Blog WSH

Trueblood v. DSHS

The Trubeblood v. DSHS case ordered the following: DSHS can no longer define its own time to assess patients.  DSHS must provide a seven day assessment of a patient within the signing of a court order (in jail) or MUST immediately admit the individual to a state hospital that will be conducting the evaluation.  

New wards must be opened immediately.  There is a severe RN shortage to prevent this from occurring.  RN’s and doctors are severely underpaid and there have been MANY vacancies resulting.  Recent actions by the CEO removed comp time from RN’s and caused RN’s to work frequently out of job class.  State Hospitals are currently a hostile work environment for any RN or health care professional.  The situation is so severe that agency doctors and RN’s must fill the void.

RN’s and Physicians require a minimum of a 20% market adjustment to compete with the private sector.  Physicians and RN’s are in great shortage within DSHS.  Collective Bargaining is a great contributing factor to the situation.  Under current collective bargaining, ALL positions are  treated equally even though some positions require SUBSTANTIAL wage increases above other positions.  This is particularly true in the case of physicians and RN’s.

At this time physicians and RN’s will be contracted out by agencies for DSHS at SUBSTANTIALLY increased wages versus increasing current DSHS employee to wages to that which are comparable to the private sector.  How is this possible?  DSHS (as Government) views funding to be from “other budgets” if other “Agencies” are involved.  This is why RN’s work 15 minutes more per day (uncompensated) than other overtime eligible classifications (or eight work days more per year in time worked than any other overtime eligible classification).  This situation is just as attributable to the RN Labor Union as it is to DSHS itself…   Both are to blame.  What is important is the ACTUAL amount payed versus the budget that is accessed.  For instance, annual time used within DSHS is not tracked as a budgetary concern while sick time is…  Yet unscheduled time absent within DSHS is not tracked at all.

The Joint Nurse Staffing Committee of Western State Hospital received statistics that indicated that each ward and each shift within Western State Hospital requires one additional RN2 FTE and MHT FTE to meet current acuity “base staffing” requirements.  In addition some wards require additional staff to meet the requirement of three RN2 FTE’s per ward per shift and three LPN FTE’s per ward per shift to meet the basic staffing requirement.  This amount will require an approximate additional requirement of 150 additional FTE’s at Western State Hospital which have never been requested by the CEO.  While each ward requires currently six staff per day, only five are provided per day (on average) with current full time positions.

The CEO has substantially increased “on call” personnel to skew the statistics.  On Call personnel work only several days a week (not five days a week as does a full time position).  Recently nursing supervisors (RN3’s) worked “out of job class" for more than 50% of the time “as a ward body” to skew overtime statistics for Olympia in the month of March, 2015.  During this period no supervisory functions occurred.  All competency assessments were canceled as were almost all classes for employees.  The CEO ordered that Western State Hospital shut down ALL normal operations in order to produce skewed overtime statistics for the month of March 2015.  Nothing that occurred in the month of March 2015 was a part of NORMAL operations.

It is time that Olympia learned the truth.  Physicians and RN’s require a market adjustment in wages in order to compete with the private sector in order to provide the services our Constitution requires.  This funding must come now or two years from now the State Hospital system will no longer exist.  

The “85 Rule.”

Many of you are not aware of the “85 Rule.”  It is time that you become familiar with the concept…  Legislators have presented SB 5473 and HB 1542 to implement the “85 Rule.”  The “85 Rule” is the following:

UNREDUCED RETIREMENT. Any member who is at least age fifty-five and has completed at least five service credit years and for whom the sum of the number of years of the member’s age and the number of years of the member’s service credit equals eighty-five or more shall be eligible to retire and receive a retirement allowance computed according to the provisions of RCW 41.32.760. 

I ask that you support the following Legislators:

  1. Chase
  2. Hasegawa
  3. McAuliffle
  4. Rolves
  5. Conway
  6. Kohl-Welles 
  7. Hunt
  8. Moscoso
  9. Reykdal
  10. Sells
  11. Pollet
  12. Dunshee

Please support these legislators to allow long term employees to retire ALIVE from a dangerous and hostile environment. 

Those of us that have worked for decades within a dangerous environment deserve an unreduced retirement for the many decades we have served the public.  

Those that have just started State employment…  Take into consideration the age that you are intended to retire within the current retirement language within the PERS system.   Please support the listed Legislators for your own future.  The “85 Rule” will ensure your future should you choose to remain working within the State of Washington under the current conditions.

State of WSH Propaganda & PERT


                                            Special thanks to the local genius that created the above graphic!  

Recently WSH apparently suppressed information regarding the Psychiatric Emergency Response Team (PERT) to not only the our WSH personnel, but also to the Legislature to provide eight million dollars plus in funding for expansion of PERT in lieu of funding much needed (and required) permanent staffing positions to null out overtime usage.  

PERT was originally intended to enhance ward staffing by allowing PERT members to do ward rounds and do nothing other than interact with patients in order to meet their needs to prevent escalations and assault situations from occurring.  Instead what was initiated was a “CEO driven police force” that was given their own uniforms so as to differentiate PERT members from other ward personnel.  Rather than initiate ward rounds and spending their entire shift interacting with patients (as was the intent), PERT members remained off the wards to await to be called to a ward AFTER the patient had already begun to escalate (defeating the purpose of PERT).  

When complaints regarding PERT were initially issued, specific statistics were provided to imply that there had been a sudden reduction of ALL assault events in Forensic Center of WSH.  The information provided in the statistics was misleading.  To understand how this PERT issue got out of control, one has to understand the chain of command at Western State Hospital.

The CEO of Western State Hospital is responsible for all business affairs, NOT clinical care decisions.  The Medical Director (the actual “clinical care CEO") must be a properly credentialed health care professional (physician) who IS responsible for all clinical care decisions at Western State Hospital.  Clinical care leadership is defined in the Western State Hospital Medical Bylaws (which are not currently being followed).  It is possible to have a CEO and Medical Director be the same person IF the CEO happens to be a properly credentialed health care professional.  This has happened on several occasions in the past at Western State Hospital.  The current CEO is not a properly credentialed medical professional who can assume those duties. 

The root of the problem with PERT was that the CEO placed PERT outside of the clinical chain of command and oversight of the Medical Director chain of command in direct violation and opposition to the Medical Bylaws.  PERT reported directly to the CEO.  When a seclusion or restraint incident occurred, a cell phone call would go from PERT to the CEO and the CEO would coerce clinical personnel to modify the clinical care initiated by credentialed clinical professionals (Physicians & RN’s).  This manipulation was apparently done to skew statistical data.   Written documentation of the CEO (sight unseen) ordering patients out of restraints and seclusion exists, even though the CEO has no proper authority issue such a directive.  When confronted, the CEO denied this and implied that the credentialed health care provider made his or her own decision when prompted by the CEOs’ actions.  RN employees who were on probationary status that complained about PERT were terminated.  One such case is now headed for civil court.  The CEO ordered that RN4’s were to place into each employees’ evaluation that the employee supports PERT.  At that time employees considered PERT to be what they called the CEO’s “Gestapo” or the CEO’s own personal police force which acted completely outside of clinical oversight.  

When issues with PERT became acute, clinical records for the Forensic Center were requested for review for a one month period.  The result of the review was that there was NO FORM of clinical record of PERT assistance to patients in any patient record.  There was no record of PERT making ward rounds regularly.  There was no record of PERT assignments of responsibility, such as being assigned a specific ward to cover.  In short, it DID appear that PERT was the CEO’s personal police force within the Forensic Center.  PERT operated outside of all clinical supervision and oversight.

Meetings were held where Physicians & RN’s demanded that PERT fall under clinical supervision as was mandated by the Medical Bylaws.  It was requested that, just as occurs with physicians & RN’s, that identification of which PERT member that reports to duty would be published at the beginning of each shift.  It was requested that PERT also be present on the ward at all times during the PERT members shift (rather than waiting to be called to a ward) and that the PERT member be identified who was responsible for a specific ward.  It was made clear that PERT was not to interfere with the clinical judgement and orders made by credentialed clinical professionals. None of these measures were implemented by the CEO.  The physicians held and passed a no confidence vote on the CEO.  There was also question regarding what professional clinical credentials should be required for PERT members as PERT was never chartered through the Medical Bylaw process.

What was the result of these actions?  Our Medical Director was “let go” by not renewing his contract with the University of Washington.  Western State Hospital has no Medical Director at this time.  Our next level of physician chain of command was suddenly vacated from WSH…  Apparently reassigned for investigation with a cover story of “medical issues.”  I suggest that an investigative reporter speak to both of these physicians.  PERT continues to report directly to the CEO and the legislature has apparently funded expansion of PERT in lieu of additional direct care positions, most likely because information of the Joint Commission report was apparently purposefully withheld from them.

The situation was reported to the Joint Commission.  The document that resulted was suppressed from common knowledge as well as the legislatures’ knowledge.  Read the Joint Commission’s findings here.  Has PERT decreased assaults in CFS?  Decide for yourself.  

F1 Assault Data
F2 Assault Data

© Paul Vilja 2017