Intermountain complaints continue

Online hospital records show sloppy, dangerous care


Since District Court Justice Michael McLaughlin sealed records about Intermountain Hospital's Residential Treatment Unit in March 2007, the hospital has been the subject of numerous official and substantiated complaint investigations.

The Idaho State Department of Health and Welfare has investigated complaints including poor discharge mechanisms that may have contributed to a suicide, improper dietary procedures for patients and building safety violations, including fire hazards.

Boise Weekly readers may recall efforts last year to access records on the RTU, a now-shuttered adolescent treatment ward. Records sought included information about a patient riot and a suicide attempt. Intermountain, a privately owned psychiatric facility in Boise, was granted a court injunction, and access to the records was denied.

Since that time, attorneys involved in a lawsuit against Intermountain's parent company, Psych Solutions, and two out-of-state investigative reporting agencies, have tried to see the Health and Welfare documents as well, based on Idaho's public records law.

Recent efforts to inspect the records have met similar legal roadblocks, with Intermountain successfully arguing that since the RTU is now closed, no public good would be served by granting access.

However, Health and Welfare spokesman Tom Shanahan points out that his department's Bureau of Facility Standards recently digitized its complaint and inspection documents, and posted them on the agency Web site. Whereas previously reporters had to sit in a closed room with a BFS staff member always present, records on all accredited hospitals in Idaho are now available online.

These files show that starting in April 2007, BFS inspectors noted that the nursing department of the hospital "failed to maintain a well-organized service with a plan of delineation of responsibilities for patient care" which "affected the care for nine or 24 patients in immediate jeopardy of serious harm or death." This included patients with diabetes and those with abnormal vital signs, such as those undergoing detoxification. The complaint includes deficiencies in medication records and medication errors.

At this time, inspectors noted that a 54-year-old male who was discharged on Feb. 16, 2007, killed himself within a few days. Yet "the hospital had not fully investigated the incident in order to determine if hospital policies had been followed. In addition, following the incident, another patient had been discharged against medical advice. Nursing staff had not followed hospital policies in the discharge of that patient."

Complaints investigated and substantiated in May 2007 focused on dietary and discharge issues. BFS determined that "the hospital did not ensure the food and dietetic services were met in accordance with practitioners' orders and acceptable standards of practice."

The kitchen dishwasher was also found to operate some 10 degrees below proper water sanitization temperature levels.

Discharge planning procedures were found to be substandard because of lack of qualified discharge planning personnel, lack of planning or screening for patient physical and mental health needs, lack of measures to ensure safety from sexual abuse or safety for family members in the case of violence-prone individuals, and an absence of discharge plan evaluation procedures.

At the same time, BFS found a number of building safety code deficiencies such as corridor walls that do not resist smoke, impediments to closing doors in case of fire, and lack of documentation that the window draperies in the resident rooms were flame resistant.

Substantiated complaints in July 2007 cited substandard supervision of patient dietary needs, specifically concerning diabetes, by a registered dietician, and lack of sufficient consultation with patients regarding their diets either in-house or prior to discharge.

Finally, substantiated complaints in reports from March include lack of adequate patient supervision by a registered nurse, lack of notification to physicians when detoxing patients displayed abnormal vital signs, the fact that "nursing staff failed to clarify and follow physician's orders" for medication administration schedules, and inconsistent policies and procedures leading to failure to follow doctors' orders for skin checks for self-harm such as cutting and other forms of self-mutilation.

Also investigated was Intermountain's nursing department, for lack of sufficient organization including no or insufficient organizational charts and job descriptions or procedures to ensure the current validity of nursing licenses.

In every instance, Intermountain responded with a written "provider plan of correction," and its accreditation has never been lost. Moreover, allegations of patient sexual contact, use of excessive physical intimidation on patients, failure to follow appropriate infection-control practices, failure to obtain fetal heart rates from a pregnant patient, insufficient staffing and deficient training were all unsubstantiated, as were incidents involving the smuggling in of contraband, lapses in monitoring and supervision of a suicidal teenager and negligence in two post-discharge suicides.

In 2007 the hospital also received full accreditation from the Joint Commission on Accreditation of Healthcare Organizations, which holds until 2009.