Alaska’s only state-run psychiatric institute has failed to meet federal regulations by inconsistently creating and updating treatment plans and not providing active treatment for some patients, the state ombudsman found in a report released Tuesday.
The report found that some of the problems that have plagued the Alaska Psychiatric Institute for years – including treatment options that do not meet federal standards and an unsafe working environment – were not resolved as of last year, despite previous promises by the Anchorage facility to improve conditions.
API is accredited by The Joint Commission and licensed by the Centers for Medicaid and Medicare Services. It could be at risk of citations or losing its accreditation if those agencies independently found the deficiencies outlined in the report. API was in that position in 2019, when it avoided losing accreditation after a private contractor took over management of the facility.
State Ombudsman Kate Burkhart said she believes the deficiencies found in the current report are similar to the ones identified in 2018 and 2019.
“This is apparently an intractable problem for the hospital because it’s the same as it was when we received the complaint in 2018,” she said in an interview Tuesday.
The findings were shared after Gov. Mike Dunleavy announced in his State of the State address last month that his administration has “turned that situation around,” increasing the institute’s occupied beds from 20 to 55. That is still below the institute’s reported capacity of 80 beds.
Dunleavy spokesman Jeff Turner said that the governor stands by his statement.
API “is functioning at its highest level in many years,” Turner said in an email.
But the investigation painted a picture of a facility still struggling to meet the needs of both residents and staff. The report found that despite an increase from a full-time staff of 268 in 2019 to 335 in 2021, that growth “has not resulted in an improvement in API’s treatment planning or the adequacy of active treatment.”
The ombudsman’s investigation was initiated after an anonymous complaint was filed in November 2020, with several complaints about the hospital. The ombudsman found many of them credible. However, it did not find evidence to back a complaint about the institute’s COVID-19 policies.
The investigation was conducted in 2021 based on a review of files from 2020. In a response to the report, Department of Health and Social Services Commissioner Adam Crum emphasized that the report failed to take into account changes made by the institute since then.
“These allegations were raised over two years ago and many changes have happened at the facility since that time,” Crum said in an email, adding that “the facility is no longer operating in a state of constant crisis.”
But Burkhart said that when given an opportunity to respond to the findings, DHSS did not detail specific ways in which the hospital has adequately updated its procedures.
“If API was providing the robust array of services as required by federal regulation to meet the standards of active treatment, they would have laid that out. And they didn’t,” she said.
The report found that the majority of patients admitted to the institute received the same “cookie cutter” services upon admission – psychiatric nursing and medication – regardless of the reason they were admitted. The majority of plans reviewed were never individualized to patients’ needs and lacked evidence of physician supervision or specific treatments.
The Alaska ombudsman is an independent nonpartisan agency that investigates complaints against the Alaska state government and departments.
The period under review partially overlaps with an 18-month timeframe when the institute was run by Tennessee-based private contractor Wellpath under a $12.5 million contract. The investigation found that treatment plans were more likely to be overseen by a psychiatrist when Wellpath was in charge.
According to the report, medical providers at API described treatment plans as a “formality” that is not usually used as a “roadmap” for patient care. That is in contrast with a commitment made by DHSS in 2019 in response to a previous report by the ombudsman, which at the time found a lack of adequate treatment planning.
Mark Regan, legal director for the Disability Law Center of Alaska, said that the fact that API has not implemented specific recommendations from the previous report is “a matter of concern.”
In a formal response to the investigation, DHSS Deputy Commissioner Clinton Lasley detailed several ways API was attempting to improve treatment plans, including offering treatment plan writing classes, and conducting internal audits.
Active treatment, which includes psychotherapy, drug therapy and occupational therapy among other options, was also found to be lacking. In November 2020, the hospital reported offering 17 therapy groups per year in the Taku unit, which houses defendants whose criminal trials are on hold because of concerns for their mental status. But the report found none of those groups met the definition of active treatment. Instead, they focused on “equipping the patient with sufficient information and understanding to participate in their criminal proceedings.” Activities included watching episodes of television court dramas like Law and Order, according to the report.
Lasley wrote that since the investigation was issued, API has invested in improving active treatment for patients by hiring social workers, occupational therapists and psychologists.
The investigation also found that the institute has created a hostile and discriminatory work environment, failing to ameliorate problems identified in previous investigations.
A toxic work environment would not be a new problem at the psychiatric institute, which has previously been fined $44,000 by the Department of Labor for being an unsafe workplace.
“There is every reason to be worried that the problems with the work culture at API are continuing, and that’s a matter of disappointment for those of us who represent and work with patients at API,” Dent said. “It’s something that people have been worried about for quite a while.”
In the course of the investigation, API saw several staff members in leadership positions resign or retire, including the chief of psychiatry, chief forensic psychologist, director of rehabilitation, and quality assurance and performance improvement director.
Among the ombudsman’s recommendations was a request that the Department of Health and Social Services “correct the inaccurate and misleading information” provided to staff in response to an anonymous complaint letter in November 2020.
That information included the false assertion by API management that “there have been no allegations of hostility or harassment against management,” according to the ombudsman report.
The ombudsman identified more than a dozen complaints of discrimination, harassment and bullying from multiple members of the institute staff. The investigation revealed that some complaints were never investigated. The details of the complaints are not included in the report.
DHSS declined to adopt the recommendation, saying that the relationship between staff and management “is better served by moving forward, rather than returning to events that happened over a year ago.”
Crum detailed several changes to API policies that could affect workplace culture, including hiring a human resources consultant to provide leadership training, creating a workplace violence reduction committee and improving turnover rates among staff members.
“(We) believe the report issued fails to fully outline the current work environment and to recognize changes and improvements that have happened and continue to happen at API over the past few years,” Crum said.
But staff departures appear to still be a challenge. In 2021, 110 employees left the hospital, compared to 57 the previous year, according to a presentation made by API chief executive Scott York last month.