Mental hospital criticized

By Cy Ryan

Wednesday, Nov. 30, 2005 | 7:48 a.m.

CARSON CITY -- "Serious deficiencies" at the Southern Nevada Mental Health Hospital contributed to the death of two patients and have resulted in the lack of treatment for others, a federal audit found.

The audit by the Centers for Medicare and Medicaid Services reported a shortage of staff contributed to many of the problems, including attacks by patients on nurses and mental health technicians.

The centers, in a report dated Nov. 16, threatened to cut off federal funds if the problems are not corrected.

Carlos Brandenburg, director of the state Division of Mental Health and Developmental Services, said that could mean a loss of $4.3 million this fiscal year and $5.3 million next fiscal year.

A corrective action plan was submitted Tuesday to the federal agency, he said.

"The bottom line is we need to ensure quality care is a top priority," Brandenburg said. "There is no excuse for this. The hospital has overextended itself."

The audit, conducted Oct. 17-19, noted two deaths in April -- a 28-year-old homeless man who hanged himself and a woman who experienced breathing problems after taking a medicine.

The report said the "root cause" of the suicide was the absence of a physician to check on the man during the weekend.

The attending physician went on a scheduled leave on Friday, and the man hanged himself on Sunday. The audit found that there was "no record that the covering physician attended to the patient."

The attending physician "acknowledged that weekend and leave coverage had become very sloppy," the report said.

At the time, there was only one on-call physician on weekends to cover 77 patients.

The female patient died on the way to a hospital after experiencing labored breathing. The audit said a nurse had not followed the procedure for implementing the first dose of a new medication, and the mental hospital had not followed a plan of care for the woman.

The hospital, which can take up to 130 patients, has a staff of 431, but needs more registered nurses and mental health workers.

The audit found that patients failed to get treatment or rehabilitation, noting that an auditor "observed patients watching television, sitting on benches and sitting in chairs not involved in any form of therapeutic activities."

One patient told auditors that the staff is too busy to help.

"All they do here is line you up to give medications and don't explain what the medication is for," the patient said.

Staff, in interviews, said they did not have enough workers to do the rehabilitation.

Brandenburg said a major problem is that the hospital has no private rooms for therapy.

"Any therapy must be conducted in an open area, and there is no way you can conduct any type of therapy in an open area," he said.

Part of his corrective plan is to reduce the number of beds by 10 and use those rooms for therapy.

The state division has not been able to hire the needed staff because of the nationwide nursing shortage, Brandenburg said.

He wants to contract help and is going to seek approval for an early hire of staff at the 150-bed mental hospital that will be completed in April.

The audit said it found there were an inadequate number of registered nurses and mental health workers "for a safe and therapeutic environment."

One nurse alone on duty told the auditors she was choked by a patient. She could not call for help and another patient had to summon aid.

One mental health worker said a patient grabbed her hair and she and the patient fell to the floor. She fractured her elbow.

Another employee said she suffered a broken jaw when hit by a patient, and she added, "It's like walking into a battlefield."

In these cases there is no other staff around to thwart the attacks, the study concluded.

A review of the records showed nine staff injuries from physical assaults by patients since January.

There were 11 vacant registered nurses positions that led to the short staffing, producing 10 shifts where there was only one nurse on the day and evening shifts.

Brandenburg said there is "a national shortage of nurses," especially psychiatric nurses. He said the state pays well but is competing with other states.

The nurses, commenting on the lack of treatment for the patients, said, "We don't have enough staff and we run this unit like an ER (emergency room)."

Workers noted that in one ward there are only three nurses, three doctors and six mental health workers to take care of 26 patients 24 hours a day.

Brandenburg said he doesn't know if he has enough money in his budget to finance all of the corrective actions needed. The federal auditors are expected to return to see if the problems have been solved.

According to a legislative appropriations report, the hospital had a budget of $61.2 million last fiscal year, which rose to $73.2 million this fiscal year and jumps to $97.2 million in fiscal 2007. That big increase is to finance the hiring of staff for the new hospital.

Brandenburg, who said he knew about the deficiencies, said, "We were trying to take corrective actions."

Both deaths were reported to a joint accreditation commission, he said.

The hospital could lose its national accreditation if the problems are not fixed, he said. Besides the loss of federal funds, other grants to the hospital, including one for a psychiatric residency, would be stopped.

Brandenburg said one thing that will help is that WestCare, which now provides beds for 38 mental patients who are transferred from hospital emergency rooms, will increase that number to 50 starting in mid-December. That will take some of the load off the mental hospital.

"Once the new hospital is ready, we will have all the resources we need," Brandenburg said. "We will have rooms for therapy."

Dr. Jonna Triggs, director of the hospital, is on extended sick leave and won't return until next month.

Cy Ryan can be reached at (775) 687-5032 or at [email protected].