Whistle-blower's Review and Follow-up of a Well Below-Average Psychiatric Facility in Covina, CA
Posted by Nurse Anonymous on 05/17/2008
HOSPITAL/HEALTHCARE FACILITY, CALIFORNIA -- Discussion for Follow-up - Re:
Serious Deficits in Mental Health Facility Standards Which Remain at Aurora Charter Oak Hospital – Covina;
Just a Symptom of a Desperate National Mental Health Picture
To All Whom It May Concern,
Aurora Charter Oak Hospital - Covina (ACOH-Covina), which is a mental health care facility located in Covina, CA, as part of Aurora Behavioral Health Care, a private, for-profit, mental health care company, has an administration, of which, on the regional corporate and local hospital level, regularly colludes with their regular nursing supervisors to subvert Patient's Rights, JCAHO (the Joint Commission on Accreditation of Hospitals), Medicare and Medi-Cal standards, and Health Dept. regulations in order to overcrowd the hospital with patients so they can build large bonuses for themselves from the faceless corporate offices back in the Midwest. As a result, violations inevitably occur, and patients are mistreated in many ways. Administration then routinely covers up many of the bad outcomes that result from this policy by directing their nursing supervisors to direct, sometimes through subtle coercion, the licensed and non-licensed clinical personnel to alter the patient’s official record, using “creative charting” techniques, as though it should be a routine part of doing business, impoverishing patient care, and jeopardizing the licenses and jobs of it nursing and allied healthcare personnel.
Another subtle tactic that the local administration uses is that they hire an unusually large amount of former or current drug addicts or alcoholics for part of the licensed nursing staff (as for the non-licensed staff, the percentage is arguably higher, based on my empirical observations), who are not even allowed to pass meds legally due to restrictions on their licenses. Medications are being passed out to adults and children by people who have serious psychiatric illnesses and current substance abuse issues, who, meanwhile, haven’t themselves been taking their prescription medications routinely. One RN, with full-blown, un-checked mania, continued to be put in charge of a whole unit of patients, despite her fellow colleague’s protests, and had her patients staring at her in disbelief of her zany actions. On Night shift, a Bipolar-Manic LVN, a normally balanced person when on her meds, was off her prescription psychiatric meds for too long, and, in a full-blown manic state, was allowed to roam about freely as an overt sexual tease, agitating patients, and distracting male and female employees alike, pulling them away from their nursing duties to engage in this semi-lascivious behavior, just because it was deemed to be “funny”.
An RN was allowed as charge nurse of the Child & Adolescent Unit for a long while, and then was fired. It was then found out that he had had a long-standing relationship with a female minor, which started when he was an adult and she was a twelve year-old... this apparently was openly discussed by this RN with other members of the staff, and administration was made aware of it, but did nothing - until something happened at work, involving this RN and a female minor.
There was also a well-known suspicion that there were two weekend PM shift charge nurses who were committing sexual acts upon one another while no RN was on the floor watching their patients. Staff on the floor treated it as an inside joke, and when finally notified by a new employee who wouldn’t stand for it, supervisors and administration looked the other way, and no action was ever taken in either case, and both employees involved currently remained at work in this facility.
Yet in another situation, the regular Noc nursing supervisor was so incompetent, that, besides the fact that she sometimes made very poor decisions which the charge nurses had to over-rule, it was a well-known fact that she spent a good part of her shift most every night hiding out in a bathroom reading a book or sleeping, while charge RN’s were busy at work, frantically trying to reach her so that important decisions could be discussed, and one employee told me that, on more than one occasion, they saw her doing word puzzles while on duty, while the rest of the hospital was piling up with admissions and work. Again, administration was made aware of her incompetence, yet chose to do nothing about it. And this is just some of the incidents that have happened in the last few years that immediately come to mind.
Basic living standards, like food, blankets, indoor cool air in the summer, indoor warmth in the winter, a non-leaking roof, and basic privacy issues were being violated. Heating and air conditioning in Building A, even after being repaired, was wholly inadequate… it only heats and cools the hallways, not the rooms… a year and a half ago, when the air conditioning unit went out in the early Spring, the patients and staff had to endure indoor temperatures into the mid-90’s plus, with no air movement, for 3 months of unfulfilled administration promises. Patient agitation levels were off-the-charts, with patient fights up and seclusion and restraints of patients happening sometimes twice a shift, and then administration tried to pin the blame on unit staff at first. It took nearly a third of the patient population and their families to write and phone in complaints, and a good part of the staff threatening to quit to finally convince them to replace the central air conditioning unit (on their own, not by professionals, which nearly caused a horrible accident when the new A/C unit threatened to come crashing through the roof during its placement, all while both staff and patients where left unprotected in the immediate area below) but, like I have written, replacing the A/C unit only partially solved the problem. The administration themselves did finally have to admit (through the nursing supervisors) that the system was not adequate for this building, which holds 60% of the hospital’s patients – but they did promise to remedy the issue, but haven’t as yet done anything about it.
Often you will find three (on a couple of occasions, even more) people sleeping in a 2-patient room, or patients sleeping on the floor, or on lounge couches, because there is no regular bed for them available, even though there are cots that sit unused in another building just a couple hundred yards away, simply because someone is too lazy to retrieve them. On occasion, due to overcrowded conditions in the past, children have been put to sleep on the floor in small office rooms meant for doctor's consultations.
Most of the time, there is no hot water for washing/bathing in patient care areas, yet, mysteriously, hot water is always present in the administration building. Dietary requirements are not being met for those that are not on a standard diet, i.e.; what the dietitian recommends is rarely written into a doctor's order, and if it is, is never followed by the Dietary Department.
There are never enough towels, blankets, washcloths, sheets, pillows, pillowcases to last through a 24 hour period – despite numerous protests to correct this rather easy-to-solve situation. Such protests have been met by administration with comments such as “the reason there are not enough linen is because Noc shift wraps themselves in them to stay warm at night… Right… the Night shift would regularly swaddle themselves with washcloths and pillowcases… how did administration ever find out… These arguments from administration were considered a laughing stock amongst the nursing staff at the time.
Patients of low ability were often allowed to walk around in their own filth (urine and fecal incontinence) for days without anyone lifting a finger to do anything about it during their wake periods, which is most always AM and PM shift. A lack of snack food and drink have lead to patient frustration, leading to agitation, all too often causing staff to have to manage the patient by chemical or physical (i.e., restraint) means.
Patients in the Needs Assessment Office are being handled by people with minimal or no credentials, who can't even spell the diagnoses they are applying to the patients, much less tentatively assigning the diagnosis correctly. Prospective patient’s belongings are being left unscreened, allowing for contraband items, such as narcotics, prescription drugs, knives, alcohol, and on at least one occasion, whole boxes of bullets, etc., to sit near the patient unchecked for hours while the patients sit waiting to be assessed and processed. These items eventually make their way onto the unit (yes, even those bullets), which have the potential to cause suicide attempts, as well as assaults on other patients and staff – even on the good people of the neighborhood community of Charter Oak, which surrounds the facility. If this lack of procedure continues, one day some paranoid individual will walk in to that facility with a loaded gun in their bags, and it will remain unscreened, up until the point this patient, or another curious mentally-ill patient, retrieves the gun and opens fire… it is an inevitability.
In the Admissions & Intake Dept., nursing was often led by a male RN who commonly wrote STAT Doctor's Orders and forged them under the name of the patient’s assigned psychiatrist. When some of the doctors had complained, administration mildly scolded the individual and swept it under the rug. There have even been instances where this same RN has fraudulently written STAT I.M. injection orders for patients that had already been transferred to other units, could not find a medication nurse willing to carry them out, so he administered the I.M. medication himself, even when he wasn’t assigned to the unit the patient was on! This happened twice that I am aware of, once resulting in the patient's blood pressure dropping dangerously low, requiring greatly increased monitoring and nearly sending him to the ER.
Another problem in admitting is the lack of proper medical clearance for in-coming patients intoxicated on alcohol and narcotics. Patients are being allowed to be processed through intake and admitted to a unit with BAL's (Blood Alcohol Level) approaching, near, or exceeding the lethal limit, because someone, either in Admitting & Intake, or a supervisor, is guessing at the Patient's BAL toxicity instead of sending the patient out for evaluation, proper testing and medical clearance. The same goes for patients not being properly drug tested, so detox orders can be obtained, if necessary.
Patient take-downs themselves have often been overt ways for staff to take out their frustrations out on difficult-to-manage patients. The results have been particularly devastating. As an example, one male patient, in his 50’s, of slight build, who was psychotic and/or high on some illicit substance, became agitated and began to throw his fists in the air. Staff intervened far too roughly, and ended up badly breaking the poor gentleman's arm, resulting in several fractures! Another poor gentleman, in his 60’s, with a Dx of Bipolar with psychosis, R/O dementia (my nursing diagnosis; not necessarily the literal Doctor Dx, since it has been almost a year ago, and I do not have the chart in hand) was taunted by AM Shift BHS workers, made to wear a hat involuntarily, of which he visibly hated, and was becoming increasingly agitated, and then was allowed to swing his arms at staff and fall on the ground a number of times, all while non-licensed floor staff stood around him laughing. I happened to be there off-duty to finish some charting, and witnessed this occurrence for an extended length of time in plain sight of other patients, some who actually attempted to go to the aid of this poor gentleman by taking him out of the hands of these “care-monsters”, but where soundly rebuffed by these same personnel, two of whom actually threatened these would-be “hero” patients by saying they would tell the med nurse to give them an injection if they “got in the way”. Only after pleading with the RN's-in-charge who were standing in the station, 10 feet away in plain sight of the incident, to do something, and receiving shoulder shrugs from both - did I make the call to alert the nursing supervisor myself. I am not aware of any staff terminations due to this egregious act, nor am I aware of any corrective action being taken on behalf of the patient (I had suggested an order for a gerichair or wheelchair with a posey vest), or any action against the staff perpetrators or RN enablers. I was tempted to terminate my employment right there and then, but I felt leaving my employment at the facility would just allow the problems there to go on unabated, so instead of leaving, I filed several complaints with Patient’s Rights, JCAHO, the Health Dept., and the local U.S. congress and state assemblypersons who represent that facility’s area.
However, due to a unrelated sham fantasy issue brought up by a vengeful former friend and co-worker, which had nothing to do with my work at Aurora Charter Oak Hospital, but rather, had a lot to do with how angry this co-worker was about getting reprimanded by me (privately, quietly, and professionally, I must add) regarding an earlier repeated issue of insubordination and conduct unbecoming of a nursing professional while on the job; administration then used the later fradulent issue, without any proof as to whether it was true, to summarily fire me in October of ’07, ending my employment, and personal involvement in, Aurora Charter Oak Hospital.
That did not end my watch-dog role there however; I still receive reports from current personnel that support me in my quest to improve conditions at Aurora, especially since the JCAHO inspection this last January, and we have begun to bring about some change, though it is not nearly fast enough, nor has it, unfortunately, effected any significant transformation.
Since then, I have been passed along a strong rumor that a licensed staff member may have been involved in some indiscretions with an adolescent patient while on-duty in the unit, and that it may have included drugs. To what extent I do not yet know, but it would seem it is business as usual for the staff at ACOH.
Now that I am in the role of an educated outsider from that facility, and have personally sought and accepted a position in one of the best, forward-thinking, caring, for-profit health care organizations in the nation, which provides, as just one of its initiatives, very good quality mental health care, which is self-audited, as well as audited externally, and spends an enormous amount of money self-educating its employees to make real quality improvements. I see the stark differences between the two ways of doing business, and I realize that my termination was a blessing in disguise… for I am able to do far more as a patient advocate in the nursing position I have now than I was able to do before as simply just another disgruntled employee. For I have begun to realize that the mostly tax-paid, government-funded corruption I observed while in the employment of Aurora Charter Oak Hospital-Covina was just a rather nasty sampling of the poor conditions that exist locally, as well as state, and nation-wide.
This large area of Los Angeles County, for which this facility provides mental health services to an underserved population, desperately needs this psychiatric hospital, but it doesn’t necessarily need its current administration or its nurse-collaborators, and it most definitely MUST be rid of its poor health and safety practices. It was my belief six months ago that this facility's license to operate should be suspended immediately, or at the very least, the administration and the facility should have to undergo a major JCAHO investigation, as well as other appropriate departmental investigations, to sort out its many improprieties.
Now that such a JCAHO investigation has occurred, my hope is that my letter above will lead to a follow-up examination of this facility, this time to demand ACOH to produce a detailed action plan to resolve the facility’s woes and it’s employees’ misconduct, with short-term mandatory deadlines as to when this must be accomplished, and real punitive action if the goals are not met.
Mental illness affects nearly every extended family in America in some way… yet we quite often treat our under-insured and indigent mentally-ill like feral dogs. As an applied sciences-nursing graduate, fresh out of college, I chose this line of registered nursing as my profession because I wanted to make a difference; I wanted to find a way to push against the tide of mediocrity that is the American mental health system. It is for the same reason I chose to work at Aurora, instead of taking offers elsewhere, and when a few colleagues and doctors warned me not to waste my skills there.
Will others stand up for once for these less-fortunate people, or will these poor souls be, once again, swept under the proverbial rug, just because they do not have a powerful political voice to stand behind them? And if the sweeping should begin again, then shame on you, Yes You… in the government, in the hospital watch-dog groups, in the patient advocacy arena, in the TV, radio, internet, and print media, and you, the individual licensed doctors and allied health personnel, who did not stand up… it IS time to say “NO MORE”, then move on to splinter that vile broom, instead of kicking back in your chair, joining your fingers together under your chin, and saying “Yes, yes, it is a very sad thing, someone should do something about it…”
Someone else, not too long ago, summed it up well, I think…
“Human progress is neither automatic nor inevitable. Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.”
Martin Luther King, Jr.
Now, a call out to all fellow skilled health care workers and Physicians:
What form of behavioral health care do you want to be a part of?
A Purveyor of “fresh, passionate, engaged mental health care”, or a Caterer of “stale, faceless, Mental Healthcare fast food on-a-Stick”? The future, ultimately, lies in your hands to effect the change, in one direction, or the other.