FREE KEVIN WALSH

Mind games played by bureaucrats at Arizona State Hospital

Mind games
State mental hospital sucker-punched

Aug. 15, 2004 12:00 AM

It wasn't supposed to happen.

After construction of a new $80 million facility, Arizona State Hospital was supposed to be beyond evaluations that include words like "deficiencies."

After an infusion of cash that has steadily increased the operating budget - this year's total of $58.9 million will go to $60.2 million in 2005 - nobody expected Arizona State Hospital to be found to have "serious deficiencies" by federal officials.

But it was.

If the Centers for Medicare and Medicaid Services don't accept Arizona's revised proposal for correcting those deficiencies, the hospital may lose its Medicare certification, which means a loss of $2.7 million in federal payments, with a potential to lose $28 million more in federal aid.

For those who've been part of a decades-old fight to improve how the seriously mentally ill are treated in Arizona, it feels like a sucker punch.

Low.

Mean.

And unexpected.

It is also more evidence - if any were needed - of the challenges of treating what Arizona Department of Health Services Director Catherine Eden points out are "the toughest patients."

These are people for whom all other options were not adequate. Their mental illnesses are profound, severe and persistent. Many are a danger to themselves or others. Many committed criminal acts, but were sent to the hospital rather than prison.

These folks need intensive care. Yet federal investigators found treatment plans that were ineffective or incomplete. Inspectors also found inappropriate use of handcuffs and seclusion.

"We take it seriously," says Eden of the deficiencies identified. But she adds that compared with the problems that led to the hospital's decertification twice in past years, these problems are far less severe.

"It's not even in the same ballpark," she says.

Steven Chickering, spokesman for the Centers for Medicare and Medicaid Services, says the requirements for federal certification deal with health and safety, but it is "not infrequent" for hospitals to be found non-compliant.

Of the 40 to 50 investigations completed each year in the region that includes Arizona, about half have deficiencies, he says.

Arizona State Hospital's first response to its "serious deficiencies" was not sufficient. An amended response was sent a week ago.

If accepted, it will remove the threat to the hospital.

But it will not remove the deep sense of disappointment Arizonans feel about this latest round of bad news about how the state does the job of treating the seriously mentally ill.