Report: API 'presents an unsafe work environment'
Employees at the Alaska Psychiatric Institute do not have safe working conditions, according to the findings of an independent investigation the state released on Tuesday.
Department of Health and Social Services Commissioner Valerie Davidson said she requested the investigation in March, in response to concerns regarding workplace safety at API.
Anchorage attorney Bill Evans conducted the investigation over several months, interviewing 46 people, including current and former employees, union representatives and representatives from the Department of Health and Social Services.
In a report to Attorney General Jahna Lindemuth, Evans highlights unsafe working conditions, insufficient staffing, a cultural divide over the issue of staff versus patient safety, a practice of favoritism by API's nursing administration, and overall low employee morale.
He cited several factors “that appear to unnecessarily contribute to the workplace dangers occurring at API.”
They include: ineffective scheduling practices, use of on-call personnel, the aforementioned cultural divide concerning use of restraints and seclusion, lack of programming, and lack of consequences for violent patients.
Evans further determined API did not engage in unlawful retaliation directed at those who complained about safety issues nor did it create a hostile workplace for those who complained about safety issues, but said he would describe the working environment at API as "challenging."
During a joint news conference held by DHSS and the Department of Law, Davidson said she was not surprised by the issues outlined in the report and is committed to fixing them.
"It is disappointing to me that [employees] don't feel adequately supported, and that's my job. And so I've been disappointed in myself," said Davidson.
API has had known safety issues for years. The Alaska Department of Labor and Workforce Development, Occupational Safety and Health (AKOSH) cited API for being unsafe in 2014, and again in November of 2017.
Following the latest report, Davidson explained steps DHSS is taking to make improvements:
- API received $3.1 million in FY2019 for 20 new psychiatric nurse positions and competitive salary increases for nursing staff at API. Beginning Sept. 16, salaries of psychiatric nurses at API will increase by two pay ranges – approximately $5-10 per hour increase.
- API has implemented a voluntary 12.5-hour shift for nurses to address problems with scheduling;
- DHSS has hired Joint Commission Resources to review and improve the hospital's seclusion and restraint policies, and to help with the implementation of those polices.
- DHSS and the Alaska State Employees Association have created a Labor Management Committee to increase communication with union representatives.
- DHSS is working in cooperation with the Alaska Mental Health Trust Authority to examine the feasibility of adding 24 additional beds to API.
- DHSS and the Alaska Mental Health Trust Authority will fund a contract to examine the feasibility of operating a separate forensic hospital in Anchorage for patients who have committed a crime or are exceptionally violent.
- DHSS submitted an application to the federal Centers for Medicare and Medicaid Services for an 1115 Behavioral Health Medicaid Waiver Demonstration. If approved this would take pressure off API and create a new range of behavioral health treatment services across the state.
API has also had issues with the Centers for Medicare and Medicaid Services (CMS).
KTVA reporter Lauren Maxwell inquired about the status of API's compliance with CMS standards on September 4, asking a spokesperson, "Can you tell me if something is happening with API regarding being Medicaid-Medicare compliant ? My understanding is that there was some action taken on Friday with administrators there for being out of compliance? Are you able to share any details of this?"
In an email, Clinton Bennett with DHSS replied, "We looked into this and confirmed that API has full certification with the Centers for Medicare and Medicaid Services."
Toward the end of Tuesday's news conference, Davidson confirmed API is under a "plan of correction" with CMS.
"They routinely do investigations of facilities and API is no exception, and we are under a plan of correction with our CMS review that was done at the end of May," said Davidson.
Davidson said the action stems from concerns about API's use of seclusion and restraint.
Both Davidson and Evans said during the news conference that they would feel safe if they were to be placed under the care of API as patients.
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