Thursday, November 21, 2013

One more step in the making. "You people know that you are functioning in violation of law. But  do not for one moment think that I am going to allow you to get away with it." 

Feds may pull funding for Arizona State Hospital. By BOB CHRISTIE Associated Press Nov. 20, 2013

Since the earliest phases of my work specific to the substandard medical-mental health care practices at ASH, I have stated that the first and best means by which to resolve these issues will only come through direct federal intervention. This realization did in fact arise while I was hospitalized at ASH in 2012, due to the fact that no matter how well documented the abuses and related ineptitude that I witnessed and experienced first hand during that time, no state agency met their most basic obligations in terms of responding to my reports in the context. Those agencies being: The Arizona Department of Health Services (WILL HUMBLE, DIRECTOR) and it's subagency AZ Behavioral Health Services (CORY NELSON, DEPUTY DIRECTOR, and former ASH supervisor 2011-12). More specifically, the ADHS Office of Grievances and Appeals (KARA BURKE, MANAGER), which is 100% obligated to take very seriously any reasonably sound reports that so much as suggest patient abuse or other like wrongdoing at ASH as per the letter of established state law, willfully engaged in ignoring the merits of my reports, and further violated very specific administrative laws that they are required to abide by. All of these issues arose under the authority of senior ASH clinical and administrative staff, and then extended via my attempts to draw the due attention of ADHS officials, including WILL HUMBLE himself. 

The following Associated Press article represents just one more step in a process that I began while still an ASH patient. I did in fact contact several federal agencies while I was at ASH, and while the response has been slow, only stimulated in effect by local media reports that did in fact flow directly from my blog based work, I am satisfied at this point in the process itself. Oversight (as represented in the article) will begin anytime federal involvement in the ASH operation is threatened, including in terms of funding sources, and so on. 

And following oversight comes accountability.

MY COMMENTS IN RELATION TO THIS NEWS ARTICLE CAN BE FOUND BELOW THE ARTICLE ITSELF. 

Feds may pull funding for Arizona State Hospital

Posted: Nov 20, 2013 3:08 PM MST

Updated: Nov 20, 2013 5:03 PM MST

By BOB CHRISTIE
Associated Press

PHOENIX (AP) - The federal government is threatening to pull funding from the Arizona State Hospital because of problems affecting patient care and safety identified in a recent inspection.

In a letter to hospital chief executive DONNA NORIEGA, the Center for Medicare and Medicaid Services said deficiencies inspectors identified in a September visit “substantially limit the hospital’s capacity to render adequate care to patients or are of such character as to adversely affect patient health and safety.” 

State officials said Wednesday they've already taken corrective action and don't expect to lose federal funding. Arizona Department of Health Services Director WILL HUMBLE says there's little chance of that and the hospital has already taken corrective action.

A letter to the hospital gives the agency until Friday to file an improvement plan. That would allow it to continue to draw federal Medicare funds at the state's mental hospital in Phoenix.

Arizona Department of Health Services Director WILL HUMBLE said the plan is written and will be sent by overnight mail Thursday.

``We are not going to lose Medicare certification. That's not going to happen,'' Humble said.

The hospital's annual report shows it received $11 million from Medicare in 2011 and $52 million from the state general fund.

The Nov. 12 letter from the Center for Medicare and Medicaid Services cites deficiencies in nursing care, patient rights and oversight.

The hospital has about 320 patients: A 120-bed unit for civilly committed mentally ill patients, another 120 beds for people sent to the hospital by criminal courts, and a sexually violent persons unit that holds 80 patients. The inspection covered only the civil commitment side.

Cory Nelson, the state's deputy director for behavioral health, said the hospital oversight board didn't have separate accounting for the civil and criminal sides, and in one case a person treated in another facility wasn't re-examined when they returned. A review of staffing also found that, in several cases, there were not enough nurses on duty to provide for the patients. He also stated that the report found no instances of abuse. But what it did find, he said, were situations which affected a "patient's ability to be in a safe environment"  The third failure involved six patients who had injured themselves, violating a rule saying patients have a right to a safe environment.

``By its nature, the state hospital treats patients with very severe psychiatric illnesses,'' Nelson said. ``Some of those illnesses include self-harm.''

The patients were under intense supervision, but Humble said it ``was not enough to prevent a bad outcome.''

(end of article)

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MY COMMENTS (3 total):

PREFACE: In terms of pending retribution, if you Rat Bastards believe that possible funding cuts are as bad as it gets, you might want to think again. I  am not going anywhere anytime soon.

(1) AS TO ADHS DIRECTOR WILL HUMBLE:

"State officials said Wednesday they've already taken corrective action and don't expect to lose federal funding. Arizona Department of Health Services Director WILL HUMBLE says there's little chance of that and the hospital has already taken corrective action.

A letter to the hospital gives the agency until Friday to file an improvement plan. That would allow it to continue to draw federal Medicare funds at the state's mental hospital in Phoenix.

Arizona Department of Health Services Director WILL HUMBLE said the plan is written and will be sent by overnight mail Thursday.

`We are not going to lose Medicare certification. That's not going to happen,' Humble said.

The patients were under intense supervision, but Humble said it `was not enough to prevent a bad outcome' ''.

ME: Typical Will "Yea team!" Humble rhetoric. And not to mention the arrogance of a state employee dictating federal policy decisions by unilaterally declaring that the possible loss of Medicare Certification is "not going to happen"? And as to the "intensive supervision" claim, I know for a fact that he is not able to provide legitimate evidence in this context, for there are very specific federal and guidelines relating to the matter of staff to patient ratios, which ASH is required to abide by; but as recent research has proven beyond doubt (conducted and presented on air by Phoenix area news source ABC Ch 15 [SEE: STATS: Violence at Arizona state mental hospital by the numbers 08/09/13 http://www.abc15.com]), that very crucial requirement has not been adhered to, in fact- in spite of Cory Nelson's untruthful statements to the contrary. If Will Humble does in fact possess actual evidence in support of his claim, he needs to share it with the public, as per the public trust. But this man, who has more authority and related responsibility than any other like state employee, in relation to public health care in all of AZ  has exhibited - repeatedly, in a range of forums- a clear unwillingness to engage in open discourse with the public (as per the ongoing refusal to respond to good faith feedback directed to articles that Humble  posts on the official ADHS blog- not only lack of response, but purposeful deletions of such feedback, thus denying the greater public to even consider such feedback), so there's no point in expecting that to happen. The fact is, many months ago, when both AZ Family (Ch 12) and Phoenix's ABC affiliate (Ch15) aired irrefutable data specific to issues affecting the safety and well being of ASH staff and patients alike, Will Humble chose to characterize the data itself as false, declaring as such that the well qualified professional journalists who had researched those reports (including Emmy Award recipient David Biscobing, ABC Ch. 15, Phoenix, AZ) are persons not willing or even capable of legitimately presenting such data. Humble made those statements in his aforementioned official ADHS blog (which I downloaded into my records, for he may well have deleted those comments already), as though the reports themselves were fabricated by those journalists. I contend that Humble willfully opted to make those statements in graphic defiance of the factual evidence include therein, which is 100% on point with the manner in which his underlings in ADHS/BHS and at the Hospital itself handle such data when patients report their actual experiences in the context. And now, with the findings of this latest report and related investigation in mind, conducted by professionals employed within Humble's own administration, he again refuses to directly acknowledge the fundamental implications provided in the investigative findings themselves. Rather than express simple acknowledgment of the possibility that these issues may exist, in fact, he instead falls immediately into defensive posture, declaring that all is in order, and always has been.  These forms of patent denial and evasive communication techniques are standard practice at ADHS/BHS, no matter how critically significant the issues are, and occur to the expense of ASH's seriously mentally ill and disabled patients. The ongoing presence of this counter productive  communication has immediate significance in terms of patient rights in all senses, for it is the patients who are most at risk if and when the one's running ASH fall short of meeting standards that are designed to ensure that the patients at ASH are provided with optimum care and treatment, as per common medical ethics and related codes of practice. Likewise, Humble is required by law as well as per the public trust (granted to him by each and every taxpaying citizens in the state itself) to direct immediate attention not to the possible loss of funding, but rather to the substance of the report itself. But he once again has refused to so much as acknowledge that substance, choosing instead to mischaracterize (demean) the merits of the investigative findings themselves. Just as he did in 2011-12, when I submitted half a dozen well documented reports to his office as a taxpaying AZ citizen-consumer deserving the services that I reasonably expected as a patient at ASH, most importantly in terms of my testimony to him about graphic patient abuse. I always submitted these reports in good faith and at relatively great effort given my circumstances at the time, putting myself at risk of further retaliation that I had already come to learn is part of any patients's experience should they choose to openly voice such concern, and compromising my own need/effort to reacquire mental and emotional stability. It is that bad. I can, of course, prove these specific allegations with little to no trouble, for I have full records of all such communications, and other like data readily on hand. 

(2)  AS TO ADHS/BHS DEPUTY DIRECTOR CORY NELSON:

AS PER THE ARTICLE: "Cory Nelson, the state's deputy director for behavioral health, said the hospital oversight board didn't have separate accounting for the civil and criminal sides, and in one case a person treated in another facility wasn't re-examined when they returned. A review of staffing also found that, in several cases, there were not enough nurses on duty to provide for the patients.

The third failure involved six patients who had injured themselves, violating a rule saying patients have a right to a safe environment.

   'By its nature, the state hospital treats patients with very severe psychiatric illnesses,' Nelson said. `Some of those illnesses include self-harm.'

NELSON also stated that the report found no instances of abuse. But what it did find, he said, were situations which affected a "patient's ability to be in a safe environment" ' 

Cory Nelson in fine form, indeed. Note the manner in which this highly trusted state official tweaks the meaning of ASH patient rights in terms of humane and safe conditions:  "….patient's ability to be in a safe environment." In terms of any hospital facilities' responsibility to ensure safe and humane conditions, the notion of safety is wholly unrelated to any patient's given ability. In choosing to mischaracterize this dynamic in the manner that  he did in this case, one time supervisor of ASH, Cory Nelson, is flatly ignoring his responsibility, to such an extent that is clear that he has no sincere concern whatsoever for the well being of ASH's seriously mentally ill and disabled patients, by positing as he has that the critical issues at stake have to do with patient deficiency. As it arises in certain situations. Herein we again see a clearly unjust manipulation of language, wherein the current Deputy Director of Behavioral Health Services in Arizona assigns the onus/causation/blame for these issues on the citizen-patient, mischaracterizing the unalienable right of any /all patients to be provided services including a safe treatment environment as a matter of patient ability  (or lack thereof, according to Cory Nelson), regardless of situational circumstances as they may arise.  I have said it before. I could not make this stuff up if I had to, much less wanted to. This shit is flat out deceit, willful and utterly exemplified, and it is occurring to the clear detriment and utter expense of ASH patients in every imaginable way. Period. 

Cory Nelson, of course, served as ASH's supervisor for a little over a year in 2011-12, during which time he utterly refused to acknowledge a range of issues that were shared with him in 100% good faith, by myself, as well as local media (specifically, AZ Republic writer JJ Hensley). He showed up from South Dakota in August of 2012- claiming himself to be willing and capable of improving the overall conditions at ASH as they stood at that time, and then immediately fell into the habit of blatantly disregarding the good faith input of persons who had vastly more experience at ASH then he did, staff and patients alike. In that short amount of time (14-16 months or so), this man also unilaterally implemented several major alterations to the operation of ASH, with little to no involvement of ASH staff across the board, and no concern for the likely impacts of these changes on ASH patients; changes that have been proven as the cause of very severe harm imparted upon the safety and well being of ASH patients and staff alike. And as Nelson's statement above illustrates- "….no instances of abuse… But situations which affected a "patient's ability to be in a safe environment"- he is also incapable of recognizing the simple fact that patient safety is 100% a matter of any/all ASH patients' most basic rights, as per established state and federal law; and the fact is, violations of those rights do amount to clear and irrefutable abuse, in a variety of contexts. Abuse as per all established law and policy has a range of forms , from physical to emotional and psychological (all of which do occur at ASH at the nursing and technician level [some nurses, some technicians]), to clinical and administrative abuse of authority (as exercised by all ASH psychiatrists, and executive staff, across the board). Cory Nelson's willful denials of these issues represent, as a matter of fact (and law), grossly egregious abuse of his given authority, for as the man representing the entire state of Arizona's behavioral health care system, he has been granted the authority and related responsibility to ensure that no unlawful practices be in effect, much less furthered and condoned. And via his authority (and his thinking, obviously), Cory Nelson is of the belief that he can communicatively mangle whatever legitimate evidence/data may happen to arise under this authority as he sees fit, regardless of the impacts on the public, in general, and in utter defiance of his required obligations to the public, in general. He is not alone in this, of course, for each and every staff psychiatrist that I had to deal with at ASH exhibited these patterns of unlawful misconduct, abusive misconduct which also extends into the on-site office of attorney Joel Rudd, who serves as ASH's primary legal representative, as per his given authority as a staff attorney with the Arizona Office of the Attorney General. And while physical, emotional, and psychological abuse that many ASH nurses and technicians engage in are definitely of concern to me at this time, I cannot emphasize enough how critical these abuses of clinical and administrative authority at ASH are, in fact. In this context, I feel it's imperative to note that in South Dakota, the bulk of Nelson's work experience was acquired through his role in that state's corrections industry (prisons), where the citizens under his authority were all felons; men and women, that is, deserving of punitive measures specific to criminal misconduct, with no relation to actual health care, in fact. This aspect of Nelson's lack if skills was clear to me as soon I witnessed his graphic lack of understanding of law and policy in the context of Arizona Administrative Code as it applies to persons affectedly serious mental illness (AAC Title 9, Ch. 21), in the context of the role ASH plays in that sense.  And yet somehow, in less than 18 months in Arizona, a man who not only lacks meaningful qualification in the area of health care, but who also had exhibited a willingness to flaunt his disregard for established law and policy specific to the operation of ASH (this, his first position in the AZ health care network), was granted a major promotion (within that network), wherein today he is overseeing the affairs of all Arizona citizens affected by mental illness. A prison official, in other words, caring for the mentally ill. 

And let's not forget: This promotion was implemented by Will "Yea team!" Humble. Business as usual with these people. Bottom line.

Granted, there are definitely some serious deficiencies at ASH, but that reality has nothing to do with the patients in the context of unsafe conditions. And these current developments, including the documented responsive statements of Cory Nelson and Will Humble, only furthers the validity of my claim that "It's not the patients who are a problem at ASH- it is the staff, through and through." This very troubling reality arose in my conscientious  awareness of how horribly the ASH patient community is being treated while I was experiencing the varied dynamics of residing at ASH for 13 full months. And to hear these highly paid state health care officials condone the substandard conditions at ASH while simultaneously assigning their responsibility(s) to the patients in terms of safety, and so on, virtually triggers the fear and internal discord that I often felt while hospitalized at ASH; fear and discord that did not arise due to the instability/volatility of certain ASH patients, but rather through the exhibited incompetence and related lack of ethos of senior ASH clinicians and executive officers, as well as state level administrators in the ADHS Office of Grievance and Appeals, and the state's highest ranking public health official himself- Will Humble.  It is truly that bad. All the way up the food chain.

(3) AS TO ASH CHIEF EXECUTIVE DONNA NORIEGA:

"In a letter to hospital chief executive Donna Noriega, the Center for Medicare and Medicaid Services said deficiencies inspectors identified in a September visit 'substantially limit the hospital’s capacity to render adequate care to patients or are of such character as to adversely affect patient health and safety.' " 

What can I say? In 2012, a state credentialing board found  Donna Noriega guilty of willfully lying while exercising her authority as a licensed behavioral health examiner/social worker (BHSW). This occurred while Noriega was the Chief Operating Officer at ASH, effectively a second officer to ASH CEO Cory Nelson. It was determined in this ruling that by specifically falsifying crucial information that she was directly responsible for, Noriega had willfully and unlawfully abused her authority as a state certified professional. And yet- somehow-, Noriega was subsequently promoted (again, by Will "Yea team!" Humble) to the position of Chief Executive Officer at Arizona's sole long term public mental heath facility. (Business as usual personified.) One may feel that this issue is of little significance (it is clear that Humble does), but I look at this way: If this woman was not capable of determining/maintaining  her clear responsibility(s) in terms of her basic BHSW license in relation to disseminating simple yet critical information, why in the hell are we the people expected to believe that she can responsibly manage the affairs and operation of a major public health facility such as ASH? I further attest to the fact that while I was hospitalized at ASH in 2011-12, Donna Noriega patently and willfully lied to me on at least three occasions when I went to her in relation to my concerns about patient abuse. She did so in order to defer the significance of such abuse, and clearly believed that I was incapable of recognizing her untruthfulness in this context. And these specific instances barely scratch the surface in terms of her broader ineptitude, ineptitude and outright malfeasance that occurred in the executive offices of ASH during all elements of the administrative wrongdoing that's been exposed of late (and to date), and which is still occurring even as I write. 

That said, I think that is about enough about Donna "You are so busted!" Noriega. For now, at least.

------------------------------------------------------------------------

During my 13 long months as a patient at The Arizona State Hospital, I did as a matter of fact come to realize that only direct federal oversight will suffice in meaningfully addressing and resolving the grossly substandard medical-mental health care and practices that each and every senior level clinician have were engaging in at that time. This realization carried over to the administrative staff at ASH once I came to understand the fact that such administrators are equally responsible for ensuring that such substandard conditions not be allowed to prevail. I have always been a teachable person, and I do value my own ability to learn. Wherever I have been in my life, and whatever the circumstances, this has been the case, and this too has been an enormous factor in my growth and maturity as a person. During my 21 full months of formal inpatient treatment for major depressive disorder (including the latter 13 months of that period of my life, at ASH), my willingness and related ability to seek and acquire useful information played directly into my treatment, beginning with the critical role that Dr. S. Rhoades filled in my first 4-6 weeks of inpatient treatment, May-June 2010, Kino-UPH Hospital (now University of Arizona Medical Center So. Campus). As I moved through the given landscapes of those 21 months (three hospitals, in all), I continued to pay close attention to my surroundings and related experiences as they arose, and it became clear to me before long that any patient dedicated to furthering their own progress in terms of diagnosis is assigned the very real need to weed out the negatives, and embrace the positives. This, of course, is central to life itself; but in acute and Level I-II mental health facilities, this need becomes especially acute. At ASH, where I had access to library resources, including medical data and material (albeit dated medical material), I found myself engaging in what I later come to know as biblio-therapy (one of my ASH therapists, Kevin Jessup, informed me as such [Hi, Kevin- I sincerely hope you are well, and thank you]), via which I therein acquired far more beneficial input than any of my ASH psychiatrists ever offered, and which did serve me as I continued to further my possible progress in terms of my formal diagnosis and related needs; and once I began advocating in defense of my own rights and related needs as an ASH patient, outside advocacy resources provided me with crucial treatises that additionally put me on track in terms of defending myself in the context, such as a full copy of The Americans With Disabilities Act, the Hospital Information Portability and Protection Act, and the Arizona Administrative Code (Title Nine, Ch. 21 Persons with Serious Mental Illness); while on my own, I accessed the internal rules and procedural codes applicable to ASH, itself. It was an at times terrifying process to go though, quite frankly, for at ASH, I attest to being subjected to myriad forms of unjust mistreatment, while paradoxically coming to understand the deeper implications with respect for mental illness and disability, in general. Terrifying in that I came to understand that only monsters are capable of neglecting, exploiting, and abusing persons as vulnerable as the seriously mentally ill; and further, that I was surrounded by and under the authority of such monsters, in the form of utterly cruel psychiatrists, bullies in the form of security, and shockingly selfish-arguably masochistic nursing staff, and so on. Since leaving ASH, I have (amongst other things) endeavored in following the activities of Hospital and state level administration, and am today equally troubled by the presence of societally sanctioned socio-psychopathy, which is at this time highlighting the misbehavior of such administrators. These are highly trusted individuals assigned the privilege and responsibility(s) of caring for deeply troubled, at risk, and vulnerable adults, which in the context of potential predation and neglect, is a recipe for disaster; every time/anytime someone with the authority of Cory Nelson and Will Humble engages in doing whatever they have to in order to deny, mischaracterize, or otherwise mask the realities of ongoing patient abuse and related clinical incompetence etc. in a setting such as  ASH, they are effectively exhibiting the same defensive behavioral traits that are recognized today as being central to socio-psychopathic behavior, as exemplified by human culture's most dangerous members, and so on. ASH as it is operating today is just that- a disaster- and thanks to the hard work of certain members of the local Phoenix area press, the public is increasingly coming to grasp how and why this is the case.

IN CLOSING: My work is ongoing. If the one's running ASH think that this threat to federal funding is all they have coming at this time, then they should think about it just that much more. The Americans With Disabilities Act dictates that no public entity (including any state's public heath care facilities) be allowed to discriminate against persons affected by disability of any kind. This most definitely includes persons affected by serious mental illness. And yet at The Arizona State Hospital, the disabled patient community in general is being denied the same level of established medical care that all Americans are due. These substandard medical-mental health care issues arise on the basis of the fact that each and every patient at ASH is seriously mentally ill and relatedly disabled; and it is all a matter of standard practice at ASH. As such, I contend that ASH has long been operating in graphic defiance of the findings and intent of The ADA. I can attest, in fact, that while I was subjected to the substandard conditions at ASH, I was often treated as though I posses no intelligence, morality, or rights as a person; attitudes exhibited by various ASH staff at all levels of employ that feed right into the occurrence of rampant discrimination, denials of human rights, and outright abuse in all forms.  All of it, as a matter of standard practice. 

And they are getting away with it.

As this process continues to evolve to the benefit of the ASH patient community, I will just say again:

You people know that you are functioning in violation of law. But  do not for one moment think that I am going to allow you to get away with it. And if you believe that is as bad as it gets in terms of scrutiny, you might want to think again. I  am not going anywhere anytime soon. 

paoloreed@gmail.com