Feds May Pull Funding for Arizona State Hospital
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 ARE SUCH CHARACTER AS TO ADVERSELY AFFECT PATIENT HEALTH AND SAFETY.
The Nov. 12 letter from the Center for Medicare and Medicaid Services cites DEFICIENCIES IN NURSING CARE, PATIENT RIGHTS AND OVERSIGHT.
But before I go any more into the issue of Pervaiz Akhter's grossly incompetent misconduct as a primary care doctor at ASH, I need to return this article to the following topic: As I have said, I did submit the standard DHHS formwork specific to my concerns not long after my request to access my records was denied. I actually reviewed the HIPPA document and determined the fact that this denial was in gross violation of my rights as an ASH patient, and then I submitted the DHHS formwork on August 31, 2011. The following time line is designed to illustrate how this process went:
On October 13, 2011, I received a response letter from Michael Kruley,
Regional Manager of the DHHS Office for Civil Rights (OCR) District IX. In this letter, I was assured that DHHS OCR was "In the process of reviewing (my) correspondence" in order to "decide whether OCR has authority and is able to action with respect to the matters you have raised." Sincerely, Michael F. Kruley, DHHS Office for Civil Rights Region IX, 90 7th Street, 4-100, San Francisco, CA 94103-6705.
On December 21, 2011, I sent more materials to Mr. Kruley that I knew would be of use to his staff as they considered the merits of my original complaint. It was at this time, December 2011, that I provided Mr. Kruley with additional information specific to drastic staff shortages at ASH that I knew had directly contributed to increases in violence and other related safety issues at ASH, as spelled out below:
Page 2
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December, 2011
TO: M. Kruley
"At this time, and apparently due to recent state budget cuts, AzSH has been operating on a clearly shorthanded (staff) basis. The unit that I am on, for example (Desert Sage east), has repeatedly been understaffed over the last 2-4 weeks, if not longer; behavioral health technician staff,e.g., has been so limited in recent weeks that even the employees are outspoken about the burden it places on them in terms of their own safety and their basic ability to effectively perform their assigned job(s); and the fallout effect has led to an increasing amount of uncontrolled outbursts involving violence and compromises in patient safety. I understand, as well, that the Hospital recently laid off 30 security guards, and while my source concerning this info. is reasonably sound (I in fact have discussed with several staff, including one security guard), I as a patient am not privy to this info. in an official capacity. But I can attest to the fact that several patient restrictions have been implemented in recent days that basically belie this fact."
On January 19, 2012, I received a phone call from Mr. Edwin Acosta, a full time DHHS OCR Civil Rights Advocate, who advised me that staff of the District IX office of OCR had determined that my formal complaint was merited, as per the letter of law and the HIPPA document. We had a very positive conversation, and while Mr. Acosta could not guarantee anything, he did assure me that he would be conducting a formal investigation. In doing so, he also informed me that an official case file had been created specific to the investigation, and he provided me with the case number: 11-133054, and encouraged me to contact him at any time via his direct phone number. I was also advised that no matter the outcome of the DHHS OCR investigation, I would be provided with the terms of the final determination once it had been implemented.
On February 08, 2012, I was advised by my ASH social worker, Robert Washington, that my discharge from ASH had been scheduled. This scheduling occurred outside of a range of standard terms of ASH/Arizona Department of Health Services protocol, including the crucial fact that the majority my various ITDP team members (9 total) had not been involved in coming to this decision, but in stating that, I digress. I mention it, as such, only to further clarify the fact that ASH administrative practices rarely, in ever, abide by such protocol, again, as a matter of stadard practice. Washington advised me that my discharge date was February 21, 2012, (a holiday, wherein my outpatient service resources were closed.)
On February 21, 2012, I discharged from ASH.
I contacted and spoke with Mr. Acosta on three separate occasions over the spring months of 2012 (Feb. 25, April 08, and May 13). In those phone conversations, Mr. Acosta could only assure me that requests for data about my complaint had been directed to ASH, and that I would be updated as these requests were processed.
On June 15, 2012, I tried to reach Mr. Acosta again, in order to both update him about my then changed contact information, and to acquire an update, as may have been available then. But my call to Mr. Acosta's direct line was redirected to a DHHS call center on the east coast, and I was advised by a call center representative that the entire structure of DHHS had been altered, including in terms of OCR. I was specifically informed at that time individuals (citizens) could no longer directly call OCR staff. When I calmly and civilly voiced my frustration, the representative attributed these changes to the authority of the Obama Administration. I then provided the call center representative I was talking to the relevant case file information, including the case number, Mr. Acosta's and Mr. Kruley's name, and fully provided all details relating to the status of my case, as it stood when I last spoke with Mr. Acosta. I was then advised that someone would be in touch with me.
On August 05, 2012, I contacted the same call center representative that I had spoken with in June, and inquired about why I had not heard from anybody. The call center representative was very gracious, polite, and sympathetic to the nature of my inquiry, but she could not offer any more information, telling me that the information relating to my inquiry had been forwarded to the appropriate channels.
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At this time, November, 2013, I have yet to hear back from DHHS OCR. I of course have all records, as well. I am willing to accept that the changes to the DHHS structure effectively smothered whatever momentum may have been generated in the earlier phases of this process, and while I am frustrated by this, I know that I am not the only American so affected.
However: I am now looking at the fact that if my original efforts to seek the services of DHHS OCR had been managed as per the assurances I was provided with in winter-spring 2012, any number of issues that are now central to federal intervention at ASH may have been avoided, including and most importantly, I feel, with respect for the death of Chris Blackman in September of this year, as well as the graphic escalations in violence at ASH that have impacted and harmed ASH patients and staff alike. Federal intervention, ergo, as illustrated last week by the following news:
Feds may pull funding for Arizona State Hospital
Posted: Nov 20, 2013 3:08 PM MSTUpdated: Nov 20, 2013 5:03 PM MST
By BOB CHRISTIE
Associated Press
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)----------------------------------------
The findings of the above investigation are 100% on point with the bulk of my contentions, to date. I have long said that the lack of direct oversight at The Arizona State Hospital has everything to do with the specific inadequacies that I became aware of while hospitalized there in 2011-12, for example; and the underlying significance of these issues is occurring in utter defiance of ASH patients' rights, across the board. Likewise, as the above news article further illustrates, the failure of persons such as ADHS Director Will Humble, and current ADHS/BHS Deputy Director Cory Nelson- who we know are most responsible for tending to the ASH operation in all terms- to meet their fundamental obligations to the citizens of Arizona as a whole, as they arise specific to Arizona's sole long term public mental hospital, are indicative of gross negligence and dereliction of duty, and stand as such as a clear breach of the public trust. Said failures have led to the death of at least one Phoenix area resident (April Mott), while possibly contributing as well to the death of at least one ASH patient (my friend, Chris Blackwell); while also undeniably causing the rabid escalation of violence at ASH which is today putting all ASH patients and staff alike in very unreasonable risk of very real harm (as reported by ABC Ch 15, in over the last 12-14 months, nursing and technician level ASH staff documented close to 800 incidents of patient on staff violence- [see STATS: Violence at Arizona state mental hospital by the numbers 08/09/13 http://www.abc15.com]- but please keep in mind, too, that such incidents are typically not documented when it is patient on patient violence, much less so staff on patient violence- which does occur with relative frequency).
For beneath it all, I attest to the fact that there are myriad abuses of patient rights that have yet to be identified in these emerging media reports; physical, emotional and psychological abuses, and all forms of other like staff misconduct that are not quite tangible or included in official ASH record keeping. This condition has everything to do with the issues underlying my original complaint to DHHS, in fact, and represents just one example of the means by which senior ASH clinicians and administrators get away with their gross ineptitude and egregious untruthfulness, all of it as a matter of standard practice. In the case of Akhter's willful denial of access to my own records which he claimed included allegations about misbehavior which I knew to be false, it is obvious that this doctor was attempting to coerce, threaten, and effectively cow me into submission, whereby I may be intimated to such an extent that I would no longer voice dissent about the wrongdoing at ASH. The fact is, as I saw it then, he patently lied about those so called allegations, and when I called him on it (by requesting to see the notes themselves), he engaged in a gross violation to my federal rights as per HIPPA to be granted access to those notes. It is that clear, it is that bad.
The ASH patients, as a rule, are in the underbelly of Arizona's dirtiest secret, and only direct scrutiny will serve to bring these issues to light. As this most recent instigative data shows, such scrutiny is reasonable at this time, and in this context, ADHS Director Will Humble declaration that "corrective measures" are in place today falls far below the expectations of Arizona citizens as a whole, particularly given that he did not offer any details whatsoever as to what those measures amount to.Likewise, Cory
Nelson's continual attempts to delineate/manipulate/distort the entire body of specific data that has arisen over the last year or more (data which I know proves my contentions) represent outright deception which I contend in malfeasant to its core, and as such, and meets the definition of fraud.
"Speak to the Truth." I do not know if you are seeing this, Officer, but if so, thank you for being there. I hope you are well. I meanwhile am back home in the Sangre de Cristo Mountains (where I belong), running and riding anywhere from 7500-9000' in the sky, and I was just in Espanola yesterday.
IN CLOSING: I have prepared and included this article at the request of someone else, and individual who will go unnamed at this time (also as per their request. But suffice it to say, it is all about furthering the exposure of the grossly substandard conditions at The Arizona State Hospital, as they stand. There are myriad dynamics in terms of causation when it comes to those conditions, but it is clear to me that one distinct aspect of said dynamics flows from the simple fact that seriously mentally ill Americans are continually neglected whenever it comes to long term public mental health facilities such as ASH, and beyond. This is as wrong as wrong gets, and as I have stated before, only direct federal intervention compelled by the meaning and merits of congressionally enacted law, including but not limited to HIPPA and The Americans With Disabilities ACT, will suffice in meaningfully addressing these issues, and serve to resolve the issues once and for all. This is not to say that there will never be another need for ASH to be looked at. But in the immediate sense, this is what is needed today. Therein my satisfaction in knowing that the process of direct federal intervention is now in motion, even it has arisen with no respect for my personal efforts, as illustrated above. But for all I know, in fact, my earlier efforts may have played into this. I do not really care at this point. As long as it gets done.
paoloreed@gmail.com
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I would really love input of any kind from anybody with any interest whatsoever in the issues that I am sharing in this blog. I mean it, anybody, for I will be the first one to admit that I may be inaccurately depicting certain aspects of the conditions
at ASH, and anonymous comments are fine. In any case, I am more than willing to value anybody's feelings about my writing, and I assure you that I will not intentionally exploit or otherwise abuse your right to express yourself as you deem fit. This topic is far, far too important for anything less. Thank you, whoever you are. Peace and Frogs.