The Spiral Continues

CMS has placed another immediate jeopardy status upon WSH with additional citations to follow from their current inspection.  CMS issued this letter to extend federal funding until April 1, 2016 at which time WSH must resolve all issues which have been presented.


During this period of time WSH Administration has initiated terror tactics against its employees.  Doctors received memos which were intended to intimidate them from openly providing information to CMS.  During this period the President of the Doctor Union (UPW) was reassigned away from the hospital with another doctor that was involved in union issues and recent negotiations.  The elected Medical Chief of Staff was routinely excluded from administrative meetings and was told that the Medical Director would redefine the role of the Chief of Staff in the future…  As a result the elected Chief of Staff resigned.  This resignation was discussed on this TV program.  The medical staff met and chose to elect the President of the Doctor Union to the elected Chief of Staff position (who was currently reassigned by administration away from the hospital).  The previous Chief of Staff was elected Vice Chief of Staff.  The doctors and direct patient care employees truly work in a hostile work environment currently under the current administration.


The spiral of incompetence began when DSHS hired the current CEO by entering into a multiyear contract the new CEO.  This resulted in the CEO not having to listen to, or interact with the personnel that have kept WSH accredited and in good standing for a decade.  When the new CEO arrived, I was the RN Union Chair & Executive and thus met with him every two weeks with other Labor leaders.  At each meeting we presented that there were vast shortages of staff that needed to be addressed.  We presented that there were insufficient food aides, resulting in direct nursing care employees PREPARING bulk delivered food for patients for over half the wards on a daily basis.  We presented that we did not have enough registered nurses to assure that three licensed staff were provided for each ward for each shift to meet high alert medication requirements.  We presented that over 170 additional full time direct patient care positions were required to null out overtime levels that were unsustainable.  The CEO very often stated “I will not be seduced into discussing staffing.”  When safety issues were presented, such as wards E7 and E8 having no seclusion rooms to apply lesser restrictive measures than restraints and direct contact, the CEO would just reply he was against it.  I participated in several hiring panels for administrative positions, in NONE of the panels did the CEO hire the panel recommended candidate, indeed each CEO hiring decisions involved hiring a lesser or unqualified candidate.  The CEO did not wish to listen to the Medical Director input, thus he terminated the Medical Director contract and did not replace that position in violation of law.  When FORCED, the CEO appointed an unqualified Medical Director (beholding to him).  When the Department of Health determined the Medical Director was unqualified by law, other appointments were forced upon him.  In early 2015 the CEO eliminated all yearly competency training that occurred for all direct patient care employees.  This has resulted in zero direct patient care competency training that has directly DESTROYED the quality of care provided.  The CEO eliminated the earning of comp time for half of the holidays of the year and also initiated routine mandatory overtime use.  This has resulted in massive recruitment and retention issues. 


Note that the root cause of this problem was hiring a CEO into a multiyear contract for the first time in WSH history.  Let me make this clear…  The current CEO is the root cause of the current situation.  The buck stops with the current CEO of WSH.  The doctors were correct to file two no confidence votes with DSHS, this is why the doctors are incurring the terror tactics of the CEO currently.  EXACTLY why were the two doctors reassigned?


For any legislators that may be reading this…  As a 30+ year employee of Western State Hospital I recommend the following actions:


  • Replace the current CEO, paying out his multiyear contract.  Never enter into a multiyear contract for any administrator in the future.


  • Review the qualifications of ALL hires (hired by the CEO) as well as hiring committee recommendation documents to determine which administrators should remain employed by WSH.  (Were they qualified for their position?)


  • Consider replacing the CEO with a Superintendent (a licensed psychiatrist who would perform the CEO and Medical Director duties both) as a cost effective approach AND implementing a medical supervisory model for WSH. 



  • Review ALL non-direct patient care hires that were made since the new CEO arrived including their credentials to hold that position.  Should misconduct by CEO be found, prosecute him. 


  • Replace the HRMS payroll system which does NOT record unscheduled absence or the actual time worked by an employee.  HRMS only records types to leave used and “completed shifts.”  When this occurs, extensive abuse and waste of public funding will be exposed saving the State millions of dollars per year.  Replace HRMS with a productivity recording system like KRONOS which DOES record unscheduled absence and the actual time worked.  This would result in the ability for DSHS to produce staffing productivity data and actually pay for itself.  


  • Immediately reinstate direct patient care personnel annual competency training.  Ultimately this is the only way we can properly address the immediate jeopardy findings and citations…  Rather than create additional audit paperwork that covers up the fact that since early 2015 the CEO eliminated all competency training.  


  • Due to the extreme level of threats and intimidation created by the current CEO’s administration, bring in a communication liaison that has never served within a WSH administrative capacity (as was implemented recently for WSH).  Much administrative misconduct has occurred, employees should be made free to report it.  


  • We DO have the exact numbers of full time positions that are required to null out overtime, provide a minimum of three licensed staff per ward per shift, provide proper coverage for scheduled as well as unscheduled absence, as well as training.  This would eliminate the need for on-call staff.  WSH requires an additional 104 RN2’s, an additional 10 LPN’s, and 62 nurse aide class employees (MHT/PSA/IC)…  These are hard numbers supported by the WSH 2014 year data.  2015 year data is inaccurate as the CEO eliminated training that year.  As for food aide’s, they provide coverage for less than half of our wards for breakfasts and dinner meals due to having two unproductive shifts when “dietary shifts” would have increased this coverage.  With the current unproductive shifts, the number of food aides must be doubled.  With good management and modification to dietary shifts, this number could be greatly reduced. 


© Paul Vilja 2017