WSH Root Cause of Failure and Solution

A document was created by Deputy Assistant Secretary of DSHS (and interim WSH CEO) on 4/14/16 which  illustrates why Western State Hospital requires an oversight body (overseeing all DSHS actions) and why DSHS can never be trusted to operate “hospitals” without having its “hospitals” meet the definition of hospital under Washington Administrative Code.  If Western State Hospital was audited, it would become known that DSHS is adept at suppressing information from being presented to the legislature, public, and accreditation and regulating bodies.  The creation of this document actually points out the root cause of the current quality problems at Western State Hospital. 


Protections and laws which have been passed to create transparency, safety, and oversight to Washington hospitals do not apply to Western State Hospital or Eastern State Hospital because under Washington law neither is a “hospital” and DSHS actually takes proactive actions (like 16-04-001) to prevent meeting basic standards that would apply in any other hospital, from applying at state hospitals.   


In her document, the interim CEO states:


  • Note: Per WAC 246-360-010(27), State Hospitals do not meet the definition of hospitals and are not required to report Adverse Events to DOH.  The hospitals may determine an event should be reported as curtesy to DOH.


WAC 246-320-010


For the purposes of this chapter and chapter 70.41 RCW, the following words and phrases will have the following meanings unless the context clearly indicates otherwise:

(27) "Hospital" means any institution, place, building, or agency providing accommodations, facilities, and services over a continuous period of twenty-four hours or more, for observation, diagnosis, or care of two or more individuals not related to the operator who are suffering from illness, injury, deformity, or abnormality, or from any other condition for which obstetrical, medical, or surgical services would be appropriate for care or diagnosis. "Hospital" as used in this chapter does not include:

(a) Hospice care centers which come within the scope of chapter 70.127 RCW;

(b) Hotels, or similar places, furnishing only food and lodging, or simply domiciliary care;

(c) Clinics or physicians' offices, where patients are not regularly kept as bed patients for twenty-four hours or more;

(d) Nursing homes, as defined in and which come within the scope of chapter 18.51 RCW;

(e) Birthing centers, which come within the scope of chapter 18.46 RCW;

(f) Psychiatric or alcoholism hospitals, which come within the scope of chapter 71.12 RCW; nor

(g) Any other hospital or institution specifically intended for use in the diagnosis and care of those suffering from mental illness, mental retardation, convulsive disorders, or other abnormal mental conditions.

Furthermore, nothing in this chapter will be construed as authorizing the supervision, regulation, or control of the remedial care or treatment of residents or patients in any hospital conducted for those who rely primarily upon treatment by prayer or spiritual means in accordance with the creed or tenets of any well-recognized church or religious denominations.


Please note that the definition of “hospital” in this antiquated law compares psychiatric hospitals as being in the same class as “any hospital conducted for those who rely primarily upon treatment by prayer or spiritual means in accordance with the creed or tenets of any well-recognized church or religious denominations.”  This dates back to institution / asylum days.  


Psychiatric care has evolved greatly in the past twenty years from an institutional warehouse to a true modern accredited hospital with modern medications and full active treatment, positive outcomes, as well as transitions back into the community.  Western State Hospital and Eastern State Hospital have been accredited by The Joint Commission and CMS as meeting the criteria for “hospital” nationwide.   Unfortunately Washington law has failed to evolve and DSHS Administration intends to keep it that way.  DSHS mismanagement and abuses will become common knowledge if the legislature strikes out WAC 246-360-010 subsection 27 part “g.”   If the Legislature was to make Western State Hospital and Eastern State Hospital a “hospital” under Washington Administrative Code and the Revised Code of Washington, numerous levels of oversight and accountability would apply AUTOMATICALLY.   Document 16-04-001 was intended to eliminate transparency, accountability, and notification of credentialing authorities such as DOH and CMS.  That document specifically states:


  • State Hospitals are not required to report adverse events to the Department of Health.  State Hospitals do not meet the definition of “hospital” under WAC 246-320-010(27).

  • The State Hospital my choose to report an adverse event…   


This is an action that was taken to prevent oversight, accountability, and transparency which would automatically apply to any hospital under Washington law.  Rather than DSHS reporting to the Legislature that WAC 246-360-010(27) was antiquated and recommended for removal and modification to make Western State Hospital and Eastern State Hospital into a “hospital” under Washington law, DSHS moved to cover up events rather than going through the process to improve care and learn from the errors.


The initiation of Document 16-04-001 also signifies an assumption that Western State Hospital will “choose” not to report events to the Department of Health as no person would be held accountable for “not” reporting.  The document is actually intended to discourage reporting of a Facilities Complaint to the Department of Health by employees as such reporting is no longer mandatory as a duty of the employees’ licensure (according to DSHS).  Thus reporting a Facilities Complaint to the Department of Health requires an employee to be a whistleblower, thus opening the possibility of the employee being subject to retaliation by DSHS…   As has occurred on many occasions and is occurring now.



Once the Legislature makes Western State Hospital and Eastern State Hospital a “hospital” under State Law…  The following will occur:


  • Eastern and Western State Hospital would be licensed to operate by the Department of Health (rather than DSHS itself under its own oversight) and be mandated to operate under Department of Health oversight and mandatory reporting criteria like ALL other hospitals within Washington.

  • DSHS cover ups would become an artifact of past institutional practices and WSH & ESH would become modern hospitals under Washington law, as they already ARE as accredited hospitals.

  • RCW 49.28.130 will apply to Western and Eastern State Hospital.  Mandatory overtime protection laws will apply to WSH/ESH for the first time.  Finding—2002 c 112: "Washington state is experiencing a critical shortage of qualified, competent health care workers. To safeguard the health, efficiency, and general well-being of health care workers and promote patient safety and quality of care, the legislature finds, as a matter of public policy, that required overtime work should be limited with reasonable safeguards in order to ensure that the public will continue to receive safe, quality care." [ 2002 c 112 § 1.]


  • Medicare certification would work the same way as with all other Washington hospitals at WSH/ESH.  Federal Medicare pays for services in acute care and psychiatric hospitals that voluntarily seek certification and are approved by the Centers for Medicare & Medicaid Services (CMS). CMS contracts with the Department of Health to evaluate compliance with the federal regulations by periodically conducting on-site surveys in these hospitals.  But in this case there is a mandatory reporting requirement.  Western State Hospital/DSHS by its recent actions is attempting to PREVENT reporting to DOH and CMS, this is the root of the current problem at WSH.


  • Food preparation is NOT currently in compliance with State law at WSH.  There is no mandatory oversight of food preparation for over half the meals served at WSH when food is prepared (bulk delivered foods are proportioned and plated) by nursing personnel on each ward.  This practice would come into compliance with State law, drastically enhancing the care that is provided at WSH.  Food handler training requirements would be more expensive at WSH/ESH if normal laws applied and were not actively suppressed by DSHS. 


  • Although DSHS would license WSH/ESH through Department of Health processes, DSHS would be under constant DOH/CMS oversight through mandatory reporting processes and in ENFORCED compliance with laws that apply to all hospitals in Washington.  There would be no need for a legislative oversight body over WSH, this would cause great savings.


  • DSHS had to DUPLICATE numerous layers of bureaucracy to emulate DOH licensure processes and quality control which would have otherwise been governed by the same laws pertaining to all hospitals within Washington.  If DSHS licensed WSH/ESH through DOH, all laws would apply as would oversight thereby ELIMINATING the need for numerous redundant structures within each hospital and DSHS itself.  This would bring about great savings by dismantling duplicate structures within DSHS.


  • Through compliance with existing hospital laws that would now apply to WSH/ESH for the first time, timekeeping issues could be addressed for the first time and employees would be compensated for actual time worked…  Saving the State millions of dollars a year in unearned wages.  See transition time issue and listen to broadcast: 20140509_JR_WesternState.mp3


  • When Western and Eastern State Hospital are licensed to operate as a true hospital under Washington law through the Department of Health, laws will apply causing great savings to DSHS.  It is these savings that would be used to fund competitive wages and sufficient staffing.


In closing, the single key to fixing the State Hospital issues is for the Legislature to make DSHS State Hospitals become a “hospital” under Washington law, therefore licensed to operate via the Department of Health like all other hospitals in Washington.  This act alone will bring the oversight mechanisms that DSHS has prevented from occurring for so many years.  Yes, the solution IS that simple.  


© Paul Vilja 2017