$2.6 Million per Year Administration Expansion Becomes Real!

Today the first position description of a Ward Program Administrator made it out to the wild before it had been posted at careers.wa.gov.  Governor Inslee (one of the only persons allowed to see the taxpayer paid CSM Consultant reports) had apparently approved the funding for the 28 Washington Management Services positions which earn $85,000 to $93,000 per year according to a WPA FAQ Sheet.  This is a $2.6 million per year (plus) unnecessary and unwarranted expansion of administration that is being made in lieu of funding direct patient care positions such as Food Aides and Direct Care Nursing personnel that are desperately needed daily to man the wards. Western State Hospital cannot currently operate without use of extensive overtime and having nursing personnel work daily out of their job class to perform food aide and other classification duties.  

What we are witnessing is massive incompetence operating within great secrecy at the highest level of State Government.  How could this happen without direct patient care personnel input?  All direct care personnel at Western State Hospital have been kept blind during this election year allegedly due to the wording contained within the Service Improvement Agreement that was entered into with DSHS and the Governor.  It has been interpreted by DSHS and the Governor to state that ONLY one or so selected individuals (selected by the Governor) would ever see the report that was submitted to CMS by the taxpayer paid CSM Consultants, and that (based on these selected individuals) interpretation of the consultant reports, correction recommendations were being implemented and funded by the Office of the Governor (Office of Financial Management) while maintaining absolute secrecy from the public.  

I make the assertion that if the top secret CSM Consultant report was made available for the public to see, we would learn that the $2.6 million per year expansion of administration was never a literal component of that report.  This was actually confirmed by interactions that the doctors union had with consultant personnel.   Rather it was the interpretation of the several individuals (administrators) that were allowed to see the document as their vision of a solution to one of the 101 issues that were being addressed.  The one thing that has been consistent over the past two to three years was the consistent massive expansion of administration at Western State Hospital at the cost of quality patient care, accreditation, as well as ultimately federal funding.  It is the direct patient care providers who should be providing the suggestions and input as to the appropriate corrections for Western State Hospital to address input contained within a PUBLIC consultant report.  The fact that the consultant report is top secret appears to be a component election year politics where transparency must not be allowed to occur or the incompetency would be out there for everyone in the public to see.  To the Legislature, DO NOT FUND this expansion of administration until you are provided a copy of the initial CSM Consultation report that was submitted to CMS for approval prior to the request for the administrative expansion (administrations’ self prescribed fix).  

DSHS and the Governor have been involved in an elaborate Unfair Labor Practice by telling all labor unions that Western State Hospital was mandated by CSM Consultants (and then CMS) through the top secret consultant report to create the $2.6 million per year expansion of Washington Management Services positions for additional Administrative personnel.  If the top secret report does not specifically call for the massive expansion of administration (if there were no alternatives that could be provided by existing supervisory or management structures), then the meetings with all the labor unions were based on a fraudulent premise that would prevent open negotiation of a massive change in working conditions which would be detrimental to all ward operations.  This concept was tried and failed in the past.  I assert that one of the individuals that was allowed to see the top secret report and make recommendations was the SAME person that brought Western State Hospital that same failed concept in the past.  Further, we have all heard that specific employees have already been promised those positions even PRIOR to their posting at this time.  The corruption of the WPA position process is extensive and warrants a full investigation as it was the last time it was implemented.  I remind everyone that Western State Hospital maintained accreditation and CMS certification for half a decade after the failed Ward Program Manager concept was abolished at great savings to the State.  

I remind everyone that prior the Inslee Governorship, Western State Hospital constantly maintained full TJC Accreditation and CMS Certification and funding.  What happened to Western State Hospital did not happen overnight, it took an extended period of time (years) for DSHS Administration to cover up ever growing and out of control overtime use while expanding administration and administrative support while never requesting additional direct patient care positions until this year when we were on the verge of losing all federal funding. The basic same DSHS Administration that has brought us to our current situation are essentially the same DSHS Administrators that are the only ones that are allowed to see the top secret consultant reports.  Would a competent administrator have allowed this current situation to happen?  Would a competent administrator have ever allowed taxpayer paid consultant reports to be kept top secret from the public?  We can end this nonsense in November.

Now lets look at the $2.6 million per year monstrosity that Inslee’s DSHS has cooked up.  

Each ward currently has a Licensed Psychiatrist (MD) that serves as the head of the treatment team.  Members of the treatment team are often a medical doctor, psychologist, a social worker, a registered nurse, and other direct care provider nursing positions (nurse aid class employees).  The Psychiatrist, based on interviews with the patient and input from the treatment team prescribes medications.  Constant input from treatment team members is provided and patient treatment plans are created and modified to provide the best care possible with the intent to return the patient back into the community as quickly as possible.  All direct patient care providers are bound by the Uniform Disciplinary Act, meaning that our licenses to practice our profession are dependent on our behavior and personal actions.  What this means is that the psychiatrist, psychologist, social worker, registered nurse, licensed practical nurse, and or nurse aid class employee are held accountable for all of their personal actions, violations of conduct will result in revocation of the license to practice by the Department of Health after an investigation and hearing.  In short, licensed direct patient care providers are held personally accountable for their actions, thus being directed by someone to perform an unsafe clinical practice is no defense for performing the practice that you may have been directed to do if it endangers the patient.  The licensed provider is accountable regardless of who issued the inappropriate directive.  The entire treatment team of each ward is entirely bound and held accountable by the Uniform Disciplinary Act.

Inslee’s DSHS now intends to create a Ward Program Administrator for each of the 28 current wards at Western State Hospital.  In doing so, Inslee’s DSHS has created an administrator position that oversees the clinical care of all patients on each ward by someone that is NOT bound by the Uniform Disciplinary Act as someone acting within ones defined area of practice.  What is the basic qualifications for the position?  See below 

IX. Qualification -Knowledge, Skills and Abilities

List the education, experience, licenses, certifications, and competencies,

Required education, experience, and competencies:

A Master's degree in Psychology, Sociology, Social Work, Social Sciences, Nursing, or in an allied field, AND

three years of professional experience in case work, social services, planning, directing, and/or coordinating

group and activities in an institution setting or experience in a related field AND three years of supervisory

and/or managerial experience, including program administration, personnel management, and budgeting.


A Bachelor's degree in Psychology, Sociology, Social Work, Social Sciences, Nursing, or in an allied field,

AND three years of professional experience in case work, social services, planning, directing, and/or

coordinating group and activities in an institution setting or experience in a related field AND five years of

supervisory and/or managerial experience, including program administration, personnel management, and


Preferred / desired education, experience and competencies:

• Master's degree or higher in a ciinical field and clinical licensure in one's specialty.

• Demonstrate leadership and management skills and abilities, including: good judgment, independent

problem solving, decision-making, conflict resolution, time management, excellent oral and written

communication, relationship skills, program management, budgeting, and personnel management. Ability

to lead others through modeling and provision of accurate, constructive feedback,

• Working knowledge of Federal and State laws and standards (e,g" T JC, CMS) standards relating to

psychiatric hospitals

• Demonstrate core understanding of psychiatric recovery principles and ability to put them into practice to

ensure recovery-oriented care for all patients on assigned ward,

• Ability to set and maintain appropriate priorities for self and ward,

• Ability to maintain high standards of professional integrity and tcensure such standards are maintained by

all ward staff,

• Ability to work collaboratively and interact respectfully with diverse staff and patients to accomplish the

hospital's mission.

• Leadership and management skills and abilities, including; good judgment, independent problem solving,

making conflict resolution, time management, excellent oral and written communication, and relationship

skills, Ability to lead others through modeling and provision of accurate and constructive feedback.

• Computer skills (Word, Outlook, intra-and internet, Visio, Excel)

Thus the person that is placed in a WPA position to oversee ALL clinical care will be an individual that is NOT working within the confines of their specific licensed scope of practice, if they are licensed at all.  Thus the Uniform Disciplinary Act operates independent and exclusive of a WPA.

What is a WPA expected to do?

Describe the scope of accountability.

The WPA provides administrative supervision for treatment team members, including: (1) Ward Psychiatrist, (1)

Ward Psychologist, (2) Ward Social Workers, (3) Ward RN3s, Rehabilitation staff (if assigned to the ward), and (1)

Ward Clerk (OA3). The WPA also has approximately fifty (50) staff from the different disciplines that they provide

administrative oversight, and non-clinical work direction covering 3 work shifts, 24 hours a day, seven days a

week. This position plays a critical role in maintaining the safety of all staff and patients on that ward. The

WPA manages the day-to-day operations, ensuring compliance with hospital policies/procedures, adherence to

applicable legal and regulatory body standards, and fulfilment of the hospital's current Systems Improvement

Agreement requirements.This position is responsible for the entirety (24/7) of operations and administrative processes on a 30-bed

psychiatric unit. 

Thus Inslee’s DSHS is placing an administrator in the role of administrative supervisor of all clinical care personnel (along with their practice) with zero licensed accountability of their own actions under the Uniform Disciplinary Act as each WPA would be performing duties well outside of their scope of practice if the WPA was even licensed.  If the WPA process were to be implemented in a legal manner within which scope of practice ruled the basic qualifications for the position, a Licensed Psychiatrist (MD) would have be become the Ward Program Administrator by default as they are licensed to administratively supervise the clinical care of all of our patients.  Indeed, I would further point out that Western State Hospital Medical Bylaws and credentialing processes come into play in this matter and that the Medical Bylaws are incompatible with the WPA concept with the current basic qualifications listed.

I assert that a Ward Program Administrator concept cannot be implemented legally without endangering our entire patient population if the current listed qualifications were applied.  Further, should 28 additional Psychiatrists be required to administratively supervise 24 hour clinical care each ward, the costs would be prohibitive.  Luckily the Ward Program Administrator concept is absolutely not required as existing structures already provide this service for a 24 hour period in full compliance of the Uniform Disciplinary Act.  Our loss of accreditation was a decision made by the Inslee DSHS Administration.  Our current SIA and possible loss of CMS funding was the direct result of actions taken by the Inslee DSHS Administration to massively expand administration and administrative support for the past two years WHILE completely neglecting to ask for sufficient direct patient care personnel to carry on daily operations.  

I have no confidence in the Inslee DSHS Administration.  I strongly suggest that all labor unions work together to expose the corruption that has taken place by demanding a copy of the top secret taxpayer paid CSM Consultant Report and then release that report to the public and legislature for review.  I also suggest that we discuss immediate informational picketing of Western State Hospital in order to inform the public of the waste of public funding through administrative expansion that is being implemented in lieu of DSHS providing sufficient direct patient care personnel to provide daily care without massive daily use of overtime, on-call personnel, and agency personnel.  We were recently told that additional direct patient personnel may not be funded, but oddly the administrative expansion is the focus of all the Inslee DSHS Administration efforts at this time.  

An additional point:  Eastern State Hospital was just fully accredited without having to expand their administration.  Perhaps their approach to minimize administration and administrative support and concentrate on providing adequate direct patient care providers and equipment may have some merit.  

© Paul Vilja 2017