Brown Paper Bag Test in a Psychiatric Hospital?


A racist threat of violence should be met with unequivocal punishment. We must stop that nonsense cold.

But here’s a hypothetical: What if the threat comes from a patient at a psychiatric hospital threatening to beat up black staff members? Then what? Should the hospital accommodate him with only white staffers? Or does the hospital have a duty to confront racism, even if it is based on a delusion?

Actually, that’s not a hypothetical. The state Supreme Court earlier this month heard a bizarre employment discrimination case out of Western State Hospital. It’s one of the most provocative I’ve seen in awhile.

Here are the facts. In April 2011, a nurse named Patricia Blackburn clocked into a Saturday night shift on the hospital’s ward for criminally committed patients and found a note from her supervisor.

Send staff to ward F8, it said. But don’t send anyone who is black.

“Did you just say I had to send a white person to F8?” Blackburn asked her supervisor, incredulous.

No white staff members were available. So her team held an impromptu color test, pulling up their shirt sleeves to compare skin hues. The staff with the whitest arm went.


More facts: The patient in question, identified as M.P., had been at the hospital seven years, accumulating an appalling record of assaults. He is 6 feet 4 inches tall, 230 pounds, diagnosed with psychosis. He was at Western State after being found not guilty by reason of insanity for assault.

That Saturday night, M.P. had threatened to beat up any “n——” who came to treat him, but said an “alien” was fine. A psychiatric hospital is a strange place.

The “whitest arm” contest so irritated Blackburn and her colleagues that they sued for workplace discrimination. At a trial last year in Pierce County, the hospital’s former CEO, Ron Adler, defended the hospital’s unwritten practice of racial staffing in emergency situations.

“The hospital doesn’t perform staffing by racial discrimination or by race,” he said. “We perform staffing to meet the needs of the patient, the needs of staff based on safety issues.”

“And sometimes that includes race?” asked Blackburn’s attorney, Jesse Wing. “Yes,” said Adler.

Blackburn, who is white, and her colleagues, who are mostly not, lost when Pierce County Superior Court Judge Kitty-Ann van Doorninck ruled they hadn’t lost pay or their jobs.

Although this policy isn’t written down anywhere, testimony at that trial suggests it happens fairly often. Black staffers described being routinely called the “N word” by patients, being swapped out for white colleagues and complaining to supervisors about it.

In a statement, the state Department of Social and Health Services said it will “do what was necessary to keep staff and patients safe.” So the policy stands.

To be fair, the hospital has good reason to be concerned about safety. Assaults happen daily there. An Associated Press story counted 41,301 days of work lost due to injury in a four-year period.

And imagine the headline if a black staffer was crippled by a patient who’d threatened race-based violence.

But Wing, the attorney for nine hospital staff members who sued, argues that making staffing decisions based on patients’ racial animus acknowledges their delusions. “And if patients are manipulating the staff, this feeds into the manipulation. It allows the patients to control who is treating them,” Wing said.

The hospital is a hospital, not an asylum, and the patients are supposed to be released to a society that doesn’t tolerate racist threats. Western State’s own policies allow for medication, isolation or restraints when patients threaten violence.

An expert hired by Wing’s team, Dr. Jeffrey Geller, the medical director at a Massachusetts state psychiatric hospital, analogized M.P.’s racist staffing demand to a patient claiming to be King George III and requiring all to stand up when he enters.

“He walks into the room and everybody stands up. Now we have just agreed with the patient that he’s King George III,” Geller said during the trial. “We’ve done nothing to assist him to understand, in fact, that he’s not King George III, and when he says he’s King George III, we’re not going to respond as if he is.”

The Supreme Court has been handed this swamp of racial politics. Wing cited Plessy v. Ferguson — the appalling “separate but equal” U.S. Supreme Court case from 1896 — in arguing against Western State’s policy.

Whichever way the court rules, it likely will set a precedent. If I had a vote, I’d agree with Geller’s King George III argument and tell Western State to find a different way to protect staff.

Dennis Fant was on shift that Saturday night on ward F8. He’s a 60-year-old black man who went to work at Western State after 22 years in the military. At trial, he said the racial-staffing policy recalled his childhood during forced busing, when his school bus was pelted with rocks as it went through a white neighborhood.

“I felt as though Western State Hospital had betrayed me and betrayed my team,” said Fant. “I felt somewhat violated.”


Reading this I knew I would share it with not just my students as a “What would you do?”, but also with my peers. I found myself getting pissed off and disgusted with how the situation was handled. Words like “lawsuit”, “humiliation”, and “unethical” tumbled through my brain, along with the horrible practice of the “brown paper bag test” from the 1900s. For those who are unfamiliar with the phrase or that haven’t heard Viola Davis or Jesse Williams powerful speech- the gist of the brown paper bag test works as follows. If your skin is lighter than a paper bag, you’re acceptable. If your skin is darker than a brown paper bag, you’re unacceptable. I agree with Gellar’s King George III argument. There needs to be a different way. How would you have handled such a patient request?


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5 Responses to Brown Paper Bag Test in a Psychiatric Hospital?

  1. King George III was, of course, prone to psychosis, yet harmless, I believe. I don’t see the parallel with putting staff in danger by provoking a potentially lethal racist attack


  2. My field is certainly NOT your field, nor do I suggest that any opinion I have in this matter should carry any weight. Now that my disclaimer is taken car of… I have worked with juvenile males removed from the home because of their behaviors. It was always a challenge (once safety issues were resolved) to determine which “battles” should be tackled immediately and which should be deferred. In my work as a minister, the same questions arise, although they are seldom accompanied by physical threats.

    I think the likelihood of physical violence makes the “King George” analogy unconvincing. The safety issues of the patient (primary) and the staff (secondary, but still very important) would seem to be the main consideration.

    That and $5.00 might get you a cup of coffee. Sometimes there is just NO good answer.


    • msw blog says:

      You sound like one of my students with the disclaimer :). We Americans are so PC. Thank you for your comment. I raise these “What Would You Do?” questions as there are plenty of grey areas in this profession and I want my students to think outside of academia. I also find that it is good for us all to think analytical and ethically; and to see how much of one’s personal self is involved in the decision making process. Thank you for reading.

      Liked by 1 person

  3. Pingback: Brown Paper Bag Conclusion…. | Real Life of an MSW

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