.

Western State Hospital had 167 staff vacancies the week that Templeton died. That's about a tenth of all jobs at the hospital. Investigators with the Joint Commission concluded that understaffing played a key role in her death and the death that same week of another patient, Paul Montefusco.

Emily Cooper says much of the problem at Western comes down to money. "It costs a lot of money to have someone watch someone that might be perceived as a risk to themselves," she says. "But at the end of the day, the cost of that, I think, is worth that person's life."

In the months since the two patients died, Western State Hospital has filled almost all of its vacancies. Officials say it hasn't been easy, since they can't match the salaries that military and private hospitals in the region pay.