Blog WSH

A Shameful DSHS Data Dump (Amended 9/30/16)

AMMENDED BLOG (9/30/16)  In my haste to respond to the release of the secret CSM Consultant report I missed a few stitches…  I will address the difference between RN3 and Ward Administrator position descriptions and correct false data within the report itself which claims that Non-RN4 Unit Managers were a factor at WSH historically when they were not.  Also of note is that Ward Program Managers only existed for a couple of years within WSH history.  Ammended input is in red. 


Today (9/29/16) the secret CSM Consultant report was released to the public for the first time as a result of numerous information requests.   The following email was sent as the information was released to news agencies:


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Note that DSHS states that the report “may” be exempt from disclosure under the Public Records Act…  The State apparently had no intention of releasing this data… In fact the report contains the following data on every page:


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Not subject to discovery pursuant to RCW 43.70.510?  I see nothing in that provision that would prevent discovery as we are not talking about patient records or possible HIPPA violations.  Very strange… 


But news agencies had ALSO filed Freedom of Information Act paperwork with the Federal Government, therefore giving news agencies access to the report through CMS via the Federal Government.  As the data was going to be released anyway, the CSM Consultant report was released today by DSHS.  That report is available for viewing below:  



Please note that the report does NOT mandate the implementation of $2.6 million massive expansion of administration in the form of “Ward Administrators" (Washington Management Service positions).   In short, DSHS openly lied to get an additional $2.6 million per year in unnecessary funding (in lieu of using these funds for additional direct patient care provider positions) blaming this report DSHS thought would be kept secret from the public and Legislature.  A severe Unfair Labor Practice has occurred as DSHS Administration forced rapid adoption and funding of 28 administrative positions prior to any form of proper disclosure and demand to bargain processes taking place. 


Submitted with the CSM Consultant report was the following fictional document… It is DSHS’s spin of the report.



In that fictional DSHS spin document it stated the following:

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I must remind you that until today, only a select few administrators had any form of access OR INPUT into the CSM Consultant report outcomes.  Note that they have EXPANDED the number of Ward Administrators to 30 from 28 that was described in the WPA FAQ document (now more than $2.6 million per year).  The report did NOT identify the need for additional ward program administrators, this was a lie.  The only mention of anything in the report similar to “ward managers” were the following:

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In addition the following components were present in the CSM Consultant report:


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Nothing that is stated above implies the following which was provided to all personnel by the CEO in the WPA FAQ document:

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The above statement which was provided to all personnel and all Labor Unions was a complete fabrication.  It was a fabrication based on the belief that nobody would ever be allowed to see the CSM Consultant Report.  The Legislature should immediately eliminate the funding it has already approved for Ward Administrators.  It was a cognitive leap to not openly discuss the report with all personnel because the above data presents a more simple solution than the costly one that was proposed.  Why did DSHS not IMMEDIATELY present the Ward Administrator concept a month ago to the labor unions as the concept represented a radical change in work conditions?  Perhaps they did not want the following information to be presented to CMS prior to THEIR plan approval and funding. 


A ward based leadership model already exists on each ward.  The Psychiatrist is the team leader and prescribes medications and approves treatment team recommendations for behavioral treatment based within their scope of practice under the Uniform Disciplinary Act.  Nursing personnel (Charge RN2’s, LPN’s, PSN’s, MHT’s, PSN’s, and IC’s) are under the direct supervision of a Registered Nurse 3 who has interdependent role and oversees specific functions of clinical care through the delegated authority of the ward Psychiatrist.  It has been the normal delegated role of the Registered Nurse 3 to perform routine audits of care and ward quality care processes, and assures standards are maintained through completion of employee performance evaluations taking input from other members of the treatment team.  RN3’s coordinated training schedules when WSH still had yearly competency training.  Under the current structure, the RN3 is the middle level ward manager.  Accountability is built into the ward structure through the Uniform Disciplinary Act.  Other members of the treatment team are the Psychologist and Social Worker who are both licensed and perform their duties also pursuant to their scope of practice under the Uniform Disciplinary Act. 


Why has this structure failed in the recent past?  Western State Hospital did not have enough charge nurses (Registered Nurse 2’s) to provide seven days of coverage through three shifts, thus WSH Administration often used RN3’s to cover as charge nurses (RN2’s) instead of allowing them to regularly perform their primary supervisory job function.  By having RN3’s serve frequently as RN2’s, the normal supervisory roles of the RN3 were fractured as work relationships frequently moved from peer lead worker to supervisor and back creating an undefined and ever changing supervisory relationship.   While some unit RN3’s performed RN2 jobs on various wards, the other unit RN3’s often covered from three to six wards preventing true supervisory oversight.  By never requesting the minimal level of staffing required to null out overtime and provide full coverage for a three year period, DSHS Administration found itself unable to allow yearly training to continue.  Competency training for all nursing personnel was eliminated in early 2015 and has NOT be reinstated to this day.  RN3’s continue to be frequently assigned to RN2 duties due to the past acts of an incompetent administration.  Rather than creating a $2.6 million per year additional administrative layer, additional full time RN2’s can be funded to allow RN3’s to perform their normal functions as delegated ward managers.  RN3’s perform all of the functions described for Ward Administrators exempt for the fact that there is one RN3 for each shift rather than an ineffective 24 hour coverage unreasonable expectation.  The Joint Nurse Staffing Committee requested 114 additional full time RN2’s, but DSHS only funded 51.  Had the CSM Report been provided to direct patient care providers for input, the recommendation would be to allow RN3’s to act as delegated ward managers during their assigned shift thus utilizing existing supervisory structures without creating yet another additional layer of administration.  The reporting hierarchy would be optimized and the ward based leadership model would be strengthened while remaining within the parameters of scope of practice and Uniform Disciplinary Act.  


A quote from WAC 246-840-705 (Functions of a Registered Nurse):  In an interdependent role as a member of a health care team, the registered nurse functions to coordinate and evaluate the care of the client and independently revises the plan and delivery of nursing care.  The registered nurse functions in an interdependent role when executing a medical regimen under the direction of an advanced registered nurse practitioner, licensed physician


Historically speaking, for a majority of the past 32 years I have worked at Western State Hospital, the Unit RN4 was the sole Unit Manager for each unit.  Only within the Phillips Administration and Adler Administrations were SEPARATE additional unit manager concepts implemented.  The RN3 was the ward manager who performed quality assurance checks, scheduled training, performed TJC Accreditation preparation, performed CMS inspection preparation,  performed all nursing timekeeping and scheduling, hired all nursing personnel, was responsible for corrective action, completed evaluations, and participated in the patient transfer process representing the entire treatment team of the ward.  For a majority of the past 32 years, it was common for an RN3 to be the ward manager of two wards rather than one.  For a majority of the past 32 years, there was a simple chain of command in which important information would go directly from the RN3 to the Director of Nursing without any additional layers of administrative personnel.  There was no such thing as “upper administration” or lateral duplicate administration positions as exist at this time. 


In the Phillips and Adler Administrations, numerous new layers of administration were initiated which essentially destroyed all previous communication structures.  The Unit Manager name was taken from the RN4 and given to another Administrator who may or may not be a licensed clinician, this Administrator was now the main communication contact with “upper administration,” when previously there was NO FORM of “upper administration” as exists now.  In the Phillips Administration for a few year period, Ward Program Managers were implemented.  Ward Program Managers replaced the traditional role of the RN3 on each ward as it related to coordinating care with the treatment team and nursing personnel.  Thus Ward Program Managers become the chief communicator of ward needs to the newly formed Unit Manager that was not an RN4.  That Administrative Unit Manager become the main communicator to “upper administration” which consisted of yet another layer for administration which was then headed by Rae Simpson, the same person that is now advocating for the return of this concept.  She was one of the few persons that was allowed to see the CSM Report prior to its release yesterday.  For many reasons, the Ward Administrator is a flawed and failed concept which creates additional and unnecessary layers of administration, destroying clear lines of communication and feedback.  When the massive expansion of administration was implemented, suddenly paperwork and forms become unmanageable as the persons that were charged with competing those clinical forms were no longer in the true communication loop.  Simple structures produce supervisor communications over complex ones.  In fact during the Phillips administration, the structures were so complex at even external agencies were unable to trace accountability to anyone as Ward Program Managers were NOT active practicing clinicians, the blame always went to the Psychiatrist, Psychologist, Social Worker, or Nursing Personal.  Further, the Ward Program Manager provided input into employee evaluations blindly as corrective or other action was confidential and not subject to an external administrators knowledge.  It was a nightmare scenario.  Luckily the nightmare did not last long.  


Unfortunately, when the Ward Program Managers were eliminated, shards of numerous additional layers of administration had remained intact creating numerous “upper administrative” structures (silos).  Those structures must be delayered in order to create appropriate and simple structures.  The buck stopped nowhere…  


Now lets look at the position descriptions for Registered Nurse 3 and Ward Administrator.  You will note that the Ward Administrator concept is a redundancy that is not required on any ward.  I point out to the following components of the Registered Nurse 3 position description:


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Ward Administrator Description:  A WPM has no authority to delegate nursing care under the law and is not held accountable by the Uniform Disciplinary Act as the job class has no defined scope of practice under the law as well as no particular required licensure.  A WPM cannot modify clinical assignments of care or modify  assignments of care.  A WPM may not issue a seclusion or restraint order nor can a WPM override a restraint or seclusion when that clinical decision is made.  (An RN3 can.)  Yet the following is the WPM job description:


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In the job description above, what you are seeing is DSHS attempting to place a square peg into a round hole.  Even though they CANNOT legally delegate or clinical care assignments or modify assignments, the appearance must be made that they have some form of supervisory/administrative duty or they cannot meet the criteria for being a Washington Management Services Employee.  This is due to the Washington Management Service Laws.  To be a Washington Management Services employee, one must meet the definition of manager or managerial employee under WAC 357-58-035.  


WAC 357-58-035 

What is the definition of a manager or managerial employee?

In accordance with RCW 41.06.022, a manager or managerial employee is defined as the incumbent of a position that:

(1) Formulates statewide policy or directs the work of an agency or agency subdivision; 

(2) Administers one or more statewide policies or programs of an agency or agency subdivision;

(3) Manages, administers, and controls a local branch office of an agency or an agency subdivision, including the physical, financial, or personnel resources;  

(4) Has substantial responsibility in personnel administration, legislative relations, public information, or the preparation and administration of budgets; and/or

(5) Functions above the first level of supervision and exercises authority that is not merely routine or clerical in nature and requires the consistent use of independent judgment.

[Statutory Authority: Chapter  41.06 RCW. WSR 05-12-068, § 357-58-035, filed 5/27/05, effective 7/1/05.]


I would argue that a Ward Administrator cannot legally meet the above criteria because of the clinical setting and scope of practice issue.  A Ward Administrator COULD meet the criteria if they were a Psychiatrist or Registered Nurse who have authority to modify clinical delegated duties or assignments.  Also, there is mention of term “Administratively Supervises,”  which is not defined under Washington law…  Actually I was unable to find a definition of the term Administratively Supervises, what does it mean?


I suggest that every person review the report in detail.  Based on the reports' contents, I have no confidence in the current DSHS Administration.  It is clear that it was their intent to fraudulently obtain millions of dollars of funding per year based on what they thought was a SECRET report that NEVER recommended such action be taken.  This event shows why transparent government is essential.  The Governor and Legislature should de-fund the “Ward Administrator” concept and utilize that funding to provide sufficient permanent full time direct patient care personnel, food aides, and custodial (environmental) care employees to null out routine overtime use.  This would eliminate the need to retain expensive non-perm on-call personnel and agency personnel that are not part of the basic staffing budget.  


Additionally, license Western State through the Department of Health to turn it into a true “hospital” under Washington Law.  This act would create mandatory reporting relationships (thus preventing routine DSHS cover-ups) and routine inspections through the Department of Health to assure compliance with all State hospital laws, this is something that has never been done in the past.  As stated in past blog entries, DSHS has issued directives to prevent disclosure of serious events.  Becoming a licensed true hospital will prevent the administrative abuses that resulted in Western State losing its accreditation and possibly CMS funding.  Further, all protections that apply under Washington law would apply for the first time for Western State employees, it would be illegal to implement mandatory overtime on certain classifications of personnel and additional food aide personnel would be required to meet safe food laws and standards.  This will require DSHS to discontinue covering up the staffing shortage that DSHS had denied for the past three years.  Request the overtime, agency personnel use, and on-call personnel use numbers for the past year.  DSHS must never be allowed to have direct facility license oversight of itself again. 


I note that communication and reporting relationships is a key issue throughout the consultant report, but in this case the consultants missed the root cause that Western State is NOT a hospital under Washington Law. 


Time for Action!

It has now been verbally confirmed that the top secret CSM Consultant report to CMS did NOT contain any specific written mandate to create a $2.6 million per year expansion of administrative Washington Management Service positions in the form of 28 Ward Administrators.  Numerous freedom of information act requests and public disclosure requests have been made for the top secret CSM Consultant report to CMS.  While the State has done everything in its power to block transparency of government, we expect CMS to provide a copy of the report via the Federal government shortly.  


DSHS Administrators lied to us when they issued the Ward Program Administrator Frequently Asked Questions document.  The Unions were presented by DSHS with an EMERGENCY mandate to initiate WPA’s without negotiation of even IF the positions were required as they represent an extensive and unnecessary change in work conditions.  What occurred was a clear Unfair Labor Practice.  DSHS refused to provide a copy of the CSM Consultant (taxpayer funded) report to the Unions to show the language that allegedly mandated their initiation and justification.  


WPA’s are a resurrection of Ward Program Managers, a failed process that was tried in the past many years ago.  After elimination of Ward Program Managers, Western State Hospital operated with full Joint Commission accreditation and full CMS certification and funding for years at great savings.  Then, the Adler administration came into existence and destroyed everything by expanding administration and administrative support personnel while neglecting and refusing to look at overtime numbers to provide sufficient direct patient care providers.  As stated in the past, I was present when Adler denied that additional direct patient care personnel were required even after Legislators showed him slides of the astronomical overtime numbers.  


It was in May of 2016 that DSHS administration voluntarily and secretly withdrew TJC Accreditation keeping the matter top secret while knowingly (fraudulently) advertising to the public and job seekers that Western State Hospital was fully accredited.  Transparency does not occur within the current Washington government.  What we have witnessed over and over again is cover ups and suppression of information to oversight bodies at WSH personnel.  


Western State Hospital is incapable of operating daily without extensive use of overtime, non-permanent on-call personnel, agency personnel, as well as ever increasing events of mandatory overtime.  Western State Hospital requires enough permanent full time direct patient care providers to null out almost all overtime, as well as eliminate the need to have non-permanent on-call personnel and agency personnel who are not covered under the basic staffing budget.  Rather than use precious funding for sufficient permanent direct patient care personnel, DSHS Administration sees its priority to expand 28 additional and redundant administrative positions to perform functions that are already completed by existing treatment teams.  The reason for keeping the CSM Report top secret is two fold…  Prevent direct patient care providers from seeing the report and providing input on the best way to solve problems with existing supervisory resources, and cover up all the issues during an election year.  The truth is that we can determine exactly how many permanent full time positions will be required.  What the current administration has asked for is grossly insufficient.  The overtime, mandatory overtime, agency use, non-permanent on-call use, speaks for itself.


We simply cannot allow an incompetent DSHS Administration destroy our CMS funding by proceeding down the current path.  We have to act independently to display our rights of free speech to impose transparency upon DSHS by informing the public of what is going on.  We need to assure that the Legislature does NOT allow continued funding of an administrative expansion in lieu of providing permanent direct patient care providers, custodial services personnel, and food aides to null out overtime.  


A petition has been created for all Western State Hospital personnel to sign.  Also, we will be discussing the initiation of informational picketing (RCW 9A.50.060) and scheduling for such events to take place across the street from the Western State Hospital main entrance.  Do NOT participate in informational picketing during your work hours, this must be done ONLY during off duty hours!  We will also be creating appropriate media events and taking out newspaper ads.  


A key point in fixing Western State is to have it become a true “Hospital” under Washington Law.  Western State must become a fully licensed facility through the Department of Health to become a true licensed “Hospital.”  When that happens, it sets up mandatory reporting relationships and would apply existing laws to Western State Hospital that apply to ALL other true hospitals…  For instance, RN Mandatory Overtime is illegal in Washington for true hospitals, but not currently Western State as it is not a hospital under Washington Law.  Currently WSH can cover up events per directives, but if Western State was a hospital under the law there would be MANDATORY reporting relationships with the Department of Health.  This would end DSHS cover ups and incompetent administration as they would be accountable to ALL hospital laws.  This one issue is the true key to assuring that Western State Hospital remains fully TJC Accredited and CMS Certified.  


Working together we can save CMS funding and bring back full TJC Accreditation, despite the current Administration.


I look forward to hearing your input. 

 

Press Conference on Western State Hospital

Please take time to view the press conference by Bill Bryant which occurred earlier today (9/21/16).  In the press conference he makes mention of many issues which I have addressed on my recent blog.  Western State Hospital indeed does NOT need a $2.6 million a year expansion of administration.  The corruption must end.



$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.

OR

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

budgeting,

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.  

RN Union FlimFlam Show!

Today RN’s were told to go to an office to vote “yes” on the next contract which is intended govern RN’s for the next two years.  Zero contract language was presented.  But the following posters were put up with the expectation that RN’s would vote “yes” without ever viewing the exact language of the new labor contract.  This has been posted to allow some RN’s to have transparency as to what to expect.  For 1199NW, please post the exact contract language PRIOR to holding a true vote.  


RN Union Pulling a “Fast One”

If you are like me, you received a newsletter stating “Vote Yes” and a phone call reminding RN’s to vote yes.  If you go the Union Website you see the below image:


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What exactly to they want you to vote “yes” on?


  • Do they want “yes” on spending $2.6 million a year on a new layer of administration (WPM’s) before there are even enough staff to man the wards?


  • Do they want “yes” on having approved wiping out comp time earning on half of all holidays?


  • Do they want “yes” on approving assignment pay instead of permanent wage increases that would actually increases recruitment and retention?


  • Do the want “yes” on approving raises for only part of our RN’s, many of whom do not receive our current assignment pay arrangement?


Ethical organizations and ethical governments assure that there is transparency through public disclosure.  DSHS Nurses do NOT work in a transparent government currently, taxpayer paid consultants provide top secret reports to only a few members of DSHS and the Governor while patient care suffers as there is zero accountability.  The RN Union is NOT an ethical organization which provides its members all the information PRIOR to pressuring its members to vote “YES” sight unseen.  


Within months we will have the option to petition away an unethical labor union that continues these unspeakable and unethical tactics upon its members while collecting our hard earned dues.  Enough is enough.  I recommend a “Yes” vote for a full DSHS RN Union decertification vote yearly next year. 


Note to 1199NW/SEIU:  post a FULL copy of the contract you wish us to vote “YES” on so that we can all read its contents and then hold meetings where members can ask questions at least a WEEK prior to having any form of vote.  The proposed contact can be posted on your website for full length viewing.  


It appears that it is the RN Union’s plan to PREVENT RN’s from reading the fine print prior to the RN Union pressuring RN’s to vote “Yes.”  As a member, we pay the dues and we are the ones that should be running the union, not organizers.  As a dues paying member, demand your right to see the contract and read it in full prior to having to vote “yes” on its contents.  OR…  If you don’t like what you see, or they refuse to provide you a full copy…  VOTE NO! 


By the way 1199NW?  When does the WPA picketing start?

WSH Has 101 Problems But A WPA Isn’t One!

This week we were “told by Administration” that the top secret CSM Report revealed that Western State Hospital has 101 areas where corrections must be made in order to retain CMS funding of $65 million per year.  We have to take administrations word on this as the CSM Consultant Report remains top secret. 


We have encountered a series of lies provided by DSHS/WSH Administration, including the lie that the top secret CSM Report required (mandated) a $2.6 million per year expansion of an additional layer of Administration through the initiation of numerous WPA positions.  I am told that many of these positions have already been promised to specific individuals even prior to the posting of the positions officially.  The concept of the Ward Program Administrator expansion (of a corrupt administration) must be extinguished and those members of the Executive Leadership Team that played a role in secretly eliminating TJC Accreditation and attempting to extort an additional $2.6 million per year from our Legislature must be held legally accountable for their actions.  The actions that were taken constitute a criminal level of misconduct as we learned that the expansion was disguised as being REQUIRED by the top secret CSM Report when it was not. 


Until the Executive Leadership Team members of Western State Hospital that were responsible are replaced, Legislative oversight will be required.  The corruption extends to the Governor level as it was the Governor level that green lighted the funding for the administrative expansion when they had TOTAL access to the CSM Report.   That CSM Report and all future taxpayer paid consultant reports MUST be made transparent and available to the public to prevent similar abuses in the future.  


This week we also learned that Eastern State Hospital has attained full accreditation, without the requirement of additional administrative expansion.  Note that Eastern State did NOT secretly withdraw TJC accreditation.  When I served on the Ad Hoc Safety Committee, I learned first hand the differences between Western State and Easter State “Hospital.”  While Western State massively expanded administration and administrative support personnel as well as administrative equipment, Easter State invested in direct care personnel and patient care equipment.  While Eastern State is a much smaller facility, they were on the correct path.  Western State to this day, even at the point of losing all federal funding, sees its problems as being based on not having enough layers of ADDITIONAL administration while there are not enough direct care providers to operate the hospital without massive daily overtime and hundreds of on-call personnel that do not appear in Western State’s staffing budget (not to mention daily Agency Staffing).  Even when a consultant firm was established (CSM), Western State administrators attempted to extort $2.6 million per year in funding to expand administration and administrative support personnel by lying about the contents of top secret consultant reports.  I do not believe that this is something that CSM had any control over, this is witnessed by the input Doctor Fields provided to the Doctor Union.


It is clear that WSH Administration and Governor must have public oversight established before any other funding is approved for Western State Hospital through the Legislature…  Taxpayers need to know where the funding is going.  I would advocate for almost all additional funding going to direct patient care provider positions and to establish competitive wages for recruitment and retention.  Western State Hospital administration needs to be delayered, this is where great savings can be found for the expansion of direct care permanent positions to a level where DAILY overtime will no longer be required. The elimination of the illegal WPA expansion alone will provide an additional $2.6 million per year to help accomplish this task (which the Governor level has apparently already approved). 


My immediate recommendation is to utilize Easter State administration to lead Western State during this CSM Consultant correction period.  Easter State apparently has the correct leadership philosophy.  The current WSH CEO and Executive Leadership Team members that are responsible for the recent actions and lies must be replaced by competent personnel.  Teleconferencing can be utilized during this period of time.  Another option is to utilize an interim CEO that we had in the past who did an outstanding job prior to being replaced by the Adler Administration, she was on loan to us from Eastern State.  This interim CEO lives in the eastern part of the state, perhaps she can lead through teleconferencing during this period while CSM Consultants remain present daily at Western State.


The Legislature must address the fact that neither Western State nor Eastern State are a true “hospital” under Washington law, this is an unaddressed artifact of the old institution days and must be corrected.  This is THE root cause of failure.  DSHS facilities MUST be licensed to operate under the Department of Health as are all other hospitals in the State.  Once licensed by the Department of Health, mandatory reporting relationships will be implemented.  DSHS will not be able to routinely violate hospital laws, cover up major events, and violate health standards as they have done in the past by claiming they are not a hospital.  Further, all laws that apply to protect hospital employees and patients would now apply to DSHS facilities once they are properly licensed.  This would create the additional problem that DSHS facilities cannot currently meet the standards required of a licensed Department of Health Facility.  Thus, the Department of Health will have to work with the Consultants to bring ALL standards to a level of safe patient care and safe staffing environments for the first time in Western State history.   


If the current level of administrative incompetence at Western State Hospital was eliminated, I believe that the CSM Consultants working with the Department of Health and Legislature can have Western State become a licensed true HOSPITAL under Washington law which is CSM credentialed and TJC accredited within the current Systems Improvement Agreement timeframes.  To accomplish this, the Legislature must move QUICKLY!  


Unethical & Unfair Labor Practices by DSHS 9/8/16

Today I have been bombarded by data regarding the $2.6 million per year proposed expansion of Western State Hospital administration that WSH Administration stated was the result of a top secret CSM Consultant report.  I had outlined this in my previous blog entry entitled Cover Ups, Government Corruption, Wasted Taxpayer Funds.  


The information I have received from many levels today indicates that the Governor, DSHS Administration, Western State Hospital Administration, and Executive Leadership Team are completely corrupt and are not to be trusted.  There was an active attempt to commit an unfair labor practice by attempting to restrain and coerce employees from exercising their rights to negotiate changes in work conditions by DSHS falsely claiming that a top secret CSM Consultant Report was compelling them to create a $2.6 million expansion of administration in order to meet Systems Improvement Agreement requirements to regain CMS federal funding of $65 million per year.  The level of corruption involved is staggering, a full and complete external investigation of this matter needs to be initiated immediately.  Please review the document called Ward Program Administrator FAQ.

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I was present at a Supervisor Meeting last week where the CEO and Executive Leaders ALL stated that the top secret CSM Consultant Report mandated that DSHS implement Ward Program Administrator positions at Western State Hospital and because of this, these positions would be implemented immediately.  There was no communication that I am aware of with any Union regarding this matter prior to this meeting. 


Today (9/8/16) the physician union (UPW) members met with Doctor Fields from CSM Consultant firm.   Doctor Fields explained that the decision to have Ward Program Administrators came from the Western State Hospital Executive Leadership Team.  Doctor Polo (Medical Director) confirmed that the decision to have Ward Program Administrators was indeed decided in an Executive Leadership Meeting, exclusive of CSM, in which there was zero Union input.  In short, DSHS Administration and WSH Administration have been lying to all of our staff as they had done with the accreditation issue. 


Today the RN Union (1199NW/SEIU) met with the CEO and members of executive leadership.  They were fed the same lies about being compelled to expand administration by $2.6 million per year…  But DSHS was now willing to change some job description information.  This highlights the level of the unfair labor practice infraction they were involved in.  The RN Union was NOT notified that CSM Consultants did NOT require the $2.6 million dollars administrative expansion in their report to retain the $65 million dollar a year CMS funding.  Not only was this an unfair labor practice, but it was an attempt to fraudulently obtain an additional $2.6 million dollars a year in needless funding of taxpayer money while setting up a situation where a labor union UNKNOWINGLY was participating in creating criteria for a position that was NOT required which would be a determent to its membership and patients.  Apparently the Governor’s office was willing to allow this fraud to continue through providing initial funding of the initiation of these fraudulent and unneeded positions.  Taxpayers must be defended. 


I am told that tomorrow 9/9/16, Local 793/WFSE was to undergo the same type of fraudulent meeting.  To WFSE…  Demand a copy of the CSM Report, demand to know who (by names) initiated the fraudulent WPA positions so that law enforcement can perform its duty.  


To Legislators, we need oversight at this time at Western State Hospital.  DSHS and Governor level have proven the level of corruption they are willing to undertake during an election year to gain taxpayer funding for needlessly expanding administration by many millions per year in lieu of providing much needed direct care positions that would improve patient care and lead to retaining of federal funding.  


We the employees of Western State Hospital ask that our Legislators stop the insanity! 

Cover Ups, Government Corruption, Wasted Taxpayer Funds

This past week we learned that Western State Hospital voluntarily and with great secrecy withdrew its Joint Commission accreditation on May 24, 2016 while it continued to advertise it was fully accredited and lied to its staff members for months.  We learned that even members of the WSH Executive Leadership Team were kept in the dark about the secret accreditation withdrawal.  We saw DSHS Administration lie to its employees in statements regarding that withdrawal.  The CEO falsely stated that the withdrawal occurred in June 2016 while the Assistant Secretary of DSHS falsely stated that there was a communication error when it appears there was actually a full blown cover up.  We have a current WSH administration that simply cannot be trusted.  They have lied every step of the way.


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This past week we also learned that the taxpayer funded consultant group CSM report was released and that DSHS has stated the recommendations of the taxpayer paid consultant group would be kept secret, with DSHS refusing to release the report (or ANY future consultant report) under public disclosure law.  Then a meeting was held by the CEO telling supervision that, based on the leadership teams’ self interpretation of the top secret CSM consultant report by the several individuals that were allowed to see it, Western State Hospital is compelled by the secret report to create an additional $2.6 million dollar a year additional layer of administration called “Ward Program Administrators” in lieu of spending these funds for adequate direct patient care personnel.  The announcement was for 28 Ward Program Administrators (WPA’s) to lead day to day non-clinical operations at $85,000 to $93,000 per year.  


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This is a repeated effort to implement a failed process that had failed and been shut down in the past.  The last time DSHS did this, it was funded through vacant registered nurse position funds.  There was a $60,000 variation in wages for many ward program managers that performed the identical duty.  Not only did the Office of State Auditor play a role in the shut down of that corrupt program, but Labor and Industries also submitted reports which assisted shut down the program based on unclear and confusing chain of command structures the program produced.  These reports are public record.  It is believed that if the CSM Consultant Report was allowed to be viewed by the public, no reasonable person would conclude that an additional layer of administration would be required and that existing clinical supervisory structures could be enhanced through the provision of additional direct patient care personnel at a fraction of the cost with superior clinical results.  I ask that the legislature view the top secret taxpayer paid CSM Consultant Report and disapprove the funding for an additional layer of administration at a cost of $2.6 million dollars per year, and above all… Let taxpayers see all consultant reports which they (the tax payer) have paid for.    


Two years ago DSHS requested zero additional full time direct patient care positions from the legislature at a time when overtime use was off the charts.  Only this year were some 50 additional RN2’s requested, when 114 was what was required.  In addition to that we required approximately 10 additional full time LPN positions and approximately 40 additional nurse aide class employees.  In addition we require over 40 food aides in order for direct care providers to not have to prepare bulk delivered food (plate and proportion) for over half the wards of Western State Hospital.  The lack of direct care providers is the true issue.  Because we are so sort of direct patient care providers, nursing supervisors are often required to perform direct patient care duties in lieu of supervisory duties.  This is the root cause of failure, another layer of supervision will accomplish nothing.  Western State Hospital is not functional because there are insufficient direct patient care personnel to provide for active training and coverage for leave. This staffing deficit has existed for years due to incompetent DSHS Administration that blindly continues (to this day) to see the problem as there never being enough administrative personnel to micromanage the massively understaffed direct patient care class of personnel.


The current Governor and DSHS Administration have taken unusual levels of action to prevent transparency of government and prevent active reporting relationships from occurring through numerous processes to assure patient safety.  I believe that these actions have been implemented to keep patient care concerns and critical incidents silent during an election year.  Patient safety has never been at greater risk than during this period of time, when directives have been issued by Administration to PREVENT reporting of events to external agencies.  We need transparency and open communication with our legislators. 


Not only has DSHS Administration severed mandatory reporting relationships with the Department of Health, it secretly severed mandatory reporting relationships with The Joint Commission, and has essentially severed direct accountability with the Centers of Medicare Services (CMS) by entering into a Systems Improvement Agreement where top secret (taxpayer funded) recommendations are being issued and interpreted by one or two Governor approved Administrators, the reports are only accessible to the Governor and a couple of WSH Administrators.  What is going on is unethical, inappropriate, and dangerous.  


The Office of State Auditor has been notified of some of the inappropriate actions, including the fact that when the Governor secretly withdrew accreditation, he may have also inadvertently withdrawn the deemed facility license for Western State Hospital to operate legally.  


In the upcoming weeks the Labor Unions must take the following actions:


  • Unfair Labor Practice charges must be filed for secretly withdrawing accreditation without informing any union of this important change in work conditions, additionally DSHS knowingly advertised to union members that WSH was fully accredited when it was not in order to entice more employees to apply.
  • All unions need to file a Demand to Bargain to address the change in work conditions resulting from an additional and unnecessary $2.6 million dollar a year expansion of administration.  
  • Informational picketing must be initiated to inform the public of the massive waste in public funding that is being initiated based on a top secret taxpayer paid consultant report which DSHS claims will never be disclosed to the public that results in expansion of administration by $2.6 million dollars per year in lieu of providing adequate DIRECT patient care staffing.  
  • All staff members of Western State Hospital need to call or visit their legislators to inform them of what is occurring.  This is an election year, we need to vote out those legislators that support secret taxpayer paid consultant reports that cannot be viewed by the public and massive expansions of administration while patient care suffers.  



© Paul Vilja 2017