FREE KEVIN WALSH

They are only in it for the money

• They don't treat patients, they often just warehouse them
• They mistreat patients
• They handcuff patients
• They dope up or lock up patients to solve problems
• The hospital is dirty and filthy
• 150 of the people who are locked up have not committed any crimes and are there against their will

Feds threaten State Hospital
Funding at risk after review finds patients mistreated

Jodie Snyder and Susie Steckner
The Arizona Republic
Aug. 6, 2004 12:00 AM

The new Arizona State Hospital faces federal sanctions if it doesn't correct problems found during a surprise review that painted a grim picture of some patients not getting psychiatric care, being handcuffed inappropriately and being secluded for hours unnecessarily.

Federal officials have already rejected one state proposal for improvements at the hospital, which treats the state's most seriously mentally ill. Another should be filed today. If the second plan is not approved, the hospital could lose its Medicare certification and as much as $2.7 million in federal payments. Federal officials could also pull $28 million in funding for Arizona hospitals that serve a large number of poor patients.

The findings come six years after a disastrous federal review that revealed dirty and dangerous conditions for patients. That hospital was decertified for two years.

The latest review is particularly damning because just two years ago the state opened the new $80 million hospital for the very patients that now concern inspectors. State officials had said the new facility was key to improving care.

Inspectors with the Centers for Medicare & Medicaid Services reviewed 12 patient cases during a May visit to the State Hospital, at 24th and Van Buren streets. They found a hospital where patients were plunked down in front of televisions or allowed to wander around instead of being engaged in treatment.

The findings

The review found:

• Patients have cookie-cutter, incomplete or ineffective treatment plans. One patient who had been at the hospital four months told them he couldn't remember any treatment other than "going to the library once," "movies and popcorn" and "medicine." A nurse told investigators he couldn't leave his unit to attend activities because of his assaultive behavior, so instead he gets a lot of one-on-one time with staff and extra medications when needed.
• Patients are handcuffed at the hospital, which violates federal standards. Top hospital officials told inspectors that nurses ordered security staff to use handcuffs during emergencies.
• Patients are put into seclusion for hours. A female patient was secluded at 3:35 a.m. She was supposed to be released "when calm and cooperative," and by 5 a.m. she was "crying, apologizing for wrongdoings." Follow-up checks on her showed no reason for her to remain in isolation, but the staff didn't release her until 6:20 a.m. Inspectors noted a hospital policy requiring such seclusion to end once a patient regains control and is no longer a danger.

"We treat people, and there's always improvements that can be made, and we're looking to make improvements," he said.

New treatment plans

As a result of the review, the hospital is rewriting treatment plans for all patients covered by the federal inspection, which is about 140 people. That process should wrap up by the end of August.

Inspectors also noted that some patients didn't take part in treatment and observed them wandering around; they didn't see staff members following up with patients. One staff member said, "Once I let them out their door, they are on their own. I do not do the 30-minute rounds to check on the patient's location and activity out on the mall or in the rehab groups."

In an interview with The Arizona Republic, Silver said, "We need to obviously think more creatively about how to motivate people."

Frequently, patients may want to "go to the cafe (on campus), have a cup of coffee and talk with their friends" rather than go to treatment, Silver said.

Seeking a balance

He said the hospital must strike a balance between "personal choice and responsibility for treatment."

The hospital also changed some of its policies to comply with federal standards.

Silver said the hospital stopped using handcuffs after inspectors left. He said he didn't know about standards that bar the practice. "Either we weren't aware of it or they (Medicare officials) didn't make us aware of it," he said.

He said the hospital also wasn't following federal standards that dictate how long a patient stays in seclusion; it is now in compliance. Finally, the hospital didn't consider a brief "personal hold," such as putting an arm around a patient, a formal restraint. It now requires a doctor's order for such holds and documents them as restraints.

Leslie Schwalbe, deputy director of the Behavioral Health Services division of the state Department of Health Services, said: "We try very hard to stay on top of all the changes and regulations. That's why you have periodic inspections to make sure you're staying up on top of it."

Both Schwalbe and Silver said they are confident that policy changes, improvements in treatment and other changes will get the hospital back on track.

When told by The Republic about the federal review, lawmakers and advocates said they were stunned.

Investigation urged

"There should be an investigation, and I think the Legislature would want to be in on that," said Rep. Phil Hanson, R-Peoria, who is on the House Health Committee.

Sen. Carolyn Allen, R-Scottsdale, head of the Senate Health Committee, said, "It's unsettling to hear these kind of problems after all that we have been through."

In 2000, lawmakers agreed to dip into the state's "rainy day fund" to build the new $80 million state hospital. The move came after the hospital was decertified in 1998 because a federal review found assaults, filth, overcrowding and patients getting the wrong medications.

The State Hospital's operating budget also has increased annually from 2001 to 2003; this year's total of $58.9 million will increase to $60.2 million in 2005.

Rep. John Huppenthal, R-Chandler, who was on the hospital's construction committee, said legislators realized it would take more than a new building to treat the people who are committed there.

"It comes down to operating the hospital, which is a difficult challenge considering you have the sickest of the sick there. (In terms of severity), it's just hard metal against hard metal," he said.

Arizona State Hospital, the only state-run mental hospital in Arizona, houses about 300 patients. Most are adults, with a handful of adolescents. Currently, about half the patients are under court-ordered treatment because they are a danger to themselves or others. The other half are criminals under court-ordered hospitalization rather than imprisonment.

The hospital, which has about 600 employees, is overseen by the DHS.

The May review looked at patients who are civilly committed to the hospital. It focused on patients' treatment plans, which were found to be inadequate in many cases.

Silver said that the hospital itself began seeing treatment problems about a year ago. But he also said that staff members don't always document everything that is happening with a patient.

Inspectors also questioned why certain patients were not already discharged. Silver blamed a lack of appropriate housing and is working with another state agency toward that end.

The State Hospital has come under fire several times in the past 15 years because of poor treatment of patients, understaffing and other issues.

It has been decertified twice before. Decertification always jeopardizes the state's pot of federal money to pay the medical bills of poor patients.

The latest woes trouble advocates, families and others who have battled for at least two decades to improve care for people with mental illnesses in and out of the hospital.

Phoenix attorney Charles Arnold filed the Arnold vs. Sarn lawsuit more than 20 years ago to get the state to improve conditions for adults with serious mental illnesses in the community. The lawsuit is still pending.

Of the federal review, Arnold said, "It reminds me of the long way yet to go in developing the kind of understanding in basic human principals that our system requires."