Alaska's only public psychiatric hospital, the Alaska Psychiatric Institute, was observed to have a number of serious problems, according to a new 85-page report made by the state ombudsman's office.

In the report, several incidents are recounted as taking place at API, including rape in a TV room, a riot followed by violence, and other allegations made to the Alaska Office of the Ombudsman displaying harm to patients either at the hands of other patients or by API staff themselves.

The report comes at a time that API faces

According to estimates, the already stretched-thin API would see a nearly 25 percent cut. The facility is also

.

In the report, officials detail events which are well-documented by both testimonies and video surveillance in the highly-monitored facility.

One case from September of 2018 involved a male patient and a female patient and took place in a TV room of the hospital, which is mandated to be in view of the nurses' station. When the one and only nurse manning the station steps out of view, the male patient can be seen raping the female patient, the report says.

That incident was only stopped when another patient entered the TV room and reported what was happening to another nurse. The opportunity left by the lack of monitoring was scrutinized by the report, but so was what happened once the incident had been reported.

"The PNA went to the door of the TV room (without entering the room) and is heard on the video saying 'Stop – we don’t do that here.' She did not approach either patient or identify what was occurring as sexual assault," the report states.

The male patient was then allowed to return to his room and shower, thereby "compromising evidence of the sexual assault." The female patient was left in the room, alone, half-naked and in view of others, for several minutes before the staff talked to her and told her to dress herself.

"The female patient dressed and followed direction to leave the TV room. She came out, walked slowly to the nurses’ counter then wandered alone down the hall. There is no evidence that API staff checked her for injury (physical or psychological) in the minutes after the assault," the report states.

In another incident, adolescent patients in the Chilkat Unit showed "agitation, decompensation, or other behavioral dysfunction," the report says former CEO Ron Hale described it as a “riot.”

Following this riot, staff physically restrained patients, leading to the shattering of one young patient's collarbone. According to the video evidence reviewed by the Ombudsman, the patient screamed “you broke my f*****g collarbone” three times in a row.

The juvenile patient was held against the wall for even longer before being put on a gurney and wheeled into a room, where he was left for more than half an hour with the injury, the report states.

Multiple cases like these were detailed in the 85-page report, including two others from June of 2018 and beyond. "How API responds to allegations of misuse of force by staff is a longstanding issue of concern, based on CMS surveys for the past three years," the report states.

Along with the incidents of concern, 11 separate recommendations were made by the ombudsman, outlining what can be changed to better serve the patients and staff at API.

The recommendations focus on disrupting what the ombudsman calls a "feedback loop between patients and staff which contributes to the incidence of violence and utilization of seclusion and restraint at API."

One recommendation focused on the types of patients admitted to API, such as those without serious mental illness. Their inclusion at the hospital poses risks to themselves, and the report recommends that DHSS place those patients in an "intermediate care facility for intellectual/developmental disabilities (ICF/IDD) or a facility that provides dementia care, and not API."

The thorough reporting concludes with sentiments of hope for API, and optimism for the staff, saying that, despite the detailed cases of abuse or neglect, everyone they spoke with "expressed hope for the hospital’s future."

"Each person interviewed identified a colleague they felt provided good care to patients, or strong support for staff," the report concluded. "Staff do share common goals and values that will help API implement the recommendations made to overcome the systemic issues identified by this investigation."

Whether those recommendations made in the report will actually be followed, or how they will fit into Dunleavy's proposed deep budget cuts to the hospital, remains to be seen.