Last year a mentally ill patient in a medium-security ward at Oregon State
Hospital lay dead in his hospital bed for several hours before anyone
noticed. As a result, the U.S. Department of Justice sent a warning letter
to the state indicating Oregon better shape up or risk getting sued by
the DOJ. In addition, the State Office of Investigations and Training
found the hospital was negligent in its care of the patient, Moises Perez.
This week the hospital’s human resources department formally reprimanded
five employees involved in the case. But reading the details of these
reprimands just leads to more questions. Three of those given letters
of reprimand are nurses. Two were found negligent in making sure staff
followed protocol and in supporting their staff.
One nurse was reprimanded because he failed to provide the required monthly
written reports on the patient for nearly five months. The remaining two
to receive reprimands are aides. One aide was cited for doing nothing
when the patient failed to appear for his afternoon medications. The aide
was supposed to alert a nurse and to record the fact that the patient
didn’t take his medications.
He indicated that he was busy preparing for the evening meal and thus was
unable to check on the patient. The other aide failed to complete required
weekly paperwork on the patient’s status. He asserts that with the
number of patients under his care, he could not always adequately monitor
each patient and had to make decisions based on urgency and patient needs.
I don’t really know what is going on at Oregon State Hospital. Either
the hospital has a lot of incompetent employees, or the conditions are
such that the employees are overworked and simply unable to manage their
jobs efficiently. Perhaps it’s a combination of both. Whatever the
case may be, it seems the patients are the ones who are suffering the
most and who have the least power to do much about it. I hope conditions
improve at the hospital for everyone’s sake.