July 15, 2014 DSHS Proposal to Close Wards to Fund PERT Team

Western State Hospital received a safety grant which allowed one year funding for the implementation of a Psychiatric Emergency Response Team (PERT).  That grant funding will end in January 2015 if the Legislature does not provide funding for PERT to continue.  Since implementing PERT, safety statistics have indicated positive results.  

As a result, DSHS has created a State Hospital Safety and Enhanced Community Treatment Proposal which includes the plan to close two wards in order to fund PERT past January 2015.

Although PERT has produced positive safety results, there are many issues that remain to be ironed out at WSH:

  • PERT does not consistently record into clinical records the therapeutic interventions which produced a positive result.  Thus treatment teams have not received consistent PERT documentation of how clinical approaches can be modified within the patients’ treatment plan.  Clinical documentation in medical records by PERT is almost nil.  

  • Physicians and RN’s report that lack of collegial interaction with PERT is chronic.  RN’s (and MD’s) are blamed by the CEO when an emergent event requires that clinical intervention be initiated. PERT has claimed they were not informed with sufficient notice to prevent many emergent events from occurring.  While doctors and nurses MUST document interventions in detail, no documentation is required by PERT as yet.  Thus doctors and nurses WILL be second guessed while PERT cannot be.

  • PERT has no accountability for completing regular ward rounds or for having any assigned ward jurisdiction.  There is no current form of milieu documentation process for PERT to track when ward rounds were made and when actions to prevent emergent events were taken or what those actions were.  This data must be tracked to support the current statistical results.  

  • Currently ward personnel are not informed of which PERT members are on duty each day.

  • Was PERT responsible for the positive results or was greater milieu awareness and intervention training of medical personnel what ACTUALLY resulted in the positive safety statistics?  That has not yet been determined. 

In order to address the above problems, SEIU filed an information request to get redacted documents for the past month regarding medical record documentation completed by PERT.  Weeks have passed, no documentation as yet has been produced by WSH.  This is very concerning.   It is an indicator that when PERT was created, additional training in milieu management was provided to care providers which may have actually resulted in the positive safety statistics change, instead of this being the direct result of only PERT itself.  Clinical documents will identify which was responsible for the positive changes.  

Now DSHS wishes to shut down two wards in order to retain funding for PERT.  Thus accountable medical personnel who specialize in the care of traumatic brain injury and older adult care (sixty patient beds) will be eliminated in order to retain minimally medical credentialed personnel to act as (currently unaccountable) PERT milieu monitors.  The exchange of services that DSHS proposes will hurt the community as well as further minimize traumatic brain injury resources that are available in Washington.  PERT as a program has much to offer for WSH and DSHS, but the price that DSHS is proposing to pay (closure of two wards with a total of sixty beds that specialize in traumatic brain injury and older adult care) is not worth it.  

I look forward to working with the Traumatic Brain Injury (TBI) Counsel to defeat this ill-advised DSHS proposal by informing the public of the true losses in community services that this proposal represents.   

I urge that you contact your Legislator to prevent the further eroding of Traumatic Brain Injury resources and older adult care within Washington.


© Paul Vilja 2017