Behind tall brick walls and secure windows, hundreds of patients at Washington state's largest psychiatric hospital live in conditions that fail U.S. health and safety standards, while overworked nurses and psychiatrists say they are navigating a system that punishes employees who speak out despite critical staffing shortages.
"They don't have enough staff to protect patients, or provide them with the bare minimum of care," said Lisa Bowser, whose mother spent two years at Western State Hospital and suffered dozens of falls and assaults.
"Going there was like going into hell," said Bowser, who has sued the state-run facility. "I honestly thought they would kill her before I could get her out."
U.S. and state regulators for years have found health and safety violations at the 800-bed hospital, ranging from assaults on staff to escapes of dangerous patients, including a man accused of torturing a woman to death. Even after that 2016 escape, a nursing supervisor told The Associated Press that a patient who had been charged with murder and found not guilty by reason of insanity was placed in a less secure ward and the nurse faced retaliation after reporting the danger to non-violent patients.
Despite a shakeup in leadership and vows to correct problems, the hospital continually puts patients at risk, according to a surprise federal inspection last month. Some didn't get oxygen and blood-sugar checks; injuries weren't properly treated; they were held in restraints too long; and the building remained a fire hazard. Some violations were cited in inspections going back to 2015.
After years of chances, the U.S. Centers for Medicare and Medicaid Services last week stripped the hospital of its certification and federal funding, about 20 percent of its budget at $53 million annually.
Gov. Jay Inslee said he wants the state to change how it handles the mentally ill but that it's making inroads.
"We have been on a course correction to turn this ship around and we are continuing on that course of improvement," the Democrat told AP.
'TREATED LIKE AN ANIMAL'
Sharon Struthers was committed to the hospital for depression in 2014 and stayed through 2015, when it failed four federal inspections. During visits, Bowser said she began to see bruising all over her mother's body, which was rarely washed, and found fungus covering her feet.
"They wouldn't bathe her," Bowser said. "She would tell me that another patient hit her. They would put her in a jumpsuit so she couldn't go to the bathroom, and the staff made fun of her for wetting herself. She was treated like an animal."
Bowser said her mother's room was covered with garbage, and she began to suffer falls that broke her arm and hip. Her mother also was sexually assaulted on several occasions, Bowser said, and staffers appeared to condone sexual interactions between patients.
Employees thought a registered sex offender placed on Struthers' ward was safe around older patients because he was a "child molester, not adult rapist," according to an email that licensed mental health counselor Mark Allen sent to hospital officials and that Bowser's lawyer acquired.
Allen said the encounter appeared to be between two consenting adults.
Just because the patient is a registered sex offender "doesn't mean he can't develop and have consensual physical/sexual behaviors, as long as the peer is psychiatrically stable, has the ability to make decisions for herself and is not considered 'vulnerable,'" the email said.
The problem is Struthers was committed to the hospital because she could not take care of herself, said Bowser's attorney, James Beck.
Struthers died at a different facility in 2016. Bowser sued Western State Hospital and the state Department of Social and Health Services, which oversees the facility, claiming abuse and neglect.
"Our position is that the treatment she received at WSH was a cause in the timing of her death," Beck said. "For someone her age, a fractured hip is a death sentence."
The agency declined to comment on Bowser's case or the counselor's email, referring questions to the state attorney general's office, which didn't respond to multiple emails and calls.
CLAIMS OF RETALIATION
Management punishes those who challenge decisions, workers say, putting additional strain on the short-staffed facility.
Nursing supervisor Paul Vilja filed a complaint last December after a man who was found not guilty by reason of insanity in the deaths of multiple people was moved from a secure ward into one with limited security that houses patients committed to the hospital because they cannot care for themselves.
"I said you are endangering my patients and he's a risk for escape," Vilja told the AP.
The health department agreed with his concerns, and the patient was moved. Within a week, Vilja was moved to the medical records department. He was unable to work with patients for six months but was recently told he can move back to the limited-security ward.
Vilja has filed a whistleblower complaint, claiming retaliation for speaking out.
Psychiatrists say they faced similar treatment. Three said they were reprimanded for objecting to management decisions that put patients and staff at risk. Two were fired, and the other was removed from patient care.
Dr. Michael Quayle said he faced a hostile work environment after reporting expired and improperly stored meat where food was prepared for patients. He sued, and a jury awarded him about $550,000 in December 2016. The next month, he asked a judge to order the hospital to stop retaliating against staffers who file complaints.
Dr. Joseph Wainer provided a statement supporting a court order.
"Western State Hospital has suffered and continues to suffer from a systemic culture of retaliation, discrimination and bullying," he told the court.
He also wrote an editorial in a newspaper, saying he saw "people who've been told that their perspective is ignorant, who have been ignored, shamed and intimidated into silence by an authoritarian leadership."
About a week later, Wainer was placed under investigation and the hospital ordered him to leave.
Another staff psychiatrist learned in April 2017 that management planned to discharge his patients. Dr. Jay Jawad objected, saying they weren't ready and could harm themselves or others.
"A haunting example of this came to light in the recent case against Western State Hospital where an unstable patient was released to the community, contrary to clinical wisdom, and later murdered his father with a hatchet," Jawad said.
The hospital started investigating after he reported his concerns and took away his clinical responsibilities.
Jawad and Wainer were later told that the investigations were closed with no findings. They have sued the hospital and the health agency claiming they faced retaliation.
When told about hospital workers' retaliation claims, the governor said "you'll always hear disenchantment" in large facilities.
Health officials declined to comment on the lawsuits, and the state attorney general's office hasn't responded.
DANGERS OF A NURSE SHORTAGE
Bowser said nurses conceded that they couldn't properly care for her mother because they didn't have enough staffers.
Instead of hiring nurses, the hospital hired "nurse educators" who don't see patients, said a hospital worker who didn't want to be named for fear of being fired. The hospital has lost 15 psychiatrists in three years with no new psychiatrists being hired, the worker said.
Selena Bertino, mother of 32-year-old Reid Bertino, a patient at the hospital for years, said the high-security ward is still dangerous because there are not enough workers.
"The unstable patients are supposed to have two staff with them at all times because they can just go off and attack people, but often there's only one staff with them," Bertino said. "Reid was severely beaten when a patient went off while he was eating dinner."
The governor acknowledged that the hospital has staffing problems but said it's started a recruitment system to attract more workers. He declined to comment on how difficult it will be to hire nurses and psychiatrists at a hospital that's not accredited or certified.
The gaps leave nurses to work an exorbitant amount of overtime, which can lead to mistakes and burnout.
Lawmakers have pressed the hospital to create a staffing model that will allow adequate funding for nurses, but the facility keeps asking for overtime funds that are "unaccountable," said state Rep. Laurie Jinkins, a Democrat on the Select Committee on Quality in State Hospitals.
"That's been a huge frustration," Jinkins said.
Health department spokeswoman Kelly Stowe said the agency is working with the governor's office on funding options after the recent inspection cost the hospital federal dollars.
"As for the latest survey, we are still in the midst of reviewing the findings and will continue our work improving quality of care and safety at the hospital," Stowe said.
Sen. Steve O'Ban, a Republican, has said the Legislature should hold a special session to address the crisis, but the governor said that wasn't necessary.
Inslee wants the state to move to a "community-based system" over the next five years that allows some patients to live in smaller facilities, including some state-run programs and private hospitals.