The federal government’s decision to halt Medicare payments for patients at Osawatomie State Hospital has brought to light horrific incidents and troubling safety issues at the state-run hospital for adults with severe psychiatric disorders.
Coming on the heels of problems in the Kansas Department of Children and Family Services, the reports cast more doubt on the ability of Gov. Sam Brownback’s administration to protect vulnerable populations and perform core services under the strain of funding shortages, low employee morale and the ongoing departure of qualified administrators.
Inspectors from the U.S. Centers for Medicare and Medicaid Services visited the hospital last week and reported that nursing staff had assigned a violent female patient to share a room with a woman confined to a wheelchair. Almost on a daily basis, CMS reported, the woman had attacked herself, staffers and other patients.
Investigators also found that a male patient with a history of criminal sodomy had inexplicably been placed on a women’s hallway of the hospital, where he “displayed inappropriate sexual behaviors.”
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Earlier, the federal agency had voiced concern about the rape of a 21-year-old mental health technician in October. The technician said she was distributing gowns when a patient grabbed her, threw her on a bed and assaulted her. Two other patients heard her cries of distress and shoved the assailant off of her.
The patient was supposed to have been checked on every 15 minutes, according to the CMS report. A technician had logged a room check close to the time of the alleged rape, and said the patient was resting. But video reviewed by CMS inspectors showed no check was made. Hallway checks that were supposed to have been made every 10 minutes didn’t happen either.
The security lapses appear to be routine, according to a CMS report to the Kansas Department for Aging and Disability Services.
“The cumulative effect of the systemic failure to supervise the provision of care, to perform required safety checks and to protect suicidal patients from hanging risks placed all patients receiving services at risk for harm,” the report said.
The hospital developed a “plan of correction” after receiving that report, and state officials believed it addressed the federal government’s concerns. But after a follow up visit on Dec. 18 the federal agency reported the additional safety violations and notified the hospital that Medicare payments for patients would cease on Dec. 21.
Medicare payments made up 23 percent of the hospital’s overall budget in 2014. Besides reimbursements for certain patients, the hospital has received Medicare funds to compensate for care for uninsured patients.
The state plans to appeal the funding cutoff. But the fiscal issues should be looked at as secondary to the failure to protect patients and staff.
The state has always struggled to staff the hospital in Miami County, but the problems became worse when the mission of the Rainbow Mental Health facility in Kansas City, Kan., shifted in 2014 from inpatient services to short-term care and referrals. More than 100 jobs were transferred to Osawatomie.
Employees from the Kansas City area found the drive to Osawatomie and the transportation costs to be onerous, said Rebecca Proctor, executive director of the Kansas Organization of State Employees.
Technicians at Osawatomie receive a little more than $13 an hour, Proctor said, and often work double shifts because of staffing shortages.
The hospital has been under scrutiny from CMS for some time. It currently is undergoing renovations to correct deficiencies that threatened federal payments last year.
Kansas’ seeming inability to run the hospital safely is damning. Caring for the severely mentally ill is an essential state responsibility. The safety of patients and communities depends on the job being done well.
The ongoing egregious problems would seem to demand new leadership. John Worley, the former clinical director, is the current hospital superintendent.
But Worley, who took charge in August, is the fourth person in five years to lead the hospital. He works for the secretary of the Kansas Department for Aging and Disability Services, a position that also is in flux. Kari Bruffett, who has led the department since May 2014, is leaving state government. Brownback has named Tim Keck, legal counsel for a different state department, as an interim replacement.
That sort of turnover is typical of Kansas government. Nine of 11 department positions have turned over since 2011, some multiple times. Years of underfunding are taking their toll, and qualified employees are departing because of low pay and poor management.
There is no easy fix for the crisis at Osawatomie State Hospital. And that is the alarming reality for much of Kansas government, where the ability to perform difficult but essential services is eroding quickly.