Monday, May 26, 2008

Can we prevent the debacle of opening the new hospital in June?

It's a safe bet that the opening of the new hospital will not go well. To recap: the new hospital is opening in June, no matter what - see the 5/24 N&O front-page story: http://www.newsobserver.com/2771/story/1083813.html . (One has to think such an imperative comes from the Governor.)

This looks like a debacle waiting to happen. It appears that the planning that should have gone into merging the two hospitals has not happened. (In my view, the last year should have been spent preparing for this month - developing a firm timeline of all the tasks that would need to be accomplished by Day One. There is little, if any evidence this has happened effectively.)

It appears that there will be serious staff shortages on Day One, suggesting that one-quarter of the beds cannot be safely opened.

It appears that the projected savings from running one hospital instead of two will be negated, as beds will be operating in not two, but three sites.

It appears that serious design flaws persist, including serious risks of patient death and escape.

It appears that the work of merging two hospital staffs, which at least involves reaching out to the staff of both hospitals, has not occurred.

I am sure there are more elements that will come to light in the days to come.

If the hospital opens as planned, there will be bad patient events. Is the Easley Administration ready for the firestorm that will come with, God forbid, the first patient or staff serious injury, or, God forbid, the first avoidable death?

At the very least, CMS, which is certainly monitoring the media activity, will come and visit; the odds are that CMS will not be amused and that CMS will send NC a letter alleging "immediate jeopardy" to patient safety.

The NC Psychiatric Association is opposing "moving to a new hospital until its building and staffing are sufficient to ensure a safe treatment environment for patients and staff." I am sure NCPA is not the only source of such opposition.

If the above is true, in my view, it is essential that the opening of the new hospital be delayed until it can be opened safely and that the Central Regional Hospital leadership, which is responsible for this, be replaced by competent leaders.

Wednesday, May 14, 2008

What a Good DMH Should Do

As we contemplate the next Administration, the following quote, which I came across in the May 2008 issue of Psychiatric Services, is worth considering:

Public mental health policy attempts to provide maximally effective services in the context of limited resources, promulgate clear service standards in the context of scientific uncertainty, and work to harmonize frequently conflicting needs and objectives of multiple stakeholders (patients, families, providers, other payers, general citizenry, and so forth).. . .

Choosing which services
to provide in a public mental health system is always a matter of balancing clinical effectiveness, cost, and political will. Political will has never been sufficient to support the full cost of all that we believe to be clinically effective, and therefore difficult choices are always necessary.

(
Joseph J. Parks, M.D., Alan Q. Radke, M.D. and Rajiv Tandon, M.D.: Impact of the CATIE Findings on State Mental Health Policy. Psychiatric Services 59:534-536, May 2008.)

This may be stating the obvious, but as we work to rebuild our shattered public mental health system, we will need to return to basic principles.