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The Fear-Sick Ward
In the autumn of 2010 the Children’s Ombudsman in Poland received a letter from the Psychiatric Hospital in Starogard Gdanski. Nurses and care assistants wrote: ‘In our hospital, on ward number 23, head of department Anna M. runs therapy for adolescents. Scenes like from a Nazi camp.
In a vast hall supported by two pillars children dressed in ripped, grey-blue pyjamas that are too short for them stand at attention. A petite woman with cold, severe features and a piercing gaze is strolling along the 24-person row. Arms folded at the back, she is pacing up and down the room. The nursing personnel look on, as if hypnotised by the figure of the mad doctor. Some of the children have wide belts placed on their hips and their wrists are tied up with leather straps. They look as if they were pilloried standing up. Dr Anna is taping out a military beat. Why have the children been stood in a row? The doctor asked them: What are genital warts? They didn’t know. They had to stand at attention by the pillars for 8 hours. The next day two children did not know the names of female [genital – ed.] organs. – You will stand here till the evening – said the doctor. – And remember, if any of you squats or lies down the staff have my permission to strap the culprit to a pillar!’
In the letter the staff go on to describe the forms of punishment meted out by the doctor, such as restricting parental visits, humiliation, name-calling and placing the teenagers in a seclusion unit for many months. – ‘Sister, sister dear! – Laura is calling out to us; she has been locked up in a seclusion room for many months. She can’t tell night from day. She is just like a little ‘animal’, and the doctor wants to show her who’s the stronger one. To get a chance of any human contact Laura will now do anything. She bangs her fist on the grille, shouts, she even asks for an injection of tranquillisers. She reports that she is menstruating even though that’s not true. She would like to see a human face through the grating, even if only for a minute.’
The letter ended with the words: ‘The ward personnel is also guilty. We have ignored many issues up to now – we looked the other way. It’s no excuse that if anyone were to stand up to the head of department they would lose their job. We don’t have the hospital management’s support but we don’t want our children to think that we have contributed to the inhumane treatment of the patients. We have had enough and we call on you to help the children. We will testify against the tormentor, Dr Anna M.’
Barefoot in bitterly cold weather
The hospital in Starogard Gdanski is known as Kocborowo. It is one of the oldest and largest psychiatric hospitals in Poland. The first patients were admitted here in 1895. The red brick buildings were designed to house a thousand patients. Owing to its history (during the Second World War, patients were brutally murdered in Szpegawski Forest) the hospital is often an inspiration for budding writers of Gothic short stories. Ward 23, described in the letter to the Ombudsman, was established in January 2009; Anna M. served as its head consultant from the beginning. Courts from all over Poland send there girls and boys with emotional or psychological disorders, aged between 13 and 18. However, child psychologists point out that adolescents who wind up on such wards are often just people who have been abused by adults, who are oversensitive and who use acting out, suicidal attempts or self-harm as a means of gaining the attention of parents or teachers.
In November 2010, having read the letter, officials from the Children’s Ombudsman’s Bureau together with a regional psychiatry consultant Dr Izabela Lucka arrived at the ward for an inspection. They passed by buildings so large that each could function as a separate hospital. Building number 23 had iron bars in the windows and densely installed CCTV cameras. The inspectors were watchful. They remembered an excerpt from the letter: ‘Children arrive here on court orders and are delivered by parents, legal guardians or social workers. They are frightened teenagers who on first contact want to show that they are plucky, defiant. This is their last such performance. The head consultant will show each one of them who’s in charge.’
In a seclusion unit the officials from the Ombudsman’s Bureau found Cezary, a boy who had already been in restraint for 1871 hours during his stay on the ward. The hospital’s director pleaded ignorance – he had learned about the punishments only recently and was unable to say who was behind them. Some of the staff blamed the head of department for the abuse, but she in turn had lodged a complaint letter in which she described punishments that she said the care assistants meted out without her knowledge. She reported that they would kick, hit, bully and pour cold water on restrained patients. The ward staff defended themselves by saying that such punishments were only employed on the head of department’s orders. According to the nurses, she forced one of the boys to wear soiled briefs on his head for a week and she would throw out barefooted children on the ward’s courtyard at sub-zero temperatures.
In their post-inspection report the Ombudsman’s Bureau officials described many instances of patient abuse, such as bullying, kicking and forcing drug-dependent patients to ‘snort’ lines of sugar. For misbehaviour, children were injected with a saline solution.
A mother of one of the boys told the local paper, Gazeta Kociewska: ‘During one of the activities invented by the head consultant the children were to sing the Rota [a Polish poem and patriotic song – ed.], solo and in chorus. My son refused. He was ashamed because he couldn’t sing. For this he was strapped to a bed. I asked the consultant, how long is this supposed to last? She answered that my son had a choice: either he would sing or he would remain tied up.’ In the same newspaper one of the care assistants anonymously described abuse of a sexual nature: the head consultant ordered patients to describe sexual positions and types of orgasms. Children had to learn how the human sex organs were built. If they failed, they were injected with tranquillisers. Some patients couldn’t take it. There were suicide attempts.
After the report was published, the regional authorities carried out an inspection. Jerzy Karpinski, the regional physician, told [the TV news programme – transl.] Fakty: ‘What was described in the report seemed quite improbable to us, but after a thorough examination we were able to confirm everything and the only course of action was to inform the prosecution service. This is a criminal matter. The patients were subjected to inhumane treatment.’ Professor Katarzyna Popiolek, a psychologist from the University of Social Sciences and Humanities, added: ‘These children ended up in hell. It was indeed a concentration camp and we’ve known since the Second World War what that does to a person.’
The ward personnel were replaced. Dr Anna M., the hospital’s director and some other staff lost their jobs. Due to the gravity of the alleged crimes, the investigation into the abuse of adolescent patients was transferred from the local prosecution office in Starogard Gdanski to the district prosecution service in Gdansk.
The doctor is doing fine
A few years later, in May 2015, I’m researching psychiatric wards for young people. I’ve heard from many police officers that rebellious teens, who struggle to fit in in a modern society, are often sent there by the courts. A psychiatric hospital may be a solution if it offers psychological help and appropriate therapy. But many Polish psychiatric hospitals suffer from shortages of properly qualified specialists and such wards become depositories or even prisons for troubled youth. On an online forum for people with emotional or psychological disorders, I read opinions about ward 23.
‘I am a mother of one of those children’ – writes one person – ‘They strapped my son to a bed, all wet and soaked in urine. He lost 15 kg. He isn’t the same boy now. He was plied with psychotropic drugs. For even a slightest misdemeanour he had to stand at attention in the middle of the corridor all day long. He was beaten and called names. When I telephoned the ward I heard staff shouting at the children but if I complained, they would then take it out on my child. Many parents are still afraid to speak about this. But I will not let this woman harm anybody else. I would like to testify against her.’
‘This psychiatrist is a sadist, the Devil incarnate’ – writes a mother of another boy. – ‘I hope she’s been locked in jail for many years.’ Below is a reply from another user: ‘The doctor is doing just fine. She is working as a psychiatric expert witness at the court and does the suspects’ psychiatric assessments. Who will prosecute one of their own?’
I check the list of expert witnesses in a database of the regional authorities of Pomerania. Indeed, 5 years after the events in Kocborowo, the former head of department Anna M. works as an expert witness in the District Court in Gdansk and as a psychiatrist in a clinic in Malbork.
Eventually, the mattress leaked
Two of the patients left their contact details on the online forum. ‘Is anyone still interested in our case? Any investigators?’ – they ask. I contact them; they respond. They also put me in touch with their friends from ward 23.
Hania describes her stay at the hospital in 2009: “I was 15 when I ended up on the psychiatric ward. Police officers who came for me then didn’t tell me why they were taking me to a hospital. Maybe it was because I missed school a lot and disobeyed the teachers. My most vivid memory is when the head consultant ordered Robert to be tied up, even though he did nothing wrong. He was chubby and this was why she mocked him. He lay there all tied up; he would relieve himself on his bed and eventually the mattress leaked, and the stuff was seeping on to the floor. You wouldn’t see such scenes even in a horror film. Everybody could come up and punch him. Some of the care assistants wanted to win favour with the doctor so they started to lash him with ropes. And he was shaking with fear. On another occasion, they tied up a boy and they spat and threw food at him. The doctor would organise brawls with girls. We were just horsing around when Dr Anna came up to Sara and said: ‘If you are so full of energy why don’t you fight for real?’ She took her to the exercise hall. Later, Sara came out bruised and humiliated while the doctor was laughing at her saying: ‘You can’t even fight.’ The doctor was in her forties, slim and with short black hair. She often wore sunglasses, even indoors. She often used swear words. Other doctors don’t speak to people like that. She called us morons, thieves and such like. Care assistants humiliated us as well, but I think mainly at her beckoning. Though there was this one thing they did of their own accord – they would touch the girls who were tied up. Apparently they see it as a ‘bonus’ attached to a hospital job. One of the girls was raped; I don’t remember whether this was done by a patient or a care assistant, in any event her parents reported it to the prosecution service. Nothing was done. Since they didn’t do anything about the rape, we were certain they wouldn’t do anything about the other punishments either. Once Dr Anna threw out on the courtyard a boy dressed only in his underwear. She ordered him to bark, to pretend he was a dog. If she had used only injections and restraint belts, perhaps no one would have ever found out about any of this. But she delighted in these humiliations. She ordered us to stick post-it notes to our foreheads or our backs with words like ‘Moron’, ‘Thief’, ‘Romeo and Juliet’. Even the nurses themselves were saying that this wasn’t normal. Dr Anna forced the girls and boys to jog in the courtyard in their underwear when it was freezing cold outside, minus 10 degrees Celsius or colder. She watched them turn blue from the cold.
There was this constant tension, awaiting punishment, bars in the windows. Most patients were heavily medicated. They moved around like zombies, they couldn’t tell which year it was or where they were. For disobeying orders, they would give you this drug called haloperidol. It twisted your arms out, gave you muscle spasms. Nurses knew by then we were given too many drugs so sometimes, instead of giving them to us, they would throw them out, but so that the doctor couldn’t see this. I think they were afraid of her too. I don’t know if you have ever been tied up, wet with urine, beaten up, humiliated. Nothing is ‘normal’ afterwards. I think that Dr Anna was sicker than we were. But why hadn’t anybody noticed?’”
Gosh, do you stink!
– “The strangest thing was that the place was packed full with all sorts of patients: people with depression, anorexia, the aggressive and the rebellious ones’ – says Adam, a former patient. – ‘I ended up there at the age of 16. I was a healthy teenager, if a little hyperactive. I was raised by my grandma. I used to rap at the teachers but others did worse things – brawls, setting chairs on fire, and they weren’t sent to a nut house. This has to do with poverty. In those places there are no rich people at all, even if they make trouble more than I did. People cannot understand what we went through there. You stand in one spot all day long, you can’t move even by a centimetre. You don’t know what you’re being punished for; perhaps you made a mistake while singing the Rota or some hymn invented by Dr Anna. Your legs are buckling but you know that if you bend down, you’ll be punished again. You watch the head consultant stroll by with her friend the psychologist. They laugh, share a joke and you can feel your life slowly draining away. A couple of times, on her orders, I was given such strong does of medications that they would floor an elephant. There was this one drug, I don’t recall its name, that made you totally apathetic – you could only sleep, but you had to study. Once I lost my speech. My gran phoned and she couldn’t believe it because I had always been so bright and chatty and suddenly I couldn’t string a sentence together. Nothing was allowed on the ward, there were only prohibitions and drugs that would make you numb. I don’t know why the hospital doesn’t provide the children with shampoo, toilet paper, washing powder. Some of those children didn’t have parents and they had to struggle to get those things every day. Dr Anna, who drove the best car, used to come up to us and say ‘Gosh, do you stink!’ And maybe we did stink a little, but let her try to live even once on 50 zloty a month and worry that she hasn’t got enough money for toiletries.
My gran enquired with the doctors what was wrong with me. She couldn’t understand why I had to stay in such a place if I wasn’t mentally ill. I still don’t get it. And once you’ve been to a mental hospital, you’re marked. As if you had a scar on your mug. Don’t reveal our names because people can be cruel, they laugh at you, they shout after you: ‘lunatic, nutcase, psycho’. When I left the hospital, I was wobbly on my legs. It took a very long time for my body to be clear of those drugs. I couldn’t focus on anything. It was only many months later that my body did return to normal.
I don’t believe the head consultant will ever go to prison for what she did to us. If she is allowed to practise somewhere else, in a different hospital, then I’m sure she will be doing the same thing again. The drugs give her absolute power.”
But there is no indictment yet
Even before 2010 reports of abuse on various wards in Kocborowo started to arrive at the prosecutor’s office in Starogard Gdanski. Prosecutors launched 14 investigations into hospital staff putting patients at risk of loss of life or serious harm to health, into abuse of patients by care assistants and into forcing an underage female patient from ward 23 to have sexual intercourse. All 14 investigations were either dropped or dismissed. In May this year [2015 – ed.], I call the regional prosecution service in Gdansk to enquire about the reasons why the head of department has been acquitted and who was the adjudicating judge. The prosecution office’s spokesperson, Grazyna Wawryniuk, takes me by surprise: – ‘You are asking about the sentence, but there is no indictment yet.’
I can’t believe what I’m hearing: – So the case hasn’t reached the court yet? But it’s already been 5 years since these events took place.
‘We had been waiting for a psychologist’s report about the victims for a long time, and there were more than 40 of them’ – explains the spokesperson. She promises to talk with the prosecutor managing the case because the investigation has indeed taken a long time.
In June 2015, I phone the said prosecutor, Bozena Kapusta, and ask when an indictment will be ready. – ‘The investigation procedures were to be concluded in June’ – she says – ‘but the psychiatrist Anna M. has fallen ill. She presented a sick note signed by the court’s expert witness and was unable to take part in the meeting to review the evidence gathered in her case. And before an indictment is formulated, we are obliged to make all evidence available to the suspect.’
– ‘And what was Dr M.’s illness?’
– ‘This information is confidential. The sick note covered a few weeks in June up to 1 July.’
– ‘The patients I have spoken to and the hospital staff who wrote the letter to the Ombudsman suggested that the head of department was the one who initiated the abuse. Has this been confirmed by your investigation?’
– ‘Yes, the psychiatrist has already heard the charges.’
– ‘Are you aware that since 2005 Anna M. has been a psychiatric expert witness in the same court that is to hear her case now?’
– ‘As far as I know, Anna M. is not on the list of expert witnesses. She is just co-opted to particular hearings by prosecutors.’
– ‘She is on the list of expert witnesses of the Governor of Pomerania, available online. And all this time she has been a practising psychiatrist. Why haven’t you taken any preventive measures, such as suspending her licence to practise in an outpatient clinic in Malbork?’
– ‘There is no need for that. There were no premises on which to do that. As you know, the prosecution witnesses are patients of the [psychiatric – ed.] hospital so you have to treat what they say with a certain dose of caution.’
– ‘They have all sorts of disorders. Anyway, I’m not sure if I’m supposed to discuss this case with you. Please contact our spokesperson’ – she says and concludes the conversation.
After my conversation with prosecutor Kapusta, on 2 July 2015, Chairman of the Regional Court in Gdansk removed Anna M. from the list of expert witnesses. I ask the court why so late – ‘Anna M. heard the first charges last November [2014 – ed.] and already 5 years ago the regional authorities confirmed that punishments had been used.
‘But before we didn’t have this information from the prosecution service’ – explains the spokesman, Tomasz Adamski. ‘Immediately the prosecutor informed us about the allegations, the court’s Chairman removed Anna M. from the list of expert witnesses. We also informed the Regional Medical Chamber in Gdansk about our actions.’
Illness has foiled our plans
Since prosecutor Kapusta doesn’t want to talk to me, I go back to the spokesperson, Grazyna Wawryniuk. She says: ‘The allegations were made against the head consultant and two care assistants, Miroslaw L. and Marcin O. The investigation established that all three of them abused patients physically and psychologically. Anna M. heard these charges in November 2014; in March this year they have been expanded. They concern inflicting inappropriate punishments on the patients. Examples include long-term use of restraint, restricting access to food parcels, ordering patients dressed in pyjamas to go outside barefoot in winter, excessive use of placebo injections and so on. These punishments were administered from January 2009 to December 2010, so for nearly two years. The case has not yet been brought to court because in June we were going to enable the suspects to familiarise themselves with the evidence. Due to her ill health Anna M. could not take part in these proceedings.’
‘This case has dragged on for 5 years. When are you going to submit it to court?’
‘It’s hard to say when an indictment will be ready because on 1 July the law has changed. Our plans were foiled by the doctor’s illness. Changes in the law mean that the prosecutor must successfully serve new instructions to all 40 victims. They have to confirm receipt to us but, of course, they may have changed their place of residence in the meantime.’
Investigation is a sham
‘The prosecutor could have verified Anna M.’s ability to take part in legal proceedings.’ – I am told by a prosecutor acquaintance of mine from another region of Poland. – Very often suspects present sick notes that arise my suspicion, so I verify whether they are able to participate in the proceedings, as they would have to suddenly go blind to be unable to read the evidence gathered during an investigation. To me, this whole investigation is a sham. I suspect that nobody had wanted to really get involved before a journalist rang. And yet abuse and maltreatment by a doctor are one of the most serious crimes. Investigation into a case like this can take a year, but not 5 years! There are only 40 victims, not 4000. Even now, serving new instructions on the victims can take a while but this need not be an obstacle. If the prosecutor’s office doesn’t know the victims’ current addresses then they are not doing their job properly. But I don’t know of any community police officer who wouldn’t get off his backside after a call from a prosecutor asking him to find out the current address of a victim right away so as not to obstruct the proceedings into child abuse. In such cases, with a little goodwill on the side of the prosecution, expert witnesses also usually move things along more quickly. It is unheard of for the prosecution service to wait for the expert witnesses’ reports about the patients for more than a year! The most important thing is that the suspects are prevented from doing more harm. Another problem is the obvious conflict of interest: the prosecutor conducts an investigation in the same district where the suspect serves as a psychiatric expert witness. The third issue is that the prosecution service could have informed the medical chamber already 5 years ago that there is a strong and well-founded suspicion of violence. The psychiatrist could have been suspended from practice immediately. In a case like this the prosecutor should take into account that the former head of department might use her position as a psychiatrist to seek out more victims. Moreover, it is devastating to the victims’ psychological wellbeing when they see that their tormentor still hasn’t been punished years after the events took place.
Released from duties by mutual agreement of the parties!
The inspection by the regional authorities revealed that the head consultant was hired to work on ward 23 without the required recruitment process. I ask the current hospital’s director, Jacek Bielan, what kind of medical experience enabled Anna M. to assume the post of head of department. – ‘I have no idea. I became a director in 2011 and I don’t know anything about the former head of department. Except that she held a grudge against us for disciplinary dismissal’ says Bielan. ‘I met her only once, in the employment tribunal. We signed a settlement and in the end she was released from her duties by mutual agreement of the parties. According to the settlement, disciplinary dismissals of care assistants were also changed into dismissal by mutual agreement.’
‘But why?’ I can’t believe what I’m hearing.
‘I didn’t want to go in and out of courts all the time. My primary duty is to look after the patients’ welfare. On ward 23 the personnel was replaced, there is effective monitoring and now everything works correctly. These were the things I had to focus on.’
‘But as they were not subject to disciplinary dismissals, the suspects could have found jobs in the same profession and could be using similar forms of punishment against other patients.’
‘I leave to the courts the question of punishing the head consultant and the care assistants. For me, this is already in the past. I don’t know if you are aware what the consultant had to deal with here. The ward was new, perhaps she made a blunder and later there were so many problems that she was unable to cope. Of course, God forbid, one should not perpetrate abuse’ – explains director Bielan.
The doctor is sick, but she will see you now
I want to check how ill Dr Anna M. really is and what sickness is causing delays in the investigation. I book a medical appointment with her. First I ring her private number.
‘But you want to make an appointment in Malbork and I receive private patients somewhere else. They screwed everything up on the clinic’s website’ Dr M. sounds irritated on the phone.
‘Doesn’t matter where, as long as you can see me soon.’ I answer and the doctor gives me the number to the Psychiatry Centre in Malbork.
I come to her with a story of severe anxiety arising as a result of maltreatment by a cold mother. Anna M. is a stylish woman. She comes across as extraordinarily self-assured, with commanding hand gestures and purposeful movements. It is clear that she cannot stand objection. Every now and then she glances at her mobile phone. Unfortunately, after a few minutes she has to terminate the appointment because ‘I chose the worst possible day’, but she stresses that she would very much like to help me and that she will work on me together with her psychologist friend. At the clinic’s reception desk I also learn that in June Dr Anna was on leave for only 3 days. Apart from that she saw patients as usual.
I ask the prosecution service’s spokesperson whether she knew that Anna M. was seeing patients at the time she could not take part in court proceedings. I’m told: – ‘Prosecutor Kapusta has instructed me to clarify that initially the sick note was valid up to 21 June but it was later extended by an expert witness to 1 July. We have no knowledge whether during that time Dr M. was seeing patients, because on what basis should we be reviewing or questioning a medical certificate that was signed by an expert witness?’
‘On the basis that Anna M. is a doctor and an expert witness herself, so her and the person who signed the certificates might be colleagues. May I ask the name of the expert witness to check whether they are acquainted with Dr M.?’
‘This is confidential information.’
There is no reason why she should not be practising
‘Which patient’s report did you wait the longest for and how long was the wait?’ – I ask the spokesperson.
‘We waited a long time for all of them. Besides, we waited nearly 2 years for a report about Dr Anna M.’s and the care assistants’ conduct towards the patients. Experts had to establish whether or not their actions remained within the scope of therapeutic procedures.’
‘What instances of patient abuse by the care assistants were confirmed during the investigation?’ I ask.
‘The beatings, kicking, name-calling.’
‘Do these men still work as care assistants?’
‘I presume they do, but I don’t know where.’
On one of the online forums I found this comment left by a patient: ‘Dr Anna M. is insulting and name-calling the patients of the clinic in Malbork. She even uses threats if something is not to her liking. How is it possible that such a person can work as a psychiatrist?’
I ask the spokesperson: – ‘Can the prosecutor be at peace knowing that the psychiatrist and the care assistants who are accused of abusing patients in the course of performing their professional duties continued to work in their profession for the next 5 years?’
She replies: ‘Prosecutor Kapusta could not have interfered in the suspect’s professional life until she had gathered all the evidence. She does not believe there is any reason to suspend Dr M.’s licence to practise as a psychiatrist.’
The prosecutor has not referred the suspect, Anna M., for a psychiatric assessment. In her opinion there are no grounds to do this.
Seeing children suffer gave her pleasure
‘The worst thing was to be tied up to a metal bed frame for days on end’ – tells me Joasia, who was a patient on the ward in 2009. ‘The mattresses were old and soaked in urine. Sometimes, when a kind nurse was on duty, she would bring you a bedpan and so you could relieve yourself. Other times, there was no kind nurse around. You’re staring at one point on the ceiling. You don’t know the time, the month. Your whole body becomes stiff and you don’t know if this is caused by fear or by those drugs. And you could be put in restraints even for 3 weeks for some nonsense. For example, we were not to address the staff as ‘Doctor’, we had to say ‘Miss’. I think that many care assistants enjoyed the consultant’s brutality. They did not have to beat us and put us down on her orders. But people like to let off steam. And that’s easiest done with those who are mentally weak, whom nobody will believe.’
‘We called doctor Anna ‘Hitler’ or ‘Gestapo officer’ – says Marta, who came to ward 23 at the age of 15 suffering from anorexia. – ‘She separated people into those of a better and those of a worse sort. She liked to talk with the psychologist, looked down on the nurses, and considered the care assistants subhuman, not worthy to exchange a word with. She favoured me, but Robert, who was not very articulate and had a slight intellectual disability, was treated like an animal. She selected several patients she considered of the worse sort and gave them so many drugs that she turned them into vegetables. She was most cruel not towards the aggressive ones but towards the weakest. I think that seeing children suffer gave her pleasure. I also remember care assistants Mirek and Marcin, who abused the youngest patients. When the boys were restrained, they would punch and kick them. For me, the worst thing was that many nurses and care assistants knew about this. They talked among themselves that they felt sorry for the children. But nobody did anything about it.’
Dr M.: it was revenge
The former head consultant of ward 23 refused to talk with me. She only noted: ‘This whole affair resulted from an act of revenge. I reported the abuse that the care assistants perpetrated on the ward and they attacked me on many fronts, they instigated this affair and wrote to the Ombudsman, among other things. Leave your telephone number please, I’m not ruling out giving you an interview in the future’ she stated at the end.
The patients’ names have been changed.
I would like to thank staff at the Children’s Ombudsman’s Bureau for their help with this article.
You can contact me through my website: www.justynakopinska.pl