Rep. Pete Higgins of Fairbanks pre-filed a Bill for the 2014 legislative session; the goal of the Bill is to improve the grievance procedure law AS47.30.847 and appeal process for approximately 26,000 psychiatric patients in Alaska. Many of the patients are acute care and are considered a vulnerable population -- an easy bill to support.
Being a vulnerable population, psychiatric patients are at times mistreated. It does not matter if the individual is receiving treatment in a clinic or committed to an institution, as long as the individual is mentally ill, he or she remains vulnerable to mistreatment.
Alaska is special but not always in a good way. Psychiatric patients have a right to file a grievance, but beyond that with little or no state involvement, it is now up to the 30 psychiatric facilities and units and their out-of-state certification organizations to fill in the details of the patient's grievance/ appeal process. And when psychiatric hospitals and units write the grievance policy, due process, appeal process, etc., they do so to protect the psychiatric facility or unit, not the patients -- Who is speaking for the patients?
Twenty-six thousand psychiatric patients in Alaska generally do not have difficulty filing a grievance. It is what happens after a grievance is filed that is our concern. We reviewed a 9-page abuse and neglect report by the Disability Law Center -- April 2011: psychiatric patients unable to file a grievance in a fair way. And also letters and reports from the state:
The Department of Health and Social Services (DHSS) is the Governing Authority of the Alaska Psychiatric Institute (API), an 80 bed locked psychiatric hospital. In a 12-month period, 2005 to 2006, 224 complaints were filed by patients. Three were sexual abuse allegations, eighteen concerning safety, and seventeen concerning medication, twenty-eight concerning basic rights, etc. All complaints were handled as informal complaints by API staff. Patients were not given the opportunity to file a formal grievance in all 224 cases.
Move forward to 4/02/2012 and the new patient grievance procedure at API. Most patients at API with a complaint have to go through an informal complaint process. There is no time frame for completion of the informal complaint process. On level 1, management can grant itself a 30 day extension to resolve a patient's complaint without being required to tell the patient. Any complaint concerning a staff member or abuse and patients cannot file a traditional formal grievance, (page 4). The average stay for a patient at API is under 14 days.
Current psychiatric patient grievance procedure law AS47.30.847 lacks details and does not apply to all psychiatric units that do civil commitments/forced evaluations; as of now many psychiatric patients are not protected by the state grievance procedure law.
Psychiatric patients have a right by law to bring their grievance to an Impartial Body but CEO's of psychiatric institutions get to choose who sits on the Impartial Body—not the patients and not the state.
In 2011 DHSS removed important grievance procedure requirements from 7AAC71.220—(Changed to 7AAC12.890(d)). DHSS is lessening the state's involvement in protecting psychiatric patients in the grievance process. That is a mistake!
Since 1992 every psychiatric facility, unit and clinic have first and foremost written loopholes in their patient grievance policy to protect the psychiatric facility. And that includes the Alaska Psychiatric Institute of which DHSS is the governing authority. It takes less than 30 minutes of reviewing 40 patient grievance procedures and past actions of psychiatric facilities and units to know it is true.
The best case scenario for psychiatric patient recovery and their protection is Alaska revising the grievance procedure law AS47.30.847, including rules for due process, appeal process, basic grievance rights all in one location for those civilly committed/forced evaluated and also for those receiving treatment at community mental health centers.
Medicaid and Medicare and the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) never intended for states to use Medicaid/Medicare and JCAHO's patient grievance requirements and oversight as a substitute for the state's involvement -- each state, including Alaska, is expected to write their own effective patient grievance procedure laws that are fair to patients and provide its own enforcement -- Alaska has a ways to go.
The benefits of the state improving the grievance procedure law and appeal process for psychiatric patients and guardians: Improved quality of care and will save lives.
To support improving the grievance procedure law for psychiatric patients and guardians, contact Rep. Pete Higgins at his office's interim phone number, (907) 452-6084.
Faith Myers and Dorrance Collins are mental health advocates who live in Anchorage.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch, which welcomes a broad range of viewpoints. To submit a piece for consideration, e-mail commentary(at)alaskadispatch.com.