Last month, St. Brendan's Hospital came under intense fire after two different women were reportedly assaulted by patients in its community-based rehabilitation programme. Although the hospital tried to portray the incidents as unfortunate anomalies, many critics, including St. Brendan's staff, have characterised the attacks as just the tip of the iceberg.

But if that is the case, what exactly lies beneath the water line? On the eve of Mental Health Week, which begins today, The Royal Gazette spoke to a current hospital employee who provided detailed information on everything from "urine-soaked chairs'' and "rusting, rotted'' beds to three suspect patient deaths and one serious injury in the last four years.

"I am a toothless dog on the block,'' the employee told The Gazette , "but there are members of the Bermuda community who do have the power to bring about change. I hope someone (who reads this) picks up the baton and fights for the disenfranchised of our society.'' *** On February 12, 1994, a 30-year-old German national named Thomas Hofer was admitted to St. Brendan's Hospital after causing a public disturbance in the Bank of Butterfield on Front Street. Three days later, the man was transferred to the intensive care unit of King Edward VII Memorial Hospital with a fractured neck.

Although an investigation was immediately launched by St. Brendan's into the cause of his injuries, few people know for certain what actually happened to Mr. Hofer, who is now languishing in a hospital near Munich. To this day, no formal conclusion on the incident has been offered to the public.

About a month after Mr. Hofer was paralysed, a young Englishman named Colin Jones admitted himself to St. Brendan's in an apparent attempt to deal with his depression and possibly suicidal tendencies.

Questions about St. Brendan's Less than 24 hours later, he was dead, the motorbike he was riding having slammed into a wall at the bottom of Collectors Hill.

Again the hospital, which was then under the directorship of Mr. Hume Martin, launched an inquiry. Again the results of the inquiry were kept under wraps.

The cases of Mr. Hofer and Mr. Jones were two of the more high-profile incidents involving patient deaths or injuries at St. Brendan's, but they were by no means the only ones.

In fact, a hospital source told The Royal Gazette recently, those two incidents simply scratch the surface at a facility that has had to face at least three suspect patient deaths since 1991, a community-based care programme that has resulted in two alleged attacks on different women and grumblings by employees about hazards and morale.

Hall and Associates lawyer Mr. Michael Scott also confirmed last week that St.

Brendan's could be facing a major lawsuit as a result of the Hofer injury.

"It (the hospital) is a snapshot of across-the-board incompetence and poor clinical practice,'' the St. Brendan's employee, who requested anonymity, told The Gazette . "It's a general lax attitude they've taken.'' As the driving forces behind the Island's only psychiatric facility, St.

Brendan's officials do as a matter of course have the admittedly daunting task of trying to care for a wide range of patient types on relatively limited resources.

In 1991-92, for example, the team under Mr. Martin was evidently hard-pressed to keep within that year's operating budget of just over $27.5 million, ultimately posting a net income loss for the hospital of $70,265.

Of those millions, however, almost three quarters (some $20.3 million) went to covering doctors' and nurses' salaries, administrative services and employee benefits, while only a fraction (slightly less than $7.3 million) was actually applied to such basic operating expenses as general supplies and services, medical supplies and hospital repairs and maintenance.

Consequently, the source and others have charged, St. Brendan's has become a hotbed of outdated and often Third World conditions.

"Certain areas of the hospital have very questionable furnishings,'' the hospital employee said.

" On the geriatric area, there are old urine-soaked chairs and mattresses, beds are rusting and rotted. The same applies to the other `old' areas in St.

Brendan's. This type of environment is wholly untherapeutic and patients can very easily give up hope of complete recovery due to drab, depressing surroundings.'' The employee also cited "incompetent repairs'' by "ill-equipped personnel'' and a fire alarm system that regularly sends out false signals.

Said the staffer of the latter: "It costs $200 every time the fire department has to respond to an alarm. It is very expensive yet nothing has been done to address this problem.'' Such alleged laxity can take on tragic dimensions when it enters the realm of actual patient care, the hospital source charged.

"I know personally of two (epileptic) clients not given anti-convulsants...who consequently lapsed into concurrent seizures and required life-saving intervention. Omission of insulin or anti-hypoglycaemics to diabetic patients have also resulted in crises.'' The employee blamed such incidents on poorly trained and unreasonably overburdened nurses' aides, saying: ...The hospital's (recent) assertion that nurses' aides do not administer medication is true of mentally ill patients but not the mentally handicapped.'' Even more serious, the staffer told The Gazette , was the case of Ms Angela Swan, a young Bermudian teacher who was admitted to St. Brendan's in a "disturbed'' state in May of 1991.

According to the source, Ms Swan was given no physical examination at the time of her admission "to eliminate organic problems'' and consequently slipped into a hypothermic state four days later.

After transfer to King Edward VII Hospital and then the United States, "she was diagnosed as suffering from viral encephalitis, an inflammation of the brain. No investigations were attempted by St. Brendan's Hospital. The lady died two months after admission.'' Just as "senseless'' as the death of Ms Swan, the staffer said, was the death of Mr. Rammie Mills, a young epileptic and psychiatric patient who had lived for "many years'' at the hospital.

In the same month that Mr. Jones was killed at Collectors Hill, "Mr. Mills was left unattended on a rehabilitation ward due to a lack of staff. Whilst resting, he suffered a seizure, fell from the bed and got his head jammed between the bed and bedside table. He died of asphyxiation.'' No investigation was launched into Mr. Mills' death either, the hospital worker said, adding: "I have become aware over the past year or so of several incidents that have cried out for open and free discussion. Instead, a veil of secrecy was thrown over them.'' Characterising many of the hospital's public statements as hollow exercises in self-preservation, the staffer suggested that Mr. Martin's comments at the time of the Hofer-Jones incidents were vague at best and untruthful at worst.

The former Hospitals Board chief told The Royal Gazette in March that the evidence of Mr. Jones' case suggested he was not a danger to either himself or others. In the case of Mr. Hofer, he would only say that the injuries "were a result of actions taken'' by the victim.

Said the staffer: "What was not revealed was that both men were known to be very disturbed. Mr. Hofer was judged to be self-injurious, Mr. Jones a potential suicide risk. They should have been kept under watch at all times.

That wasn't always done.'' While current Hospitals Board director Mrs. Sheila Manderson was last week provided with a detailed list of her employee's assertions by The Royal Gazette , she declined to comment on them, saying only: "The Bermuda Hospitals Board appreciates your attempt to be fair in giving us the opportunity to respond; however, we cannot and will not conduct the very difficult business of running the hospitals by responding to anonymous information leaked to the Press.'' An identical list of concerns that was sent to the office of Health and Social Services Minister the Hon. Quinton Edness also went unanswered.

Such reticence on the part of St. Brendan's officials are not unusual, said the source, who claimed that the only function of the hospital's public relations efforts "has been to blind the public to the goings on'' there.

Added the employee: "Whenever anything goes wrong, there is a knee-jerk response and practices are temporarily altered in response. This retroactive approach, as opposed to pro-active management, is indicative of the administration's ineptness.'' Whatever the administration's policies on public relations may be, however, St. Brendan's could find it difficult in the coming months to avoid outside scrutiny of its operating procedures.

Last week Mr. Scott of Hall and Associates told The Gazette that Mr. Hofer's case was "under active review'' and would likely become a suit against the Bermuda Hospitals Board after information is gathered from Mr. Hofer's German and Bermudian doctors.

In April it was reported that it would take an estimated three years to determine if the former chef at the Once Upon A Table restaurant would ever walk again.

And the staffer encouraged a woman who was recently assaulted by a St.

Brendan's patient on a secluded Devonshire beach to force an inquiry into why a person with a recorded history of "violence'' and "paranoia'' was allowed by the hospital to roam the Island freely.

"...I would urge the victim or anyone associated with this person to demand a thorough and in-depth investigation,'' the employee said. "You will be shocked at what you discover.''