Health, safety and management concerns pile up at Washington psychiatric hospital, feds say

A federal report released by state officials Tuesday shows Western State Hospital, the state-run psychiatric facility in Lakewood, lost certification this week for a litany of reasons, including by restraining patients longer than needed and having inadequate fire protections.

The Centers for Medicare and Medicaid Services announced Monday it would pull $53 million in annual funding from the 857-bed hospital after a two-week survey found it came up short in four of 26 broad health and safety standards.

State officials have been quick to note Western State has improved dramatically since 2016 — when the state first entered into an improvement plan with CMS — thanks to staff raises, new leadership and physical upgrades at the facility. But the detailed inspection record shows persistent managerial problems, staffing shortages, incomplete data and record keeping, dangerous missteps in medical and psychiatric care and ongoing ligature risks.

“We’ve had the initial opportunity to look at the information in the report and now will turn our focus to analyzing the details and what actions we need to take,” said Cheryl Strange, the Secretary of the Department of Social and Health Services, in a prepared statement on Tuesday. "The work to improve the quality of care for our patients at Western is unending."

Strange and other hospital officials were not immediately available for an interview with The News Tribune and The Olympian on Tuesday.

Many of the problems identified by CMS this week are not new. For example, surveyors previously cited the hospital six times, first in November of 2015 for using limited and flawed data to track the quality of nursing care plans.

Among the problems noted at the hospital were:

• Restraining a patient for hours though his behavior didn't warrant it.
• Inadequately testing injured patients, including failing to evaluate the head injury of a patient who fell.
• Causing patients to miss dental appointments due to a lack of staff to escort them.
• Ligature risks, which can lead to patient death by suicide.
• Various fire-safety concerns, such as not having sprinklers in all necessary parts of the hospital.

In all, CMS issued more than 100 pages of notes detailing problems with Western State. Kelly Stowe, a DSHS spokeswoman, said hospital leadership is "still analyzing everything" to determine its next moves.

She said they hope to fix many of the issues but acknowledged resolving problems related to physical deterioration of the aging facility "isn't going to be easy." The hospital first opened in 1871, according to DSHS.

Stowe did note the hospital had "several" anti-ligature and fire suppression projects planned in 2017 that were delayed when the state's construction budget was held up over an unrelated battle over rural water policy.

"We've started many of them but we weren't able to start in time to get them finished before the final survey occurred," she said in an email.

In part due to concerns with the age of facilities Western State, lawmakers have been pushing in recent years to move most civil, or noncriminal, patients out of the hospital and into community settings around the state. Civil patients are currently treated in the hospital's older wards while forensic patients, who are involuntarily committed as part of the criminal justice system, occupy some of the more updated areas of the hospital.

Western State typically serves about 580 civil patients and 270 forensic patients at a time.

Officials also contend civil patients are better served in smaller settings closer to home, rather than at a large central facility like Western State. They also hope the change will reduce wait times for civil patients and free up space at the hospital to treat more forensic patients, who have also faced long admission waits.

Despite hundreds of millions of dollars spent on the mental health system since Gov. Jay Inslee came into office, progress on shifting most civil patients out of Western State has been slow.

Lawmaker from both parties promise it will be at the forefront of the 2019 legislative session, which begins in January. Inslee has said the effort should be completed in five years.

This story was originally published June 26, 2018 at 4:11 PM.