Blog WSH

Replace The CEO

DSHS Administration up to the Secretary of DSHS has been consistently provided feedback to replace the current CEO.  The doctors of WSH have had two votes of no confidence in the CEO, each was transmitted to the Secretary of DSHS (with no resulting comment or action).  When the CEO came to WSH, I was the Chair and Executive of the RN Union.  I had a front row seat in observing the crash of Western State Hospital to the near elimination of Federal funding.  

Since day one of the current CEO, I observed that the CEO was incapable of understanding any clinical input that was provided.  I noted that the current CEO had zero understanding of the uniform disciplinary act or nurse practice law.  What was unique was that this CEO came in with preconceptions which blocked him from even contemplating what was presented to him on a daily basis.  Those preconceptions were apparent in this CEO’s record while serving in Alaska, yet DSHS still hired him.  

Prior to the current CEO being brought to WSH, an interim CEO was placed into the CEO position of WSH.  Dr. Mary Ann Keogh Hoss Ph.d., CTRS, FACHE, FDRT served as the interim CEO.  I have served at WSH for over thirty years and can state that she was the most competent CEO that Western State Hospital had ever seen.  Her “no nonsense” approach and ability to listen to clinical concerns differentiated her from all other CEO’s that had served at WSH prior to her appointment.  Her leadership alone resulted in the implementation of a staffing software program (Scheduler) at WSH which allowed DSHS to track staffing performance data for the first time in DSHS history.  Her rapid actions and leadership skills allowed WSH to create additional staffing during a several month period that WSH experienced lower admissions in CFS, saving the DSHS budget great amounts of money.  I think that the most important component of her qualifications was that she was a clinician who understood the input that was provided from her clinical personnel.  Most of all, she listened to her clinical staff and UNDERSTOOD what was being presented to her from a point of personal knowledge.  During her tenure as Interim CEO of Western State Hospital she recognized the need for further education for WSH clinical supervisors and EXPANDED training to supervisors, teaching the classes herself.  

In contrast, the current CEO is billed by DSHS as also being a qualified clinician from Alaska.  As the Chair and Executive of the RN Union at that time of his arrival I noted that the current CEO simply disregarded all clinical input provided to him.  It is my personal opinion that the current CEO simply was unable to relate to, and understand any clinical input that was provided to him.  Immediately upon his arrival, input regarding the extensive staffing shortage was provided to him in detail…  To which he responded “Paul… I will not be seduced into further discussions of staffing.”  WSH held biweekly meetings between the CEO and labor which was called the “Solutions Group.”  I personally witnessed the current CEO (with HR supervisors and labor relations personnel present) lose his temper, act inappropriately, and walk out of meetings.  During one of these tantrums by the CEO, I asked the WSH head of HR if such behavior was appropriate?  There was no response.  These abuses of authority continued without response from HR or other witnesses to these meetings.  The current CEO so intimidated the members (administrative leadership persons) at these meetings that they never provided truthful direct feedback for what I perceived was fear of retaliation.  

I can also address how current level of incompetence at WSH occurred…  I had served on several administrative level hiring committees.  In no administrative hiring committee on which I served did the current CEO hire the recommended candidate by the committee…  in fact on all occasions, he hired individuals that the majority of committee members thought were either unqualified or less qualified.  Apparently this behavior is a continuation of his past behaviors in Alaska.  I reference the following incidents that are recorded on the internet (of which until recently I had no personal knowledge):

It appears that the current CEO fails to listen to WSH committees and operates within his own perceived “reality.”  This is true of his unique implementation of PERT (Psychiatric Emergency Response Team) where he took clinical control of this process and actually assumed clinical control over psychiatric practice which resulted in complaints to CMS, TJC, and the Department of Health…  As well as citations issued by all against WSH.  The current CEO received numerous recommendations by the Safety Committee to provide for hardened seclusion rooms for every ward to provide safety for patients and staff, which he openly opposed over the objections of the committees and clinical personnel.   This is demonstrated by the following document:

Seclusion rooms provide for less restrictive approaches than to make physical contact with patients with restraint processes.  The CEO is singly responsible for preventing wards E7 and E8 from having hardened seclusion rooms which has resulted in patient and staff injuries.  The Central Safety Committee and East Campus Safety Committee endorsed and priced the addition of these important safety considerations for each ward.  The current CEO’s rational for this was the equivalent of arguing that fire extinguishers should not be provided because we are opposed to fires…  Recommendations of committees are often directly blocked by the current CEO due to his own unique interpretation of “reality.”

Staffing concerns had been presented to the current CEO since his arrival.  I was present when the CEO went before the Legislature and stated that no additional full time direct patient care staffing would be required at WSH even after Legislators pointed out the vast use of overtime which was occurring.  Again, the CEO’s own “reality” did not match the input of clinical staff at WSH.  The first action of the current CEO was to eliminate an RN position in the patient clinic, this is a matter of record.  Next he disregarded the staffing plans which were submitted to him, never responding to them…  A mathematical staffing model was created which indicated the EXACT number of full time positions that would be required to null out overtime and provide adequate care for patients at the current level of care…  This data was completely disregarded.  Instead, rather than hire the necessary full time positions, two day per week on-call personnel and float positions (non-permanent personnel) were created to the detriment of care at WSH.  

This past year the current CEO ELIMINATED all competency training of direct patient care personnel in order to cover up the short staffing issues that he had ignored since his arrival.  In January of 2015 the Joint Nurse Staffing Committee issued a report to him with staffing recommendations to which he never responded, even though through labor contract he was required to respond within 90 days.  Utter disregard to laws and standards is the hallmark of the current CEO. The current CEO created a massive expansion of WMS (Washington Management Services) administrative support personnel to help cover up what he had done with regard to failing to address inadequate staffing…  He hired additional administrative support personnel to handle the staffing office to coordinate the on-call two day per week personnel.  When this had zero impact on overtime, the current CEO ordered that all competency training of direct care personnel would be DISCONTINUED in early 2015.  The elimination of all training did reduce overtime numbers, it also endangered the patients and prevented staff from being properly trained.  The elimination of all training of direct patient care personnel directly violated what the Ad Hoc Safety Committee recommended.  The Ad Hoc Safety Committee results stated that DSHS would EXPAND training with additional staffing, not eliminate it has the current CEO had ordered. 

Because of the current CEO Administrative appointments, each of which was counter to what which each hiring committee recommended, incompetent or less qualified personnel have been appointed into every key position since the current CEO’s arrival.  Each appointment has been beholding to the CEO as a result.  Surrounded by “yes persons,”  the current CEO has been able to enforce his own conception of “reality” without ever having to comprehend the input that was provided to him by clinical care personnel.  Also by surrounding himself by “yes persons,” HR and other checks and balances within the system have been thwarted.  When the current CEO departs, many lawsuits will follow pertaining to his behavior and discriminatory actions (hostile work environment) imposed against personnel that have tried to address what is currently occurring at WSH.  The hospital keeps copies of all hiring committee records, this issue IS a matter of record. 

The current CEO eliminated the Medical Director in direct violation of RCW 72.23.030 in early 2015 and did not appoint a qualified psychiatrist to replace the position until forced to do so…  As with his other appointments, when he was forced to make an interim Medical Director appointment he placed an individual into the position who would be beholding to him because the person did not meet statutory standards or qualifications for the position.  This issue was one of the immediate jeopardy issues that was filed by CMS against WSH.  The current CEO was FORCED to appoint a qualified interim Medical Director immediately or face loss of Federal funding.  CMS viewed the issue as presenting an immediate threat to the lives of our patients.  WSH had operated MONTHS without a qualified Medical Director.  The current CEO even stated to medical staff in writing that he had consulted with the Office of Attorney General who had allegedly told that it was legal to continue to have an unqualified Medical Director.  As stated, the current CEO operates within his own unique “reality.”

The solution to this issue is to replace the current CEO with a “Superintendent” by hiring a candidate that is a qualified psychiatrist who can act as the CEO and Medical Director (both) as a cost effective solution to the current problem.  There are two candidates that I would suggest at this time…  Dr. Joseph Wainer (new Medical Chief of Staff) or Dr. Brian Waiblinger (previous Medical Director that was eliminated by the current CEO).  Either could assume the duties of both the Medical Director and CEO (simultaneously) while having to only pay for one position rather than two.  This would allow a clinically skilled leader to provide CLINICAL leadership for WSH while being able to comprehend the data provided daily.  This action would prevent the loss of Federal funding. I apologize to the two named persons whom I hold in high esteem for presenting their names…  Neither had any knowledge that I would do this.  I am sure that our Medical Leadership would support either candidate.

As stated before, I am presenting my personal views as a private person.  I do not present any of my views as a representative of DSHS or any union.  

DSHS Nurse Abuse

Recently the CEO of WSH has mandated multiple mandatory overtimes while stipulating that RN’s must be scheduled to only one RN2 per ward “regardless of staffing numbers” (for holidays).  This incompetent approach, supported by the Secretary and Assistant Secretary of DSHS has resulted in massive overtime use and endangerment of patients.  “Communication meetings” have been held with the Secretary and Assistant Secretary of DSHS with ZERO positive results.  The incompetent directives and procedures remain in place to devastate staffing, destroy the DSHS budget, and endanger our patients.  What we are now witnessing is disgusting as well as being an insult to our intelligence.  What we are also witnessing is patterned behavior by the current WSH CEO.   See the below headline about our CEO’s actions in Alaska:

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For weeks now, DSHS has implemented mandatory overtime at Western State Hospital.  Employees who do not know our patient treatment plans nor individual ward procedures have been assigned to provide patient care.  DSHS has through its holiday scheduling practices mandated a thirty-to-one patient to staffing ratio for RN2’s.  This level of overload prevents the meeting of standards on a daily basis and horribly endangers clinical care.

DSHS currently compensates its licensed nurses (RN’s and LPN’s) twenty percent below the private sector.  This results in continually increasing vacant position numbers.  WSH is already at the breaking point of being able to provide clinically safe care as has been demonstrated by the recent CMS (Medicare/Medicaid) surveys.  Has DSHS asked the Legislature for the additional 104 RN2, 10 LPN, and 64 nursing aide FTE’s?  Has DSHS asked the Legislature for the amount of Food Aides required to provide for full meal service beyond less than half breakfast and dinner daily meals?  The answer is NO!  WSH has only hired more administrative support personnel and on-call personnel that work only several days a week to cover up the incompetence of DSHS administrators.

Here are some interesting and true facts about DSHS.  DSHS payroll system does not record unscheduled absence in any permanent records, thus no employee productivity data can ever be produced.  DSHS has cut deals with various unions to falsify payroll information within public records.  Some overtime-eligible employees (the minority) work eight hours per day for eight hours of paid wages at the collectively bargained hourly wage rate.  The majority of overtime-eligible employees work only seven hours and forty five minutes per day (or 8 work days less per year than the other employees) for eight hours of compensation at the collective bargained hourly wage rate.  This illegal falsification process is called “transition time.”  The falsification of DSHS wages occurs through CIBS (Consolidated Institutional Business Services) by their transcription (of false data) to HRMS (Human Resource Management System) which conducts payroll duties.  

Are nurses treated differently within DSHS than with any other employer within Washington?  The answer is yes!  Only DSHS nurses are exempt from mandatory overtime exemptions that are afforded to all other nurses within Washington.  I present the following data which is provided through the Labor & Industries website:

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The above copy is abbreviated.  See complete copy here.

Of special note to DSHS nurses is the following:

  • State psychiatric hospitals.
  • Other state facilities operated by the Department of Social and Health Services.
  • Home health facilities that do not operate under the license of another health care facility.
  • Nursing homes that operate under their own license.

Yes, within Washington, only DSHS nurses can be discriminated against to work mandatory overtime regardless of the danger.  DSHS nurses work within the most dangerous environment within the State

It is time that RN’s and LPN’s worked together to lobby the Legislature for equal nurse protections under the law.  DSHS abuse of nurses must be ended and DSHS must change to meet the practice standards of the current century.  Our Federal funding is at risk for good reason.

WSH requires an immediate change in leadership to survive.  I recommend that a qualified psychiatrist be appointed by the Governor to act as the CEO and Medical Director (both) at WSH for a cost effective resolution to the clinical incompetence demonstrated by current WSH Administration. I demand compliance with:

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As is stated in my cover page…  The views presented here are my own and do not represent those of DSHS or any labor union.  I am expressing my personal opinion as a 30+ year nursing supervisor employee at WSH who has participated and co-chaired numerous WSH committees over the past decades.  I have also served many past terms as the Chair of the RN union.  What was presented is my honest opinion of the current situation at WSH.

© Paul Vilja 2017