Health care workers holding purple and white protest signs that say things like "United For Our Patients"

Cascade Behavioral Health Staff Strike Against Unsafe Working Conditions Continues

by Alexa Peters

Content Warning: This article contains brief mention of suicide.

On the evening of Aug. 1, Eiob Teklie, a mental health technician at Cascade Behavioral Health (Cascade) in Tukwila watched as an unstable male patient stole an employee badge and ran with free rein throughout the multi-wing psychiatric facility, verbally and physically assaulting employees and tormenting patients suffering from acute mental illness. 

“This patient in particular was very inappropriate toward other patients, toward other staff members in the unit. He targets females in particular, he makes inappropriate sexual comments. He touched the female staff, female patients,” said Teklie in an interview with the Emerald. Teklie witnessed the chaos on Aug. 1 and added, “We’re faced with these patients almost every day, but this one is different to a point we all feared for our safety. He was very combative.”

The incident, according to Teklie and other members of Cascade staff, is just one example of the level of workplace danger they’re subjected to daily at the facility — conditions they say they’ve repeatedly complained to management about and that have only gotten worse during the COVID-19 pandemic.

“It has been a long-time problem that we have been asking for a safe workplace, for a workplace free of violence,” said Biniam Berhe, a registered nurse at Cascade. “We have been asking in letters [and] orally to the management to give us a safe workplace.”

On Aug. 6, a few days after the incident, several Cascade employees, many of whom are immigrants, abruptly walked out of work on a safety strike without union backing. On Aug. 8, after determining their safety strike was within legal bounds, SEIU Healthcare 1199NW, which represents 26,000 nurses, health care employees, and mental health workers in hospitals, agencies, and clinics statewide, joined the demonstration. It has continued into September.

Health care workers stand and sit posing for a picture holding purple and white protest signs that say things like, "Safe Staffing Saves Lives"
Cascade Behavioral Health Strikers (Photo: SEIU 1199NW)

“People are getting hurt every single day. [They have] no security, you know, and a lot of their workers are women, right? Anyone could walk through. It’s terrible,” Jane Hopkins, executive vice president for SEIU Healthcare 1199NW, told the Emerald.

Previously Highline Medical Center, Cascade Behavioral Health was purchased by Tennessee-headquartered Acadia Healthcare in 2014, at which point security staff were eliminated and the facility became a majority involuntary facility, servicing mostly patients convicted of violent crimes. 

During the incident on Aug. 1, staff members called emergency services three times, but Tukwila Police never arrived on the scene. 

“We called Tukwila police, 911, three times within that period of time. All those times they say, ‘sorry we cannot come to the building,’” said Teklie. A new law, House Bill 1310, limits use of force and has been interpreted by some departments as preventing police from assisting in mental health situations.

To make matters worse, several Cascade employees have reported to SEIU 1099NW that they have not been adequately trained in workplace violence prevention.

“How would anyone expect a man like me or my colleagues with no appropriate training [to] take a patient down, completely putting ourselves in danger?” Teklie added.

For several hours, staff attempted to detain the patient, an ex-wrestler. Eventually, they cornered the man in the nursing station, fending off his punches and kicks with a mattress. In that time, 11 health care workers were injured, including one nurse who was rushed by paramedics to the emergency room. The nurse has been recovering at home and is receiving outpatient treatment for his injuries. 

“[This nurse] was gasping for air,” said Teklie. “I thought he might be on a wheelchair for a very long time because he [couldn’t] feel his toes at all. He couldn’t move his legs at all.”

At one point, the patient stole an employee badge and took the elevator to other units in the hospital, where he turned his aggression on more patients.

“He went to 2 West. Those patients in particular [are] delusional. Then from 2 West he ended up going to another unit … with highly suicidal patients. Small things would trigger them — the next thing you know they’re in the corner of their room thinking how to kill themselves,” said Teklie. “So this kid came into that unit and the next thing you know, everybody freaked out.”

Along with the safety issues that arise from the lack of security and insufficient workplace violence training, SEIU 1099NW says they have filed complaints with the Washington State Department of Health over Cascade’s lack of COVID precautions and PPE, which staff members say may have resulted in some patients and employees becoming infected with COVID-19.

“We are mental health nurses, [bringing] masks from home and [not] provided [with] PPE like employees are supposed to be given. Even the [masks] we bring from home we were told openly not to put on,” said Berhe.

A man with sunglasses stands at a podium and speaks into a microphone. Someone is holding a sign behind him that says "Safe Staffing Saves Lives".
State Rep. David Hackney speaks at the Sept. 2 rally. (Photo: SEIU 1199NW)

In an Aug. 13 statement from Cascade Behavioral Health, the hospital declared the allegations around insufficient COVID precautions to be false.

“We want to stress that we strictly follow all CDC guidance. Since the beginning of the pandemic, we have followed rigorous safety, hygiene and cleaning protocols. We have ample personal protective equipment (PPE) and our common areas are cleaned thoroughly throughout the day by staff and each night by our cleaning staff,” the hospital stated.

Also on Aug. 13, Cascade workers met with U.S. Labor Sec. Marty Walsh via Zoom. In their press release, SEUI 1199NW shared statements from Cascade staff who spoke on the call:

“I was injured in the incident that happened August 1, which forced us to strike for our safety. I have been traumatized,” said Sara Moallin, a registered nurse and member of the SEIU Healthcare 1199NW bargaining team at Cascade. “I feel like my coworkers and I have been abandoned. Cascade isn’t [a] safe place to work anymore because management has failed to create a safe work environment, and because law enforcement refuses to come to the hospital when we call for their help.”

“Yes, we can get jobs elsewhere, but any other human being could walk into that building and face that same danger that my friends and I faced, and we are standing up so that this won’t happen ever again,” said Eiob Teklie, a Mental Health Tech at Cascade. “Cascade and Acadia must stop putting profits over patients. We live in a land of law where everyone’s rights and safety are protected, but I don’t think this company is living by the law when they put money before their employees, and before their patients.”

The union also states in the press release that “… Cascade parent company Acadia Healthcare has fostered an abnormally unsafe work environment, with severe understaffing, decrepit facilities, a shocking lack of COVID-19 protections, and escalating, unchecked workplace violence.” Acadia Healthcare’s website boasts over 20,000 employees in 229 facilities across the U.S., including six in Washington State.

What’s more, Cascade employees say they are also striking for safety because the pandemic has further agitated patients, making workplace violence more common, and recent data from health care institutions throughout the world supports Cascade employee’s claims. 

In one recent poll by the British Medical Association, 51% of doctors surveyed said they had witnessed violence or abuse against other staff. The number rose to 67% for doctors working in general practice during the pandemic. Likewise, Pamela Popp, a Denver-based executive vice president and chief risk officer of GB Healthcare, recently told Business Insurance that they’re seeing an increase in violence “across all health care settings” as a result of patients being more anxious and agitated due to the pandemic. 

As for creating a safer environment at Cascade, the picket line’s demands are simple, SEIU’s Hopkins says. Employees want security staff to be hired and improving staffing levels, as measures to address the unsafe working conditions. Hopkins also mentioned their desire for more training on de-escalation and for Cascade to return all workers to their positions at the end of the strike without taking any action against their health care licenses. 

According to Hopkins, Cascade management has responded with a proposed $1,500 contract signing bonus that would require workers to commit to staying at Cascade for three years — or be forced to pay back the entire amount — and at least 16 striking workers from Cascade have been terminated. SEIU 1099NW has filed unfair labor practice charges with the National Labor Relations Board for each of these terminations, which they believe to be illegal retaliation for a lawful safety strike. 

As of September, picketers entered their second month of daily protest outside the Tukwila hospital. At a rally on Sept. 2, safety strikers were joined by Rep. David Hackney (11th LD) and Tukwila City Council Member Cynthia Delostrinos Johnson, as well as other labor and community leaders.

Speaking to the strikers and their supporters, Hackney noted the diverse nature of the crowd and said it’s particularly important to fight for immigrants and People of Color. He praised strikers for taking a stand.

“The number one obligation of a hospital — and of State — is to make sure both the patients and the employees are safe,” Hackney said. “And when you’re not safe, you have to stand up and do something about it. … You can not ever bargain away your safety and the safety of your patients.” 

Hackney said he didn’t fully understand the issues at hand until attending the rally and promised to take what he’s learned back to Olympia and encourage colleagues to sign onto a letter of support for the strikers. He said he’s confident the workers will prevail.

“Everyone deserves the dignity of working in a safe workplace,” Hackney said.

Alexa Peters is a freelance journalist and copywriter living in the Seattle area. Her work has appeared in The Seattle Times, The Washington Post, Leafly, Downbeat Magazine, Healthline, and more. Her Twitter is @ItsAllWriteByMe and her Instagram is @AlexaPetersWrites.

📸 Featured Image: Cascade Behavioral Health strikers (Photo: SEIU Healthcare 1199NW)

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