Eastern State Hospital Found Lacking Federal Funds And The Very Future Of The Facility Are In Doubt After Inspection

Eastern State Hospital’s future is threatened if patient care doesn’t improve at the psychiatric institution.

The state hospital is in trouble after a recent inspection found staff ignoring patients’ medical and therapeutic needs.

The federal Health Care Financing Administration is now reviewing the hospital’s plans to correct nursing shortages, care problems and safety concerns.

If HCFA isn’t satisfied, it can cut off two-thirds of the hospital budget, stopping the $21 million it delivers annually to the brick behemoth perched above Medical Lake.

Such a move could close the hospital.

State officials are so alarmed they assigned Pat Terry, the former head of Western State Hospital, to craft a plan to remedy hospital problems.

“I’m here to make sure we don’t lose our (federal) certification,” she said. “If they don’t accept our plan, we could be in serious financial problems.”

Some hospital employees claim the bleak annual review is a side-effect of the hospital’s recent push to cut expenses by about 10 percent.

Other Eastern staffers say the drop in care quality reflects plummeting morale at the 300-bed hospital where many workers fear the ax like never before.

Still others say it’s a combination of factors, including the fact that while the hospital staff shrinks, psychiatric patients tend to be sicker and more demanding.

Regardless of the reasons, the hospital is now committed to a litany of changes and improvements, including the hiring of 19 more registered nurses.

Hospital CEO Steven Covington said in a March interview that Eastern’s quality of care had not suffered as he cut the annual budget from $35 million to $32 million since arriving two years ago.

The recent inspection report indicates otherwise.

Therapy services were cut dramatically in the past year, noted inspectors for the state Department of Health, working on contract for HCFA.

Patient participation in therapy groups has dropped to about a third of last year’s level. Inspectors noted a lack of sessions on life skills and programs to prepare patients to re-enter the community.

The hospital plans to hire four therapists and assistants. It also will attempt to expand the assortment of patient programs and increase participation.

Nurses were not following up adequately on patients’ symptoms.

Inspectors noted examples, including the case of a man who died of heart failure almost four hours after a nurse noted fluids were collecting in the back of his throat.

“There was no documentation of follow-up or suctioning,” the report noted. “There must be adequate staffing to ensure that the (nurse) is available for immediate bedside care of any patient.”

The hospital plans to ensure all nursing staff members get training by the end of this month that helps them better assess the physical condition of patients.

The hospital lacks the nursing staff to adequately supervise patient care.

Inspectors found that many ward shifts at the hospital often lacked registered nurses to oversee care. Staffing was such that it was hard to perform all the required treatments, medications and supervision, nurses complained. Inspectors noted one result of the nurse shortage was that 20 percent of the patient charts lacked weekly progress notes.

Several nurses, who asked not to be identified, said the hospital’s poor performance reflects simple morale problems.

“It’s gone downhill,” said one nurse who recently retired. “They’re all terrified they’re going to be fired.”

Almost 40 medical staffers have lost their jobs, quit or retired in the past two years.

Judy Ramberg, a certification specialist for HCFA, said the agency will examine the hospital’s plan to correct the problems and the federal agency will decide within 60 days whether to continue its Medicaid and Medicare payments. “If the deficiencies aren’t corrected we will go ahead and terminate.”

Other issues inspectors raised included safety and sanitation concerns.

Inspectors found punctured fire walls and unlocked electrical panels. They also saw a vegetable preparation sink was not separated from the sanitary sewer in a hospital kitchen. Inspectors noted it was possible for vegetables to become contaminated.

Inspectors also criticized the state’s top officials at the Department of Social and Health Services for failing to adequately oversee the hospital.

The report noted Covington has not been evaluated since he arrived in August 1994. He is supposed to receive annual evaluations.

But Covington already has been examined by the state auditor’s office. A report released last month verified some employee complaints about Covington.

The state determined that Covington misused state telephones and vehicles for personal purposes and enjoyed too good of a deal on the house he rents from the state for $91 a month.

A state ethics review board is now examining the audit and whistleblower complaints as well.

Some hospital sources insist Covington has been repeatedly warned staff cuts would hurt the hospital’s quality of care.

The state referred all questions regarding the HCFA report to Terry, who is nearing the end of her assignment to help Eastern overcome its bad inspection report.

Terry said she expects the hospital will rebound nicely to its “wake-up call.”

“I have total confidence that if they follow the plan submitted to HCFA that Eastern can be an outstanding hospital,” she said. “The staff here works very hard.”

, DataTimes