The patient attacked Ruby Simon in the linen room.
The 60-year-old nurse was grabbing pajamas for another psych patient at the Michael E. DeBakey Veterans Affairs Medical Center when a 27-year-old veteran burst into the room, ripped off his shirt and tried to strangle her. After 12 years in the VA's mental health ward, Simon knew what to do: She raised her hands to keep the man from being able to tie his shirt around her neck. It bought enough time for another patient to subdue her attacker.
"If I hadn't known how to protect myself, I'd have been dead today," she says from her home.
Four years ago, she found herself in a similar situation. A patient, enraged because he was out of cigarettes, punched her in the face, breaking her glasses and sending her home for six weeks.
Simon didn't want to move out of the psych ward after either incident. She loved her job and cared for her patients. She says administrators forced her and 13 colleagues out of the ward in January after implementing a patient "takedown" class designed to make them fail.
After failing the six-hour course, the nurses -- in their fifties and sixties -- were scattered to other units in what they say is a ploy to hasten their retirement. Simon was sent to the nursing-home ward.
The nurses have complained to the administration and filed a complaint with the EEOC. They say that race played a part in determining who passed the class -- 12 of the failed nurses are black, one is Indian, and one is Asian. But mostly they say that all they want is to be allowed to do the job they've been doing for the past 12 to 28 years.
Located in the Texas Medical Center, the DeBakey facility is the primary health care provider for more than 137,000 veterans in southeast Texas, according to its Web site. DeBakey offers everything from allergy treatment to vocational rehab. The hospital boasts a laundry list of national awards and honors.
Hospital spokeswoman Bobbi Gruner was reluctant to address the nurses' complaints, but she was eager to discuss the facility's massive patient-care load.
Last year, the Houston hospital and its satellite clinics in Lufkin and Beaumont logged more than 700,000 outpatient visits. More than 11,000 patients checked into DeBakey, and 235 into the nursing home. The Mental Health Care Line admitted nearly 1,300 patients and had more than 140,000 outpatient visits.
Staff members are required to abide by the Violent Behavior Prevention Policy, a set of regulations designed to maximize patient and employee safety. A "Code Green," for example, is called when senior staffers observe "actual or impending violent behavior, self-injurious behavior, or property destruction." When a Code Green is called, a team of staff members (including nurses) and security guards physically subdues the patient.
Simon and her colleagues have assisted in Code Greens for years. But when they were told they had to pass a class on how to physically restrain an aggressive patient, they were surprised. Initially, they say, the class was to apply to all staffers, including physicians and their assistants, psychologists and social workers. Ultimately, only the nurses were required to pass the takedown procedure.
The nurses say that the two-day class (totaling six hours of actual participation) included a new takedown tactic where two staff members grab the arms of a person acting as the wild patient while one nurse drops to a knee and forces the patient to the ground. Unlike with a Code Green, they say, the nurse is primarily responsible for restraining the patient.
Mabelline George, another nurse who failed the class, says the nurses didn't receive enough training before they were tested. In her 17 years as a mental health nurse, George says, she's never been injured by a patient. She says she and her colleagues usually have been able to talk down an aggressive patient, rather than having to tackle him.
"Which should be the goal, if you're going to talk about patient safety," she says.
George wants to know why nurses were singled out. "If it's a requirement for the nurses in mental health, it should be a requirement for anyone that works in mental health," she says.
The 57-year-old says she plans to retire in two years.
"I don't intend to work until I'm 100 years old," she says. "I am going to retire. But it's going to be on my timeline, not theirs."
Yvonne Balderas has been a mental health nurse for 23 of her 28 years at DeBakey. Like George, 63-year-old Balderas has never been injured and has never had to take down a person on her own.
After failing the class, she was reassigned to the medicine ward, where she hadn't worked since graduating medical school.
"It's just like I'm starting over," says Balderas, who also had planned to retire in two years. "Maybe they just want some younger people, I don't know. But it seems that they're trying to force us to retire, and I'm not ready to retire."
Gruner, DeBakey's spokesperson, initially said the administration was well aware of the nurses' complaints. But when asked to explain why they were reassigned, she said she didn't know what the nurses were complaining about. The Houston Press offered to provide Gruner a copy of a complaint letter signed by six nurses, but after the letter was e-mailed and faxed to Gruner, she said she never received it. Then she said she could not legally comment anyway, citing the nurses' privacy. Finally, after the Houston Press read her the letter over the phone, she was able to comment.
"It's primarily patient safety, and other employee safety," she said. "That's why we have a Violent Behavior Prevention Policy. We are talking about patients with certain medical, surgical [and] psychiatric conditions that really affect the patients' episodes of violence. And this is not something we take lightly."
Terry Jemison, a spokesperson for the U.S. Department of Veterans Affairs in Washington, D.C., was unable to say whether the procedure was implemented systemwide or was unique to DeBakey. He stated in an e-mail: "After a quick scan of the Houston policy, some of our national mental health managers were laudatory and said such policies typically are in place at all VA sites (or should be) The teams often are trained as a group in safely subduing patients by force as a last [resort]. This is only done when the patient is in imminent danger of harming themself or others and no other intervention is effective."
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Simon was the only nurse interviewed for this story who is going to leave before she had planned to. She hoped to work three more years, but instead will retire in February.
For Simon, it's not the premature retirement so much as the reasoning behind it. She says she's acted on Code Greens before, but the tactics taught in the class were not applicable to those situations. There's just no way a 50- or 60-year-old nurse can subdue a young, well-trained veteran.
"The way they teach you in the classroom, you don't do that," she says. "These veterans can kill you, because they've been trained how to kill."