Gov. Jay Inslee is calling on his state Department of Health to strengthen enforcement of private psychiatric hospitals, and make its findings more accessible to the public, in response to a Seattle Times investigation.

“It is clear to me that our existing regulatory structures are inadequate for ensuring that new, privately run facilities are meeting the levels of transparency, safety and quality that patients and their families deserve,” Inslee wrote in a letter to Department of Health Secretary John Wiesman this week.

The directive marks a shift in tone for Inslee, who has supported the expansion of private psychiatric hospitals in a state that has long been short of treatment options. In his letter, the governor suggested revisiting the role of for-profit psychiatric companies.

“I am deeply troubled at the prospect of corporations exploiting gaps in our oversight systems to profit from vulnerable Washingtonians and hard-working hospital staff,” he wrote.

As private psychiatric hospitals have expanded in Washington state, with more than 850 new beds approved since 2012, some have repeatedly failed to meet regulatory requirements and put patients and their own staff at risk, The Times found. Hospitals are only required to disclose specific types of serious harm to the Department of Health and face no penalty for failing to do so in Washington, unlike other states.

Private psychiatric hospitals reported 15 “adverse events” over three years to the department. Over the same period, The Times found 350 incidents in which patients or staff were assaulted, suffered an injury, attempted suicide, escaped or died suddenly.

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While many states publish hospital inspection reports online, Washington state only discloses them in response to a public-records request. The Department of Health hasn’t taken an enforcement action on a psychiatric hospital in more than 13 years, opting to encourage compliance without penalties.

“Do we have all the tools we think we should have? No,” Wiesman said in an interview Thursday. He expressed particular concern about newly opened psychiatric hospitals, saying “it’s a time when more scrutiny certainly might be in order.”

The regulator is exploring a range of administrative and legislative changes, Wiesman said. Among the options: A provisional license for new hospitals that would come with more frequent inspections; the ability to issue civil fines; requiring psychiatric hospitals to report a broader range of safety incidents, including all deaths; and the authority to temporarily take over management of a troubled facility, akin to the power the state has for nursing homes.

The department already has authority to put restrictions on a hospital’s license, but Wiesman said such an action could have unintended consequences and also could be challenged in court.

“It’s a really, really heavy hammer that perhaps puts a lot of other patients at risk, and it doesn’t happen immediately,” he said.

The Times reported in August that regulators found violations at Smokey Point Behavioral Hospital on 12 inspections over 15 months. The hospital’s operator, a for-profit company called US HealthVest, recently opened a second psychiatric hospital in Lacey.

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In approving the new hospitals, the Department of Health conducted a limited review of a predecessor company run by the same executive team, called Ascend Health. The regulator examined accreditation decisions by The Joint Commission, a nonprofit that vets hospital quality, but it didn’t review serious violations at two Ascend hospitals in other states found by government inspectors.

A Massachusetts health-care system that is partnering with US HealthVest to build a new psychiatric hospital said it would conduct a review of the for-profit firm following The Times’ report.

US HealthVest has said that “all of our hospitals have been fully compliant with all state and federal regulations.”

Inslee, in his letter, called for the department to “ensure a more thorough review of an applicant’s previous record and history.” He also asked the department to accelerate its plans to post inspection reports on its website, and Wiesman said he hopes they will be available in two months. The Times has posted dozens of the reports online.

Wiesman said the department is also considering requiring psychiatric hospitals to report when someone dies.

At Cascade Behavioral Hospital in Tukwila, The Times found at least seven patients died or suffered injuries that caused or contributed to their deaths over 19 months. Cascade has said these and other safety incidents are isolated cases and “not at all reflective of the overall quality of care, patient experience and community public health benefit provided by our clinicians to thousands of patients annually.”

Over a decade, private psychiatric hospitals have reported 23 adverse events to the department that involved serious injury or death. On Wednesday, the regulator said it couldn’t determine how many resulted in death “because the information reported by health care facilities as defined in the law does not differentiate between death and serious injury.” It identified two of the deaths of Cascade patients found by The Times.

Inslee Letter to Wiesman 091119 (PDF)

 

Inslee Letter to Wiesman 091119 (Text)