Blog WSH

PERT Analysis by Physician

The following was submitted by one of the most highly regarded physicians at Western State Hospital:

Dear Medical Staff,


In light of the Medical Staffs concern about the increasing assaults coinciding with the start of PERT in CFS, as well as subsequent concern by The Joint Commission, the hospitals Quality Management department created a report to address this concern.  The report was generated by the Quality Management Department, headed by Mark Simon-Haines and Theresa Becker.  I have attached the report to this email.

The report provides sixteen graphs of monthly assaults.  Each graph depicts monthly assaults on the individual wards of the Center for Forensics Services (CFS) for the past three years.  I found the report rather confusing (16 different graphs) but I believe it concludes that any increase if it exists is probably a natural fluctuation.  The report also emphasizes that only a few wards saw any increases so not caused by PERT.

It wasn’t clear to me why the report avoided looking at CFS as a whole and why it didn’t look more at overall trends and fluctuations in assaults.  I have limited access to the hospitals data, but because I found the Quality Management report rather confusing, I decided to work with this limited data and create some spreadsheets to tally up assaults, injuries and seclusion/restraint hours.  Here’s what I got.

In this first year of PERT’s operation in CFS, a dramatic reduction in Seclusion and Restraint hours occurred (-85%) compared with the previous year.  This associations seems undeniable.

However, accompanying this reduction in seclusion and restraint hours was a 47% increase in assaults and 20% increase in injuries (see the table below).

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 This increase in assaults is actually quite disturbing when considering the 19% decrease in CFS between 2012 and 2013 (a year before PERT began) and the overall hospital downward trend in assaults since 2005.  On average, since 2005, the hospital has seen a 5% annual reduction in assaults.  The 47% increase in assaults in CFS accompanying the start of PERT does NOT appear to reflect a normal fluctuation of assault rates, when viewed against the backdrop of the hospital wide data since 2005 (see table below).

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Western State Hospital Citations

Today I was able to obtain a copy of the Western State Hospital citations from Labor & Industries (L&I), Centers for Medicare & Medicaid Services (CMS), and The Joint Commission.  I have compiled them all here.  Please take time to review the extensive citations…  They are no longer top secret from the clinical professionals that work at Western State Hospital.  

The next step is to allow direct care clinical professionals to have input into the correction plans.  Clinical professionals will not only view the problem that was addressed differently, but they will have more appropriate clinical and comprehensive solutions if allowed to contribute.  Shortly, our Safety Committees will see these citations for the first time.

The Joint Commission Citations & Plan of Correction:

Centers for Medicare & Medicaid Services Plan of Correction:

Labor & Industries Plan of Correction:

Safety Report

CEO Staffing Plan (Stated to be “off the table” at this time)

Western State Hospital On The Edge

Western State Hospital is now in jeopardy of losing accreditation as well as Federal funding.  Recently the Department of Health conducted inspections for (CMS) Centers for Medicare & Medicaid Services.  View the numerous citations that were filed against Western State Hospital by CMS.  Plans of correction have been initiated, including putting in an interim Medical Director.  

Labor & Industries has fined Western State Hospital, and a correction plan is in progress for the deficits they had discoverd.  Fines will go before a judge shortly.

The Joint Commission on hospital accreditation recently inspected WSH, many citations were also issued.  As in most cases, these findings and correction plans tend to be held top secret by the current WSH Administration and are not published for all employees to see.  See some of the early citations.  

In a recent East Campus Safety Committee meeting it was presented that licensed clinical professionals (physicians, psychiatrists, psychologists, rehab specialists, and registered nurses) have been excluded from citation information and decisions on client care changes.  A resolution was passed demanding transparency of all citation information for clinical professional review and input for patient safety.  Receiving a copy of the CMS citations was a result.  We have not yet received the latest Joint Commission citations, but we have requested to obtain a copy of them.  It must be noted that the copy of the citations from CMS was provided by a Unit Director, a member of the CEO chain of command that operates outside of the Medical Director chain of command.  I commend that individual for taking this action to provide transparency to what is taking place at this time.

The CEO is the business head of Western State Hospital, but he is not a licensed clinical professional with even rudimentary understanding of clinical practices and staffing concerns…  In fact, sustained actions have been taken to exclude licensed clinical professional input in patient care decisions now for an extended period of time.  The CEO has created chain of command structures that work outside of the Medical Director clinical chain of command…  The CEO and DSHS Administration chose to TOTALLY bypass clinical chain of command by not renewing our Medical Director’s contract even though there was no incumbent Medical Director available.  These were direct and knowing actions that have put WSH accreditation and Federal funding in jeopardy.  Many of the citations pertain to these actions.  Please review them.  These actions are why our physicians voted no confidence with the CEO and the reason why there is minimal support for the CEO by our clinical professionals as a whole.  The vote of no confidence may be the root cause of the CEO and DSHS Administration not renewing the Medical Director’s contract in favor of having no form of Medical Director and completely disregarding Medical Bylaws.

As stated in my last blog entry, staffing is a huge concern at this time.  The CEO did not request additional full time positions from the Legislature when our statistics indicated we required an additional over one hundred and seventy full time positions to null out overtime.  Western State Hospital is now operating with an approximate 8.5 million dollar deficit…  Created by the CEO by not addressing staffing aggressively to the Legislature when he testified before them.  

The CEO is now resorting to desperation to address the problem that he himself created.  His first action was to remove the ability for employees to earn comp time for six holidays a year (drastically impacting morale as well as recruitment and retention).  He has had supervisors work out of job class as a float pool in order to skew staffing statistics while direct supervision was essentially not occurring.  He has eliminated all competency training classes.  Training for nursing is now a thing of the past.  This skews attendance statistics to indicate that there is a sudden decrease in overtime to justify the full time administrative staff that he hired to perform staffing services for over $160,000 per year in additional costs of personnel that DO NOT provide direct patient care.  Western State Hospital now operates daily at minimum base staffing levels where three licensed staff cannot be provided to all wards…  Food aides cannot be provided to even half of the wards for all meals.  Massive hiring of on-call staff has occurred to allow for current levels of operations to continue with only moderate (not severe) daily overtime use…  Some seventy employees that work several days per week compose the massive on-call pool.  

If you are a licensed clinical professional, your credentials are in jeopardy daily.  We are advising all registered nurses to obtain liability insurance.  At this time directives have been issued to minimize registered nurse coverage for all holidays to only one per ward as a maximum, thus cutting earning potentials for RN’s drastically.  If you are a registered nurse, it will be difficult to ever get approval for time off without serious seniority.  There are attempts to take away any control that RN’s have over their own schedules at this time.  Clinical supervision will have no say if an employee asks for time off to go to a doctors appointment or even a prescheduled clinical procedure.  Staffing is so poor that these acts of desperation are rampant.  In my section of the hospital, it is impossible to ask for a weekend day off if you happen to be an RN2.  Recent ads for RN’s appear humorous to WSH nurses, the false advertising is quite absurd.  Recruitment and retention of RN’s is dismal. The horrible working conditions has already reached the public by word of mouth.

As bad as RN’s are treated at WSH, physicians are now being treated worse.  Physicians recently received a letter from DSHS Administration stating their intent to use Locum physicians.  All part time current physicians received a copy of this letter stating that they needed to bid for their own jobs or they may be replaced by higher paid agency physicians.  RCW 41.06.142 outlines the process of purchasing services by contract…  Note the criteria that must be met in order to contract out services.  Locum physicians earn approximately double the wages of permanent physicians who receive only a fraction of the wages provided in the private sector.  Recruitment and retention of physicians is dismal.  

Market adjustment of wages is necessary for physicians, registered nurses, licensed practical nurses, psychologists, and social workers.  Recruitment and retention numbers speak for themselves.  WSH is failing. 

DSHS is now in crisis and must spend double the wages of full time employees in order to retain agency registered nurses and physicians in order to operate and not expose the incompetence that has occurred by not addressing this problem directly to the Legislature earlier.  

An audit of new full time positions created during this current CEO’s term of duty will indicate VAST growth of administrative positions that do not provide direct care, some of them getting over 20% raises by direct CEO action.  At the same time, an audit will indicate that physician and RN positions languished with some physician and RN positions being eliminated to create funding for additional administrative positions and raises for administrative positions.  

Drastic rapid action is necessary to rescue DSHS Facilities from loss of Federal funding and accreditation.  

© Paul Vilja 2017