The movie takes place in a different time, just to be clear.
The patient in question was faking being crazy. Acted out and challenged her every single day. He even snuck all of the patients out of the hospital, stole a bus and a boat, and went off on everyone for shits and giggles at every opportunity.
Of course I don't agree with the lobotomy. But he was pushing real damn hard for it.
He was also a jail jumper. They put him in that ward to finally get rid him.
Ratchet was fine giving them their meds every day, and being the only nurse in charge of doing meetings and everything else, until he showed up and instigated everything.