TBO.com - TBO is Tampa Bay Online

Psychiatric Ward Rebuked For Suicides

ADVERTISEMENT

By ELLEN GEDALIUS

The Tampa Tribune

Published: August 22, 2008

Updated: 08/22/2008 04:00 pm

TAMPA - Conditions at Tampa General Hospital's psychiatric ward are so bad they pose "an immediate and serious threat to the health and safety of patients," according to a federal agency's investigation into two suicides at the hospital.

The U.S. Department of Health and Human Services is threatening to withdraw Medicare reimbursements to the hospital unless Tampa General can prove by Sept. 6 that it has taken steps to fix problems at the 22-bed psychiatric ward.

In a scathing 44-page report, the Department of Health and Human Services, working with the state Agency for Health Care Administration, detailed shortcomings at Tampa General's psychiatric ward. The investigation was prompted by an anonymous complaint to the federal agency after two people committed suicide within two days of each other in July.

On July 21, Annette Howard, 44, hanged herself with a bedsheet tied to a closet door. On July 23, Brian Murphy, 28, died after hanging himself the same way in the same room where Howard killed herself.

"I find it somewhat amazing Brian was transferred to a room where the lady hung herself," said Ron Murphy, Brian's father. The report, he said, "just builds a case for a lawsuit alleging neglect."

Tampa General treated more than 800 patients in its psychiatric unit last year. Patients are treated for a variety of psychiatric problems, including anxiety disorders, bipolar disorder, depression and schizophrenia. Tampa General is one of a few hospitals in Hillsborough County that accepts patients committed under the state's Baker Act.

Hospital Chief 'Saddened, Embarrassed'

Tampa General's president, Ron Hytoff, released a statement Thursday saying he was "saddened, embarrassed and concerned reading the surveyor's observations about our psychiatric unit."

The hospital released the report Thursday. Among the findings:

•Staff members had been instructed to increase the frequency of checks on patients after the first suicide but there was "no change in policy implemented, no form changes and no formal time plan for the increased observation to take place."

•Although one of the patients had a history of having suicidal thoughts, self-injury and depression, there was no evidence the patient was assessed to determine whether a higher level of observation was needed.

•Staff members were supposed to check on patients every 15 minutes. But on some dates, discrepancies in the documentation meant investigators could not tell whether all those checks were made, including on Murphy the day he committed suicide.

•Patients did not appear to have been re-evaluated for suicidal tendencies after the first attempted suicide in the unit.

•Four plastic bottles of different cleaning solutions were kept in an unlocked closet, accessible to patients.

•Only 17 of 137 direct care staff members attended an in-service training session about suicide in the days after the two deaths.

Because of fear of possible lawsuits, the hospital would not give investigators adequate information on any investigation the hospital had performed on the two suicides, the report said.

Hytoff said the hospital is improving its observation of patients and changing policies and procedures in the psychiatric unit. He declined to be interviewed by the Tribune.

The federal report drew sharp reactions from those connected to the suicide victims.

"I don't understand how two people in a psychiatric unit managed to hang themselves," Murphy said. "He was in a psychiatric unit. He was not supposed to be able to do stuff like that. The hospital is responsible for neglect."

Murphy, who lives in Longwood, said he intends to consult a lawyer.

The Howard family already has an attorney, Mike Trentalange.

"It's not an isolated event at Tampa General Hospital," Trentalange said. "It's a culture of carelessness.

"People pay closer attention to the merchandise at Target than they did to these two people. Someone needs to be charged criminally for this."

Tampa police found no criminal wrongdoing when they investigated the circumstances surrounding both suicides, spokeswoman Laura McElroy said.

Trentalange filed a lawsuit against the hospital Thursday in circuit court, citing "unlawful, deceptive and misleading business practices." He contends the hospital has failed to disclose information he has requested about the incident.

John Dunn, a hospital spokesman, declined to comment.

Failure Of Care Can Default Contract

According to the hospital's Medicare contract with the federal government, the hospital agrees to abide by specific regulations to ensure quality care. Tampa General received $168.4 million in Medicare reimbursements last year, Dunn said.

When a hospital fails to comply or when a serious threat to patient health and safety is found, the government can rule that the hospital defaulted on its contract and cannot participate as a Medicare provider.

Now, Tampa General has to come up with and implement a plan to fix the problems, said Lee Millman, a spokeswoman for the Centers for Medicare & Medicaid Services, the division of the Health and Human Services Department that is overseeing the investigation.

That hospital's plan would need to be approved by the Centers for Medicare & Medicaid Services. The state Agency for Health Care Administration also would do an unannounced inspection.

If the plan was accepted, funds would continue to flow to the hospital. If not, the hospital would lose its Medicare funds, meaning it would not be reimbursed for services provided to Medicare patients. The hospital could still treat Medicare patients, but patients might then be billed directly for services.

Medicare reimbursements made up about 22 percent of the hospital's budget in the 2007 fiscal year.

It is rare for a hospital to lose its Medicare funds, but it does happen, Millman said.

The psychiatric unit at Tampa General remains open. "All of the employees, physicians and volunteers understand that the community must have absolute trust in the operation of our psychiatric unit," Hytoff, the hospital's president, wrote in his statement. "Restoration of that trust is our No. 1 goal."

Editor Todd Pratt contributed to this report. Reporter Ellen Gedalius can be reached at (813) 259-7679.

Share this:

Loading Comments...

Email Print

ADVERTISEMENT