Monday, January 12, 2009

A Knock at the Door: (Part Four of Workplace Psychological Abuse)

Note: If you haven't read the first three parts of this series, I recommend that you read them before reading part four. They are found at: Part One -

Part Two -

Part Three -

Also note that the names used for people in part 4 are pseudonyms.

I left Saint Alphonosus Regional Medical Center in Boise, Idaho at the end of August, 2006 after working there for 30 years in the Respiratory Care Department. Saint Alphonsus is part of the Trinity Health care system, headquartered in Novi, Michigan. I was forced to retire early as a result of being injured on the job by a psychologically abusive co-worker. The bullying aimed at me from the abusive co-worker started abruptly in January of 2004. By the time I left St Alphonsus (often referred to as St Als), 20 months had passed since I was diagnosed with Post Traumatic Stress Disorder (PTSD) as a result of the co-worker's bullying. The PTSD diagnosis was made by Saint Als, as occurring on the job at St Als.

I reported the PTSD injury to management more than two dozen times and never received a response addressing the injury. Neither did I receive any protection from additional injury, nor any offer of treatment for the PTSD. Those reports went to department, human resource, and senior management, as well as to the CEO, the chairperson of the bioethics committee, and even to the vice-president in charge of organizational integrity at the mother company, Trinity Health.

After leaving Saint Alphonsus I did what any responsible citizen and health care professional would do. I reported what happened to me to many of my former co-workers. Since what I experienced represented a public health and safety hazard I was obligated to report it. I had already reported it numerous times to management without having the problem addressed, so now it was time to publicize it as much as possible. The Code of Ethics of the American Association for Respiratory Care, of which I'm a member, states that members are required to: "Refuse to participate in illegal or unethical acts, and refuse to conceal illegal, unethical, or incompetent acts of others." Several times management tried to get me to conceal the unethical and patient-endangering behavior I was facing. They did that by ordering me to lie about the PTSD injury if asked, and by threatening to terminate me if I talked about the psychological abuse with my co-workers in the Respiratory Care Dept.

The reports I sent out were in two forms. About four hundred people received, by e-mail, a 3-4 page condensed version of what I had experienced. Approximately 60 people, including most of the members of the Respiratory Care Dept., received a longer, more detailed report, a copy of the historical document that I started writing in Dec. of 2005. They also received copies of a couple articles on the topic of workplace psychological abuse, and a copy of Noa Davenport's book "Mobbing: Emotional Abuse in the American Workplace."

Management at Saint Alphonsus responded to my reports in a fury. I was preparing for work on Oct. 14 ,2006 when there was a vicious knocking on my front door, immediately followed by a rattling of the door knob. When I hesitantly opened the door I was facing several police officers. They told me they had a report that I had threatened to harm either myself or others. They handcuffed me. I was stunned for several minutes but eventually realized that this was management at Saint Alphonsus retaliating against me for reporting the abusive way I had been treated to the public. Of course the report was false. At no time had I ever threatened to harm anyone.

I was taken into "protective custody" and hustled straight to (would you believe it?) Saint Alphonsus Psychiatric Center! (At that time it was called the "Behavioral Health Center.") The psychiatrist who initiated this process I will call Dr Grizzle. At that time Dr. Grizzle was arguably in one of the most prestigious positions at the psychiatric hospital. He was an employee of senior management, the same people who, in my reports, I accused of behaving in a manner that was abusive and injury-causing toward employees. I stand by those accusations today. There is no evidence that anything has changed in management at Saint Alphonsus to correct this health-endangering problem. I found out later that Dr. Grizzle had been instrumental in keeping the psychiatric hospital open when management had considered closing it. If there were a change in senior management as a result of my reports, it could result in him losing his position and losing a significant portion of his income. Dr. Grizzle's action in having me admitted to the psychiatric hospital was a "punitive psychiatric admission" following the tradition of the former Soviet Union. It was done to depict me as someone with serious psychiatric problems, thereby attempting to discredit my reports of abusive behavior by management at Saint Alphonsus. Dr. Grizzle clearly had a significant financial interest in discrediting my reports.

The usual process is to take the patient first to the emergency department to be evaluated by an emergency physician. Dr. Grizzle conveniently sidestepped that step, probably because I worked in the emergency department for the past thirty years and knew nearly everyone employed there. Dr. Grizzle could not risk having me evaluated by someone who actually knew me, a physician who did not have a financial interest in having me depicted as one with serious mental health problems. The Emergency Dept was part of my regular assignment as a respiratory therapy supervisor. Also the document given the police require them to take the patient to the nearest psychiatric facility. Saint Alphonsus was NOT the nearest facility, but Dr. Grizzle could not risk having me evaluated by an objective psychiatrist, so he altered the document, crossed out that portion, and indicated in writing that I was to be taken to St. Als instead. It's also important to note that Dr. Grizzle initiated this process of involuntary admission apparently without attempting to contact my physician, psychologist, pastor, nor any member of my family, nor anyone who knew me. Neither did he place my name into google and check my writings that can be found on the internet.

The staff at the psychiatric hospital were told by Dr. Grizzle that they were getting a violent psychotic patient. That explained the numerous perplexed stares I received from the staff when I arrived there. There was no evidence I was the person they expected. The handcuffs were too small and had already scrapped some of the skin off my wrist. They were removed as soon as I arrived there, and I sat patiently in a nearly barren room with cheap lightning. I quietly waited. I called my wife who was visiting our daughter and son-in-law. The adult psychiatric examiner from the state department of Health and Welfare, Mr. Green, arrived and evaluated me. A little later he told my wife, daughter, and three employees there that I was not holdable, that I would be released shortly because there was no reason for me to be there. It was Mr. Green's responsibility to prevent a unjustified admission. Later he was overheard telling Dr. Grizzle on the phone, "I have no reason to hold Mr. Nolt." "Hold him anyway!" was Dr . Grizzle's response. After hanging up, three people heard Mr. Green make the comment that he would now have to "get creative" to find a reason to keep Mr. Nolt. (On June 13, 2008 my wife and I met with Mr. Green's supervisors at the Idaho Dept. of Health and Welfare to discuss his actions. They indicated that if the adult examiner comes to a conclusion different from that of the psychiatrist, and then the patient is released and commits some harmful act, the Department of Health and Welfare is liable. They gave us the misleading impression that the examiner usually agrees with the psychiatrist. However I've learned since from those who have worked at the psychiatric hospital that it's not unusual for the examiner to disagree with the psychiatrist, that, and this is an exact quote, "it happens all the time." It seems clear that Mr. Green was pressured by Dr. Grizzle to change his assessment).

The first time Dr. Grizzle and I met was the next day. He spent about 30-40 minutes alone in a room with me. I found out later that Dr. Grizzle was there to conduct an evaluation, but he never made any attempt to do so. Most of the time he spent talking about his own accomplishments, telling me how long he's worked in Boise and how many people he knew. He pointed out that he's evaluated everyone on death row in the state of Idaho. He frequently repeated himself. When he spoke I listened, and when he asked a question I answered it. However when I asked him a question, he refused to answer, and when I spoke, or tried to explain something he would interrupt me and refuse to listen. A couple times he yelled at me: "You're an incredibly naive person!" "You're an incredibly naive person!" He never explained what he meant. Several times he referred to management at St Als as "The Empire." He would abruptly switch from talking about his accomplishments to talking about basketball or some other sport, and then abruptly switch topics again. He bragged about having me locked up by asking me repeatedly who I thought it was that started the process of having me incarcerated. When I said I didn't know, he responded by eagerly saying, "I did! I did!" - as if he expected me to be impressed. He accused me of writing things that were "very threatening," but when I asked him what was threatening in my writings, he refused to answer. He simply said, "you know," and then changed the subject. Although we had never met before, Dr. Grizzle claimed that the PTSD diagnosis I received 22 months before, a diagnoses that had been confirmed by two psychologists, was incorrect. He claimed I was suffering from just "a little grief."

My wife accused Dr. Grizzle of unethical behavior. He denied it, but within two hours had another St Alphonsus affiliated psychiatrist there to conduct an evaluation, a Dr. Ball, who had to leave in the middle of his evaluation and never completed the assessment. Dr Grizzle did not attempt an evaluation of me and Dr. Ball did not complete one, but both wrote reports in my chart as if they had, although Dr. Ball acknowledged in his report that he did not complete an assessment. It took five months and multiple requests for my attorney to get a copy of my chart from St Alphonsus. We were shocked by what the chart contained. The dates of my admission were inaccurate, as was much of the history. In the chart, Dr. Grizzle claimed that I had multiple (9-10) serious psychiatric problems. That was entirely new information to me and my family. I never had any symptoms of most of those diagnoses. But Dr. Grizzle did not tell me nor any member of my family what those diagnoses were, and he never offered me any treatment for them. We first found out five months after the unjustified involuntary admission when we got a copy of the chart.

The reaction of the staff at Saint Alphonsus Psychiatric Hospital to my involuntary admission was revealing. Mr. Green told five people that there was no reason for be to be there, before changing his story under pressure from Dr. Grizzle. If there had been any doubt in his mind, he never would have told a patient's family that the patient would be released in a couple hours. Two nurses told me they didn't know why I was there because, as they put it, "You seem perfectly normal to me." I specifically asked one nurse if he thought I needed to be there and he responded emphatically, "No, you definitely do not need to be here!" One nurse refused to care for me because she did not want to get involved in litigation. Another nurse came and handed me the names of two psychiatrists, telling me that those psychiatrists were NOT affiliated with Saint Alphonsus and if I was required to see a psychiatrist in order to be released, I should see one of them, and NOT see a Saint Alphonsus psychiatrist. An employee at the hospital reported my involuntary admission as an unjustified admission to the Trinity Health Integrity Hot Line. The hot line is supposed to be non-punitive, but she was fired shortly afterwards. One nurse told me that she heard I was locked up because I had sent out over 400 e-mails! Reporting health and safety hazards that jeopardize a community is the responsibility of any conscientious citizen and in the 21st century using e-mail is the simplest, quickest, and cheapest way to fulfill that obligation.

In my medical record Dr. Grizzle made numerous false claims. He claimed that he spoke with me at some length about the significance of my writings. Not true. He simply accused me of writing something that was threatening, but adamantly refused to tell me what it was. Of course he couldn't admit that he had a financial interest in attempting to silence or discredit me. One piece of powerful evidence proving that this admission was an act of retaliation against me by St. Alphonsus, is found in the Global Assessment of Functioning (GAF) score handed me by Drs. Grizzle and Ball. The GAF is a scale that evaluates the current functioning level for a psychiatric patient. Since neither physician evaluated me, the GAF score I was given had to be based on what I wrote. I was given a score of 35-40 by Drs. Grizzle and Ball. Keep in mind that my personal psychologist said that at the lowest, my GAF score was in the 70-75 range, and that would have been app. a year earlier, before I received therapy and medication and when I was still assigned to work with the abusive co-worker in a toxic work environment. A score under 50 is considered disabled. I checked with several professionals, including a PESI Health Care lecturer who was in town to conduct a seminar on PTSD, and was told a person with a GAF of 35-40 is not able to hold a job, get up in the morning, function or interact normally with anyone, and is inevitably institutionalized. The historical document used by the psychiatrists to determine the score given me was written from Dec, 2005 until Aug. 2006, a period of nine months. For Five months of that time (April - August ,2006) I was working full time at one medical center and part-time at another. I was assigned the task of caring for patients on life support in the emergency dept. at one facility and in the intensive care unit at the other, (and was doing the latter less than 12 hours before the police came to my door on Oct. 14). I responded to cardiac and respiratory arrests at both facilities, and to any major trauma patients arriving at one facility. I was the only rrespiratory therapist on duty at one facility between the hours of 11:00 pm and 6: 00 am. (I worked the night shift at both facilities). At both locations I was constantly working in the presence of, and being observed by many other medical professionals including physicians. No questions were ever raised about the quality of care I provided, or about my ability to do my job. During that entire time period I would, three or four times a week, either play full-court basketball with other guys, most of them significantly younger than I, or go on long (45-90 min) runs alone, or with a running group. I interacted normally with family and friends. I often make my own homemade note cards using my photographs and in one month (April, 2006) I constructed 600 of them. I was not disabled by any definition of the word. The GAF scores assigned me by Drs Grizzle and Ball were deliberately falsified by those two Saint Alphonsus and Trinity Health psychiatrists in order to discredit my reports of abusive behavior originating from management at Saint Als. In so doing they were following the wishes and instructions of management at St Als.

I was released after six days and nights. With the exceptions of those two psychiatrists, the rest of the staff were fine. They knew I didn't belong there, but couldn't challenge the physicians without jeopardizing their own employment. I was disappointed at the facility, however. The food was mediocre, but we've come to expect that from medical facilities. A lot of patients responded to the conditions by simply pacing like animals in a cage. There was no music, which I found troublesome since I listen to music nearly every day. There were no exercise facilities available. When I asked what I could do for exercise, someone suggested walking the halls, but immediately I was warned to be careful, because if the staff sees you pacing, they "might think something's wrong with you." I didn't do much walking. Lack of exercise opportunities, especially for those who exercise regularly, undermines a patient's physical and psychological health. Saint Alphonsus and Trinity Health should know better. There was virtually no reading material available. I read nine books while I was there, including a large collection of poetry by Garcia-Lorca who was executed for what he wrote, but those books were all brought in by friends or family.

Visiting times were limited to a couple hours an evening, and a few additional hours on weekends. I got an incredible amount of support from family and friends with more visitors in a couple hours than all the other inmates combined. However that was only available for two hours. The other twenty-two hours of the day had to be spent not listening to music, not reading, not getting any exercise, not communicating and interacting with visitors, since there was very little one could do, but much that one could NOT do because of Saint Alphonsus' pathetic commitment to mental health in Boise. If one was admitted there without psychiatric problems they could certainly develop them by being there.

Shortly after my release I heard, indirectly, that Dr Grizzle lost his position as a result of the way he treated me. The report was that I was the last, or one of the last patients he ever admitted to Saint Alphonsus. If that is true, responsible management should have also taken steps to undo the harm he did, beginning with having the phony medical record he generated declared invalid. Unforutnately that hasn't happened.

People have asked me about the state of my relationship with my former employer, and with those responsible for the bullying and the aftermath. I've made attempts to communicate about this traumatic experience with those who were responsible, and have been partially successful. Some people assume that I have taken legal action against Saint Alphonsus and Trinity Health. For several reasons I have not filed a lawsuit and have no plans too. One of the reasons is my Christian faith and my commitment to peacemaking. The Mennonite Church has traditionally frowned on lawsuits, seeing them as being too vindictive for a Christian to pursue. The Mennonite Confession of Faith under Article 22 entitled Peace, Justice, and Nonresistance" includes the following: "As disciples of Christ we do not prepare for war, or participate in war or military service. The same Spirit that empowered Jesus also empowers us to love enemies, to forgive rather than seek revenge, to practice right relationships, to rely on the community of faith to settle disputes, and to resist evil without violence" (Page 82). I agree with that position, although I believe there are circumstances in which legal action is justified for a Christian, and I also believe that, although frequently misused, litigation, the legal process, and attorneys can be and often are, powerful tools for justice in the world.

Other reasons I have refrained from legal action include advice from books on the topic of psychological abuse in the workplace reporting that taking legal action, and even winning a law suit is not necessarily very satisfactory. Just as important is the reports I've received from individuals who have won lawsuits against Saint Alphonsus and received compensation, but now cannot talk about it because of a gag rule. It's my impression that those who have been silenced by a gag rule envy the freedom I have to speak out. Such gag rules should be illegal since they protect companies from having to deal with the natural consequences of their misbehavior. Gag rules enable a business or corporation in their wrong-doing. That represents a safety hazard to the community. In my situation a gag rule would violate the Code of Ethics of the AARC, and in following it I would be neglecting my obligation to report health and safety hazards that exist in this community. It's my belief that behavior in the workplace at a medical center that injures employees also jeopardizes visitors and patients, especially when, as in my experience at Saint Alphonsus, such behavior is not just permitted, but also participated in by management.

Professionals who I received counseling and advice from the past four years, (other than those employed by St Als), have been appalled and stunned at the malicious behavior directed at me by St. Als management. I've received a considerable amount of encouragement to continue pressing this issue which is another reason why I continue to pursue a course encouraging communication about this serious problem with those at Saint Alphonsus responsible for the bullying. I'm willing to discuss any aspect of this problem with anyone. I have nothing to hide.

One of the most bizarre charges Dr. Grizzle hurled at me was the suggestion in my medical record that my pacifist's beliefs constitute some kind of threat. Perhaps Dr. Grizzle doesn't know the definition of the word "pacifist." If I had mentioned that I was a "militarist," then he might have a legitimate concern since a militarist is someone who might be willing to use violence against others to try to correct an actual or perceived wrong. But a pacifist will not. A pacifist is one who refuses to use violence. The label "pacifist" was not just chosen by me for use in my report of this abusive work sitution at Saint Alphonsus. It's been a part of my life. I've been a member of the Mennonite Church denomination since 1960. I'm a charter member of Hyde Park Mennonite Fellowship in Boise which was founded in 1977. I've had articles published which document my commitment to peace and pacifism since the early 1980s. Some of them are included on this blog. I've been involved in local, regional, and national peacemaking activities for many years. I've been a committed pacifist for many years. However the word "pacifist" is not synonymous with "passive." To be passive about this threat to the health and safety of the community would be irresponsible. I have been, and will continue to be a pacifist in my communication and interaction with others regarding this issue, but I will not be passive. I will not do as ordered by Saint Alphonsus, that is, be quiet about it and pretend it doesn't matter if employees are being mistreated and injured on the job at Saint Alphonsus.

I was released from the psych hospital after six days and nights. Not once was I offered any treatment for the fabricated diagnoses charged to me. I was assigned to a particular "group" but only found out during an informal conversation with a staff person the evening before I was released. I attended two group counseling sessions but they were not in any way relevant to my situation. The inaccurate documentation on my chart claimed that I refused to attend any session. Dr. Grizzle was sick three of the days I was in there and did not stop in to see me, but he still charged me for visits those days as did the psychiatrists who saw me in his place. Later I found out from a former employee that Dr. Grizzle has been doing that for years. One of the psychiatrists who took Dr. Grizzle's place I will call Dr. Rockefellar. Dr. Rockefellar visited me one day. He said he was filling in for Dr. Grizzle and asked me if I needed anything. I said "no." Than he said that the plan was to release me on Friday. That was the extent of our conversation. It lasted less than 20 seconds. Later I received a bill in the mail from Dr. Rockefellar claiming that he had spent fifteen minutes with me and charging me $80. Fifteen minutes is 45 times longer than the actual time spent with me and the $80. charge for 20 seconds work represents a billing rate of $14,400. an hour!

After being released from the hospital I received a letter from Saint Alphonsus promising me forms to complete to report the injury I suffered and to apply for compensation. The forms never arrived. Other people, including medical professionals, have told me that what I experienced at the hands of Saint Alphonsus management and Dr. Grizzle was not really an "involuntary admission," or "protective custody," but rather a "kidnapping," and a "punitive psychatric admission" done to depict me as having serious mental problems in order to discredit my reports, and also done to retaliate against me for reporting health and safety hazards that exist at Saint Alphonsus to the public. I agree.

Leonard Nolt

(Part 5 - coming soon.)

"For there is nothing hidden that will not be disclosed, and nothing concealed that will not be known or brought out into the open." Luke 8:17

Sunday, January 11, 2009

No Purple Hearts from Pentagon for PTSD

An article in the The January 10, 2009 Idaho Statesman announced that the Pentagon had ruled against awarding the Purple Heart medal to military veterans suffering from Post Traumatic Stress Disorder (PTSD) as a direct result of the wars in which they participated. The Purple Heart medal is perhaps the best know and most honored military award. It's reserved for those who have been wounded, or in some cases, even killed in warfare.

Although this decision is a tragic mistake, it is not surprising. The Pentagon has always been more proficient at causing harm than at accepting responsibility for the harm it causes. Some studies have discovered that as many as twenty percent of veterans who participated in conflict suffer from PTSD. Defense Dept. press secretary Geoff Morrell is quoted as saying, " I don't think anybody should assume that that decision is in any way reflective on how seriously we take the problem of PTSD." Actually in spite of Mr. Morrell pleas, that decision does indicate how seriously the Pentagon takes the problem of PTSD. There is no question that PTSD has been around as long as modern warfare and probably longer. In the last century PTSD was identified by other terms such as "shell shock." Medical and scientific proof of it's existence and the harm it can have on soldiers and other victims date from well into the 1900's.

Those who suffer only from PTSD, can still be as seriously injured as someone suffering from a physical injury. PTSD is a psychiatric injury, not an illness. It can be as disabling and life-threatening as any physical injury. The claim, as quoted in the article, that "there is absolutely no way to prove that someone truly is suffering from it or faking it," is a pathetic excuse. If it can be diagnosed, it can be proven.

However there is another reason the Pentagon announcement is not surprising. Although I've never been in the military, I was diagnosed with PTSD in December of 2004. The injury I suffered was the result of having to work with a psychologically abusive co-worker or "bully" for a year. We both worked in the Respiratory Care Department at Saint Alphonsus Regional Medical Center in Boise, Idaho, part of the Trinity Health system headquartered in Novi, Michigan. The bullying I was targeted with went on for another twenty months, after I was diagnosed with PTSD, even though the diagnosis was made by Saint Alphonsus as occurring on the job at Saint Alphonsus! By then I was forced to leave Saint Alphonsus after 30 years employment there, because I was gradually becoming disabled by the chronic abuse.

I reported the PTSD injury to management more than two dozen times including department, human resource and senior management, the CEO, and even to Trinity Health vice-president in charge of organizational integrity. I never once received a response addressing the injury. I was never offered any protection from additional injury nor any treatment for the PTSD injury. So it's really not surprising that the Pentagon does not recognize the seriousness of PTSD. Medical centers still do not recognize PTSD or offer any treatment for PTSD to their employees. Unfortunately it's unlikely the Pentagon will take PTSD seriously as long as there are medical centers in the United States, such as those operated by Trinity Health, which do not take PTSD seriously.

Leonard Nolt

Words from five-year-old, and soon-to-be-six, Zachary

On Friday, while riding in the car, listening to "O Come Let Us Adore Him," on the CD , Zachary said, "I wonder how old God is, since it's already been Christmas."

Yesterday I received the latest issue of Esquire Magazine in the mail which has a picture of the president-elect on the cover. I held the magazine up and asked Zachary if he knew who was on the cover and he replied: "Obronco Obama."

Today we bought him a new pair of size one air Sketchers at Fred Meyer and he responded by saying Thank you, Thank You, Thank You, Thank You, over and over again and then in the car on the way home while holding them in his lap, he said, "I'm a lucky man!"

A couple weeks ago while watching The Sound of Music, at the scene where Maria is arriving at her new job to care for the seven children, and first enters the Captain's mansion to see the large cavernous room, the hallways, and chandelier, Zachary said, "That kinda looks like an art museum and they forgot the art."