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April 2, 2012
TOPEKA A new inspection report on the state mental hospital here has underscored the severity of what has been a major problem at the facility for months and years: Because of the poor working conditions, state officials are having a hard time keeping doctors, nurses and others on the job.
The Joint Commission, a national organization that accredits hospitals, found that the facility in the past five years lost more than two-thirds of its medical staff due to budget cuts, turnover related to poor working conditions and other factors.
Employees complain they have been forced to work overtime to the point they are mentally and physically exhausted. Many have left in frustration. And now, according to some at the hospital, state officials have difficulty getting nurses from temp agencies to take shifts at the hospital even for short spells.
Currently, the hospital has 790 employees. It’s authorized to have 886. The hospital’s 467 mentally ill patients are at the facility because they have been deemed a danger to themselves or others. The hospital complex includes three 30-bed psychiatric units, a 190-bed forensic unit and a 177-bed sexual predator treatment program. Of the 467 patients, 217 are in the sex predator program.
State officials acknowledge that the staff shortages, starting earlier this year, required some direct-care workers to sometimes work 12- and 16-hour shifts.
“Our primary challenge at Larned is staffing,” said Angela de Rocha, a spokeperson for the Kansas Department of Social and Rehabilitation Services, which oversees Larned and the other state hospitals.
Since July 1, 2011, according to state figures, the hospital has paid almost $1.4 million in overtime wages. It’s spent $135,000 on temp-agency nurses.
The staffing dilemma has created or contributed to other problems noted in the report from the Joint Commission.
The commission’s inspectors called the hospital’s high turnover rate “alarming,” and told state officials they must quickly correct 30 problems — most of which stemmed from the staffing issues — or potentially lose accreditation.
In an effort to trim state spending, Gov. Sam Brownback last year offered incentives to state employees willing to take early retirement. Budget documents show that earlier this year, 43 Larned State Hospital workers accepted the offer. The governor’s budget recommendation for Fiscal 2013 called for filling 12 of the 43 positions.
The inspection team visited Larned between March 5 and March 9. It found 14 problems serious enough that the state was given 45 days (until May 5) to correct them. It was given 60 days to correct the other 16 problems. After the 60 days, an unannounced return visit will come as inspectors check the state's remedies.
Among the findings outlined in the 37-page inspection report:
• The hospital has been without a medical director for three months. It also lacked a director of pharmacy. (Officials currently are in the process of hiring a new pharmacy director, de Rocha said. And a New York doctor who likes to hunt and seeks a rural setting has shown interest in the medical director's job. He might be coming to Larned for an interview within the next two or three weeks, according to SRS officials.)
• Among the hospital’s registered nurses, the turnover rate was almost 43 percent.
• It was not unusual for one of the hospital’s psychiatric units to be without a registered nurse on site due to the nurse being summoned to other parts of the hospital.
• Many of the hospital’s fire extinguishers were kept in locked compartments. Workers did not have immediate access to the keys.
• Drugs were dispensed without proper oversight. The medical staff “had not actively contributed to the measurement of, assessment and improvement in the use of medications.”
• On Feb. 15 and Feb. 28, there was no documentation of any of the medications administered on the hospital’s psychiatric unit.
• After patients were given new medications, nurses did not do follow-up checks to see if the medications had caused complications.
According to the report, the hospital's procedures for distributing medications were an “extremely high risk activity” that “represented a significant vulnerability” for both the hospital and its patients.
“At a minimum, we should have adequate staff so that there can be adequate treatment,” said Rep. Pat Colloton, a Leawood Republican who read the commission report. “When I read about the medications being dispensed inappropriately, I have to say I am very concerned. This is a poor way to handle a very serious health issue in this state.”
The inspectors also noted that the state’s recent efforts to hire nurses for the hospital’s psychiatric units had been hampered by the fact that higher wages were paid for nurses in the hospital’s prison units.
The prison, de Rocha said, pays nurses between $17 and $18 an hour; the psychiatric units pay between $14.30 and $15.03 an hour. Given the choice, more nurses were choosing the higher pay in the prison units.
As for doctors, SRS has hired a recruiting firm that specializes in finding physicians willing to work in rural areas.
“That firm is on site today,” de Rocha said.
But the inspectors noted that hospital officials faced an uphill climb trying to find and keep medical staff.
“The CEO has been actively attempting to recruit and retain qualified medical and nursing staff,” the inspectors wrote, “but staffing and budget limitations have made it difficult.”
The report noted that almost two thirds of the medical staff had been lost over the past five years due to “turnover and elimination of positions” and “there has not been the capacity to recruit and retain medical staff because of competitive economic forces.”
Others said pay was less an issue than the hospital's location and the work conditions.
Larned is in western Kansas on U.S. Highway 56 between Great Bend and Kinsley. It has a population of about 4,200 people and lacks many of the urban amenities sought by doctors and other well-trained medical workers.
"They've had their recruiting challenges for a while," said SRS Deputy Secretary Gary Haulmark, newly appointed to run the division that oversees the hospitals. "I think the biggest part is that it's tough to recruit people in Larned, Kansas. Not everybody is willing to relocate to rural Kansas."
Work conditions, too
“The problem isn’t the pay as much as it is we’re rural, there just aren’t that many people out here. There were years ago, but there aren’t now,” said Carl Parker, an officer with the Kansas Organization of State Employees chapter at Larned State Hospital. “We have people driving in (to work) from as far away as Hutchinson, Hays and Ellsworth.”
Parker said he was speaking in his role as a KOSE chapter vice president, not as a 17-year employee of the hospital.
“The other thing is people around here have heard so many bad things about how people are treated, about the overtime and how you never know when you’ll get off work,” he said. “If you supposed to get off at 3 p.m., they’ll call you at the last minute and say you have to stay until 7 p.m. That happens all the time.”
KHI News Service talked and emailed with various Larned hospital workers. Most agreed to discuss their work only on condition of anonymity.
Representative of the comments were these emailed by a nurse:
“Everyone is frustrated with having to stay all the time, people are having to stay 2-4 times per week, they’re tired and burnt out. Then we talk about keeping a positive attitude. How are people supposed to keep a positive attitude when we never even know when we’re going to get to go home. We spend more time at work than we do at home!"
SRS officials downplayed the commission's report, saying the understaffing has been a persistent problem at the facility and that efforts are underway to correct the problems cited in what they described as a routine outside review.
“We have clarified some of the findings and are in the process of remedying the other issues that were identified,” de Rocha said. “Accreditation reviews are a regular occurrence at institutions of this type. The purpose of the accreditation process is to identify problem areas, strengthen the hospitals performance processes and improve the care they deliver, not to force their closure.”
'Loud and clear'
But others said the report pointed to serious problems.
“When you don’t have enough staff you’re not treating people, you’re just warehousing them,” said Charlie Ross, who leads the Depression and Bipolar Support Alliance in Lawrence. Ross been hospitalized twice for his mental illness.
“The place (Larned) is totally disorganized — that comes through pretty loud and clear,” from the report, said Stephen Feinstein, a former state hospital superintendent in Kansas and Oregon and a past president of the National Alliance on Mental Illness.
“This is one of the worst surveys I’ve ever seen,” said Greg Valentine, a former superintendent of Osawatomie State Hospital and the Rainbow Mental Health Facility in Kansas City, Kan.
Valentine is now director at the Delaware Psychiatric Center in New Castle, Del.
Haulmark last week described the commission findings to the House Social Services Budget Committee.
De Rocha said SRS would continue to “make regular reports, as required, on the situation until oversight of the hospitals is handed over.”
Earlier this year, the governor proposed moving SRS programs for the disabled, including the hospitals for the mentally ill, to the Department on Aging, which is slated to become the new Department for Aging and Disability Services. The governor’s proposed reorganization is scheduled to become effective July 1.
Brownback has recommended spending an additional $2.1 million to expand the Sexual Predator Treatment Program at the hospital, which currently is over capacity. And Haulmark said SRS might make additional requests of the Legislature during the wrap-up session, if agency officials determine they don't have all they need to address the problems cited in the commission report.
The KHI News Service is an editorially independent initiative of the Kansas Health Institute and is committed to timely, objective and in-depth coverage of health issues and the policy making environment. Find more about the News Service at khi.org/newsservice or contact us at (785) 783-2529.