- Associated Press - Monday, September 28, 2015

SEATTLE (AP) - Washington state’s largest psychiatric hospital could lose millions of federal dollars for failing to ensure the safety of a patient who was tied down and sedated when another patient attacked him with a shoe and fist, causing serious injuries.

The Centers for Medicare and Medicaid Services sent Western State Hospital a 90-day termination notice last week that said the Lakewood, Washington, facility violated program rules that require it to protect its patients’ safety and rights.

The warning was the latest in a list of troubles facing the state’s mental health system. A federal judge issued a permanent injunction against the state’s two psychiatric hospitals in April for failing to provide timely competency services to mentally ill people charged with crimes. And the brother of a patient who died after choking on an orange in a hospital dayroom while staff walked around him is suing the workers.

Western State Hospital must submit a plan to address the violations by next week and have the deficiencies fixed by Dec. 2, or the U.S. Department of Health and Human Services will end both Medicare and Medicaid funding, Stephanie Magill, spokeswoman for CMS, told The Associated Press.

“The health and safety of our beneficiaries is our highest priority,” Magill said.

The hospital receives $4.7 million from Medicaid and $11.2 million from Medicare annually, said Kathy Spears, spokeswoman for the Washington Department of Social and Health Services.

Victoria Roberts, deputy assistant for the state Behavioral Health & Service Integration Administration, said they are working on a plan to fix the problems and they intend to meet the deadlines so no funds will be lost.

Two patients, identified only as #1 and #2, argued often, according to the investigators’ Sept. 3 report. Patient #1 would “whisper to (#2)…you need to go back to your homeland” and they would erupt into “verbal altercations.”

They had an argument at 8 p.m. on Aug. 15, and patient #2 threw liquid at patient #1, who responded with a punch, the report said. When they kept trying to get at each other, hospital officials placed patient #1 in seclusion. They gave him drugs and put him in a five-point restraint, the report said.

At about 1:50 a.m., the other patient walked past staff and assaulted the man who was being restrained, “causing a nasal fracture, facial lacerations and facial trauma,” the report said. He was taken to the hospital and after being treated was brought back to the same ward as the patient who assaulted him, the report said.

The hospital didn’t move the attacker to the forensics unit until two days later, the report said.

Investigators who interviewed staff and reviewed records found numerous problems with the way the situation was handled.

The head nurse and medical director knew that the two patients had fought earlier on Aug. 15, but nothing in the attacker’s records show he was “monitored or supervised after the event,” the report said.

A staff member told investigators that when patient #2 went into the seclusion room, “I thought (#2) was going to kill (#1).” The attacker later told staff “he hit me so I have to hit him back,” the report said.

Based on these findings, federal officials said the hospital “no longer meets the requirements for participation as a provider of services in the Medicare program.”


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