White Coat Notes

Brookline psychiatric hospital resumes taking patients

Brookline, MA, Arbour HRI, Lane Turner/Globe Staff
Brookline, MA 11/25/13 The state Department of Mental Health has suspended admissions at Arbour HRI following numerous reports of unsafe conditions at the Brookline psychiatric facility. The hospital is part of Arbour Health System, which has been cited repeatedly in recent years for understaffing and is part of a national chain that has faced scrutiny for the same problem. Lane Turner/Globe Staff.The Boston Globe

A Brookline psychiatric hospital is again accepting patients, but on a limited basis, after the state gave preliminary approval to the hospital’s plan for correcting serious safety and human rights violations found by inspectors, including the forcible strip-search of a patient.

The Department of Mental Health notified Arbour HRI Friday that it could admit up to four patients a day, and have no more than 15 patients. The number of allowed patients could increase as regulators review the hospital’s progress.

The state prohibited the 66-bed hospital last month from taking any new patients after administrators failed to fully address inspectors’ concerns about staffing, cleanliness, and a lack of leadership.

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In documents sent to the state last week, the hospital said it would submit daily reports on its staffing levels, provide new training about the proper way to restrain patients when necessary, and reinforce that no patient should be searched involuntarily.

The hospital is also organizing a task force to create a “culture of care” curriculum. Details of disciplinary actions taken against nursing staff were redacted from a copy of the plan the state provided to the Globe late Tuesday.

A Department of Mental Health spokeswoman declined to make Commissioner Marcia Fowler or Licensing Director Lizbeth Kinkead available for an interview. Kinkead said in an e-mail that state oversight will be ongoing.

“Protecting patient care and treatment is paramount and takes precedence over any other consideration, and we are satisfied that Arbour HRI is working to ensure that the changes are made, that the culture of care is up to our high standards, and that these are visible throughout the hospital,” she wrote.

The hospital is part of Arbour Health System, which provides 1 in 5 psychiatric beds in the state and serves large numbers of people who are poor and disabled.

Arbour facilities are part of a for-profit chain of mental health hospitals and clinics that have been cited repeatedly in Massachusetts and other states for poor training and understaffing.

Arbour spokeswoman Judy Merel did not respond to most questions Tuesday about what the hospital is doing to improve conditions.

She said the health care system is not pursuing changes to hospital administration.

The latest citations at Arbour HRI were prompted by unannounced inspections in September and October, after a woman was forcibly strip-searched when she was admitted Sept. 4 ; last month Fowler called it “a very serious human rights violation.”

The state released reports Tuesday detailing inspectors’ findings.

Instead of assigning an employee to monitor the patient until she agreed to be searched and dressed in a johnny, in accordance with hospital policy, the patient was restrained physically and with medication. She was stripped, with little regard to her privacy, inspectors found.

“There were many staff members, male and female, involved in this situation including but not limited to the maintenance staff,” inspectors wrote.

The woman was interviewed by inspectors and said she refused a search at first because she did not understand why it was necessary. She told inspectors that when she realized she would be restrained, she tried to comply but was told by a manager,who initiated the search, “It’s too late.”

The hospital human rights officer told inspectors video from the hallway outside the patient’s room did not raise any “red flags.”

But inspectors wrote that it showed people stopping to look in the window of the patient’s room as she was restrained and searched.

Hospital documentation was incomplete. The patient said administrators did little to address the situation with her, though she remained at the hospital for weeks.

A manager told inspectors the patient declined to speak about it, said an inspection report.

The state received several anonymous calls from employees who said they felt “coerced by leadership to be silent about the incident or their jobs would be in jeopardy,” which hospital officials denied, said one inspection report.

Inspectors also found filthy bathrooms, dirty tables in common areas, and locks on the cabinets where patient food was kept.

The hospital did not always meet minimum staffing requirements, a situation that made it difficult for nursing staff to respond during patient emergencies, one inspection report said.

Interviewed last month, Fowler said the findings showed a “lack of leadership and oversight of that facility.” The hospital’s first corrective action plan, filed Nov. 15, promised to improve staffing levels, increase maintenance, and more closely review the strip-search case.

But the state found it was inadequate, and halted admissions Nov. 21.

Kinkead, the licensing director, wrote in a Nov. 22 decision letter regarding the strip search that some hospital employees felt administrators remained “clueless and unaccountable,” refusing to admit they violated their policies.

As the number of patients remaining at Arbour HRI declined, the hospital consolidated, moving patients on a women’s unit that specializes in treating people with a history of trauma or sexual abuse to a co-ed unit.

The state Disabled Persons Protection Commission received five complaints in a day from women distressed by the move and by having to live in proximity to men in psychiatric crisis, said commission records.

A spokeswoman for the Department of Public Health, which reviews whether psychiatric hospitals meet standards required to participate in government insurance programs, said Tuesday that it is conducting an ongoing inspection of Arbour HRI.

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