Alaska State Ombudsman, Kate Burkart, released a report of a recent investigation of a complaint about the Alaska Psychiatric Institute. This investigation began after an anonymous complaint was received on November 17, 2020. The complaint includes 13 allegations. The Ombudsman prioritized investigation of allegations about patient treatment, hospital oversight, and discrimination and bullying in the workplace.
The Ombudsman found the following:
- API has not consistently created and/or updated treatment plans, which are required by federal regulation 42 CFR 482.61 for all patients;
- API has not provided active treatment, as defined by federal regulation 42 CFR 482.60-62, consistently to all patients; and
- API has failed to prevent, mitigate, or resolve behaviors creating a hostile and/or discriminatory work environment.
The allegation that Health Facilities Licensing and Certification didn’t conduct site visits in response to complaints about API during the COVID-19 pandemic was not supported by the evidence.
Treatment plans are a required part of the medical documentation for inpatient psychiatric hospitals. They also provide an opportunity for patients to provide input about their treatment goals, modalities, and progress, but the evidence showed that the patients’ initial treatment plans provided ‘cookie cutter’ services – psychiatric nursing and medication – regardless of the admission reason. A large number of treatment plans lacked evidence of psychiatrist oversight (required by federal regulation), specific treatment and therapeutic services, or individualized treatment goals.
The evidence showed that patients weren’t offered the required active treatment. While patients were offered groups facilitated by psychiatric nursing assistants, mental health treatment and rehabilitation services by licensed health care professionals was not consistently provided by API.
Similar findings were made in 2019 based on evidence that API wasn’t providing adequate treatment planning or active treatment to patients. During a 2020-2021 investigation, evidence showed those recommendations either not implemented or had been implemented and then stopped with changes in management.
Previous recommendations were made, and the Department of Health and Social Services responded in agreement to implement the ombudsman recommendations made in 2019. According to the Ombudsman, the DHSS included an explanation of obstacles to successfully implement and didn’t commit to implement the recommendations.
The Ombudsman’s investigation revealed a pattern of complaints to HR and leadership being dismissed, ignored, or only partially investigated. These complaints included allegations of racial discrimination, gender discrimination, bullying, sexual harassment, and other conduct in violation of API policy and/or state and federal law. The investigation also revealed evidence that API and DHSS leadership were aware of complaints about API managers, whom the anonymous complaint alleged had engaged in “hostility and staff intimidation,” and had restricted staff’s “ability to voice concerns regarding management” – but still denied any such complaints had been made.
Recommendations were made to address the complaint that API failed to prevent, mitigate, or resolve behaviors creating a hostile and/or discriminatory work environment. The DHSS accepted one recommendation and declined another.
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