Swamp Musings

Interesting...

Mental hospital criticized

Audit blames two deaths on deficiencies

By Cy Ryan
Sun Capital Bureau

CARSON CITY -- "Serious deficiencies" at the Southern Nevada Mental Health Hospital contributed to the death of two patients and have resulted in the lack of treatment for others, a federal audit found.

The audit by the Centers for Medicare and Medicaid Services reported a shortage of staff contributed to many of the problems, including attacks by patients on nurses and mental health technicians.

The centers, in a report dated Nov. 16, threatened to cut off federal funds if the problems are not corrected.

Usual crap, eh? There's more:

Carlos Brandenburg, director of the state Division of Mental Health and Developmental Services, said that could mean a loss of $4.3 million this fiscal year and $5.3 million next fiscal year.

A corrective action plan was submitted Tuesday to the federal agency, he said.

"The bottom line is we need to ensure quality care is a top priority," Brandenburg said. "There is no excuse for this. The hospital has overextended itself."

The audit, conducted Oct. 17-19, noted two deaths in April -- a 28-year-old homeless man who hanged himself and a woman who experienced breathing problems after taking a medicine.

The report said the "root cause" of the suicide was the absence of a physician to check on the man during the weekend.

The attending physician went on a scheduled leave on Friday, and the man hanged himself on Sunday. The audit found that there was "no record that the covering physician attended to the patient."

The attending physician "acknowledged that weekend and leave coverage had become very sloppy," the report said.

At the time, there was only one on-call physician on weekends to cover 77 patients.

The female patient died on the way to a hospital after experiencing labored breathing. The audit said a nurse had not followed the procedure for implementing the first dose of a new medication, and the mental hospital had not followed a plan of care for the woman.

The hospital, which can take up to 130 patients, has a staff of 431, but needs more registered nurses and mental health workers.

The audit found that patients failed to get treatment or rehabilitation, noting that an auditor "observed patients watching television, sitting on benches and sitting in chairs not involved in any form of therapeutic activities." ever been to a shrink farm? Sheesh.

One patient told auditors that the staff is too busy to help.

"All they do here is line you up to give medications and don't explain what the medication is for," the patient said.

Staff, in interviews, said they did not have enough workers to do the rehabilitation.

Brandenburg said a major problem is that the hospital has no private rooms for therapy.

"Any therapy must be conducted in an open area, and there is no way you can conduct any type of therapy in an open area," he said.

Part of his corrective plan is to reduce the number of beds by 10 and use those rooms for therapy.

The state division has not been able to hire the needed staff because of the nationwide nursing shortage, Brandenburg said.

He wants to contract help and is going to seek approval for an early hire of staff at the 150-bed mental hospital that will be completed in April.

The audit said it found there were an inadequate number of registered nurses and mental health workers "for a safe and therapeutic environment."

One nurse alone on duty told the auditors she was choked by a patient. She could not call for help and another patient had to summon aid.

One mental health worker said a patient grabbed her hair and she and the patient fell to the floor. She fractured her elbow.

Another employee said she suffered a broken jaw when hit by a patient, and she added, "It's like walking into a battlefield."

In these cases there is no other staff around to thwart the attacks, the study concluded.

A review of the records showed nine staff injuries from physical assaults by patients since January.

There were 11 vacant registered nurses positions that led to the short staffing, producing 10 shifts where there was only one nurse on the day and evening shifts.

Brandenburg said there is "a national shortage of nurses," especially psychiatric nurses. He said the state pays well but is competing with other states.

The nurses, commenting on the lack of treatment for the patients, said, "We don't have enough staff and we run this unit like an ER (emergency room)."

Workers noted that in one ward there are only three nurses, three doctors and six mental health workers to take care of 26 patients 24 hours a day.

Brandenburg said he doesn't know if he has enough money in his budget to finance all of the corrective actions needed. The federal auditors are expected to return to see if the problems have been solved.

According to a legislative appropriations report, the hospital had a budget of $61.2 million last fiscal year, which rose to $73.2 million ($563,077 per year per inmate, $1,543 per day)) this fiscal year and jumps to $97.2 million in fiscal 2007. That big increase is to finance the hiring of staff for the new hospital.

Brandenburg, who said he knew about the deficiencies, said, "We were trying to take corrective actions."

Both deaths were reported to a joint accreditation commission, he said.

The hospital could lose its national accreditation if the problems are not fixed, he said. Besides the loss of federal funds, other grants to the hospital, including one for a psychiatric residency, would be stopped.

Brandenburg said one thing that will help is that WestCare, which now provides beds for 38 mental patients who are transferred from hospital emergency rooms, will increase that number to 50 starting in mid-December. That will take some of the load off the mental hospital.

"Once the new hospital is ready, we will have all the resources we need," Brandenburg said. "We will have rooms for therapy."

Dr. Jonna Triggs, director of the hospital, is on extended sick leave and won't return until next month.

Cy Ryan can be reached at (775) 687-5032 or at cy@lasvegassun.com.

I posted the whole article. Highlights are mine of course. Worse is to come. Observe (truncated but linked):

Mental facility to make changes

New hospital may solve problems

By Cy Ryan
Sun Capital Bureau

CARSON CITY -- Serious problems such as deaths and an absence of therapy for patients at the state's mental hospital in Las Vegas will be eliminated when a new 150-bed psychiatric hospital is completed in May, state officials predicted Wednesday.

Dr. Jonna Triggs, administrator of the Southern Nevada Adult Mental Health Services, said the hospital will be able to hire 350 more workers to add to the mental health facility's current 431 employees.

Michael Hillerby, chief of staff for Gov. Kenny Guinn, said the new $36-million, 150-bed hospital would help alleviate some of the deficiencies outlined in a federal inspection in October.

150 inmates and 781 guards? Sure reads that way.

Auditors from the Centers for Medicare & Medicaid Services reported "serious deficiencies" at the current psychiatric hospital -- among them, patients watching television and sitting around rather than getting rehabilitation treatment.

And they blamed the "root cause" of two deaths on the hospital.

A major problem, the report concluded, was lack of staff at the hospital, which had many positions vacant.

The hospital Tuesday filed a plan of corrections, detailing how it will shift some staff to help with patient care and also try to hire some of the new staff early.

"It is very possible a request may have to come to the (Interim Finance Committee) for more money to the hospital," said Assemblywoman Sheila Leslie, D-Reno.

Leslie, vice chairwoman of a Legislative Interim Committee on health, said the panel would review the situation Dec. 13 with Carlos Brandenburg, the administrator of the state Division of Mental Health and Developmental Disabilities, which oversees the hospital.

"We have chronically underfunded mental health for decades," she said. As a result, the state is having difficulty attracting psychiatric nurses, Leslie added.

"The state work force is chronically underpaid," she said. "This is not acceptable."

In the report, auditors blamed an episode in which a patient hanged himself at the hospital on a Saturday in April on the failure of the weekend physician to consult with the patient. In the second fatal case, a woman died on the way from the state facility to a medical hospital. In that case, the auditors said, a nurse at the mental hospital failed to handle the case properly.

The Oct. 17-19 inspection of the hospital could jeopardize federal funds, estimated to be more than $9.6 million in the present two-year biennium, unless corrections are made.

Hillerby said Mike Willden, director of the state Department of Health and Human Services, is "doing a very good job to address those issues" in the audit.

The governor, Hillerby added, is "keeping an eye" on the hospital, but he said he did not know whether any changes would be made.

Triggs said she has asked "for more resources in Southern Nevada" for years. The 2005 Legislature "did magnificently" by allocating the extra employees, she said. The budget went from $61.2 million last fiscal year to $73.2 million this year, and will rise to $97.2 million next fiscal year.

While the state could lose federal funds, Triggs said, the hospital's national accreditation is not in jeopardy.

After the two patients died in April, the Joint Commission on Accreditation of Health Care Organizations accepted a corrections report and indicated it would not withdraw accreditation. The corrective steps outlined include plans to hire, by Dec. 5, an additional psychiatrist to work during the weekend to treat patients considered a suicide risk.

Two full-time rehabilitation specialists also will be hired immediately to beef up patient therapy. And the hospital will keep 10 of the 131 beds vacant to improve the staff-patient ratio and to provide private space for treatment of individuals.

Cy Ryan may be reached at (775) 687 5032 or at cy@lasvegassun.com

The 2006 figures of $97,200,000 in 2007 seems a tad high. Either Cy has screwed the figures or I need to be sucking thorazine. Down here in Florida murderous bastards incarcerated get full-time A/C, big-screen teevee, and walkies plus a lot more sex than most working stiffs. Plus they get broken teeth fixed ($1,600+, cash in advance for one) free.

I just have a hard time believing the "underfunded" crap with the simple division indicates well over a half a million a year per inmate. Underpaid? With the huge overstaffing, WTF?

Damn. If those numbers are correct, I'm gonna move to LV and buy a case of Jack Daniels.