- Associated Press - Wednesday, February 17, 2016

SEATTLE (AP) - Washington state’s largest psychiatric hospital could lose millions of federal dollars because a staffing shortage has made it difficult to run a safe facility, yet two psychiatrists who criticized hospital management were told to work from home this week during a period when federal inspectors were expected to visit, according to hospital staff.

“This was devastating for the physicians as they sat at home wondering whether they still have a career simply for speaking out,” said Dr. Joseph Wainer, a hospital psychiatrist who recently resigned as Western State Hospital’s Chief of Medical Staff. “The effect on the medical staff is chilling, to know those who were vocal are now on home assignment.”

Officials with the Department of Social and Health Services have told lawmakers staffing shortages are the reason they have not been able to comply with a federal judge’s order to provide timely competency services to mentally ill defendants. They also said an inability to hire and retain trained staff resulted in failed inspections by the Centers for Medicare & Medicaid Services.

Four times in 2015, the federal agency threatened to cut millions in funding for the 800-bed hospital after inspections found that system-wide failures caused serious harm to patients and placed their health and safety at risk.

Last week, the agency rejected the state’s plan to correct some of the violations, according to CMS spokeswoman Julie Bannester. The state agency’s revised plan is under review. Meanwhile, federal inspectors visited the hospital last week and new surveyors were expected to return this week.

Wainer said the two doctors who were told to work offsite had raised concerns about the hospital’s focus on satisfying the federal inspectors instead of trying to improve the actual quality of care.

“In the context of an anticipated visit by regional CMS surveyors this week, two of the hospitals most outspoken physicians were placed on administrative home assignment last Friday,” he said.

That has left several wards without staff psychiatrists at a time when staff is most needed, he said.

Carla Reyes, assistant secretary, DSHS Behavioral Health Administration, acknowledged they’ve initiated two hospital investigations and the employees were assigned to work that doesn’t involve direct care to patients. She said they were sent to work at the agency’s Olympia headquarters starting on Thursday. But she denied Wainer’s claims the move was retaliation for criticizing management.

“CMS surveys are unannounced visits during which CMS identifies wards, staff and records they wish to see or review and we comply with the direction provided by them,” she said in an email. “We have not, nor would we ever, engage in activity that places any staff on home assignment to keep them away from CMS surveyors.”

Washington lawmakers infused millions of dollars into the state’s mental health system last year and have added funds to raise the salaries of hospital medical staff in order to draw in new hires, but the problems persist.

Many staff blame management.

Hospital criticism grew louder last week when the CMS surveyors were on-site, which prompted Victoria Roberts, deputy assistant secretary for the agency’s behavioral health administration, to caution workers about what they say, according to emails acquired by The Associated Press.

In one note sent to hospital and agency staff on Friday, Roberts said many people had exchanged emails while the investigators were onsite and she said she cringes when she thinks about “how they would read to the general public or the legislature.”

“Please remember that emails are public documents that may be requested for review at any time by anyone,” she warned. “Saying this is not an attempt to thwart communication. It is a request that you use some discretion.”

Roberts encouraged staff to have open and frank discussions with hospital management.

That prompted a response from Dr. Michele Morrison, according to another email.

Retaliating against hospital staff for speaking out is a common practice, she said in an email. The hospital’s “Code of Conduct has been used punitively by the executive leadership to stifle what they see as dissent and what many of us see as free speech.”

“People talk, and they have a right to discuss matters as they see fit as long as they are not being intentionally disruptive or libelous,” she said. “Leadership does not need to respond to breakroom chatter as long as people feel able to bring their genuine concerns to their leaders without fear of retribution.”


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