Text Version of Opening Remarks from Vincent P. Meconi
Monday, September 17, 2007
Thank you. I appreciate the opportunity to offer some thoughts.
What is the Delaware Psychiatric Center? Despite a 3-month barrage of newspaper articles and several legislative hearings, I don’t believe that the public has been offered much in the way of an accurate portrayal of the hospital, its patients, or especially its staff.
Some of you on the panel have been to the DPC many times, others have visited occasionally, still others may have made your first visit earlier today.
I hope that you either already know or will come to know two things that the general public will not understand if all they know is what they’ve seen in the media. The first is just how ill our patients are. On one of my many visits to the hospital, an attendant summed it up very nicely: “The DPC isn’t like going to a regular hospital with a broken arm, and they put it in a cast and you go home and eventually it heals. You’re dealing with the human mind here.” Our patients have a variety of mental health treatment needs, including major depression, bipolar disorder, schizophrenia, personality disorders, dementia, and co-occurring substance abuse disorders. Many of these patients have behavioral concerns, such as Pica, the ingestion of materials that are not food products, cutting, and antisocial behaviors. Several of these patients also have physical and chronic healthcare needs and must also be treated for medical conditions such as cancer, diabetes, AIDS, hepatitis A, B and C, and compromised respiratory systems. Very few of our patients come here as a first resort. Considering that the majority of admissions to the DPC are clients who could not be stabilized in the community, it is understandable that the patient population at the DPC constitutes some of the most challenging cases to treat in the mental health system.
The second is how difficult a job our staff, especially our direct care staff, has. I, myself, have seen patients strike or verbally abuse our staff, who shrugged it off as if nothing had happened. A few Fridays ago, I was touring a unit unannounced when a patient began screaming and cursing. I didn’t want to go near that particular patient, but the nurses and attendants calmly and matter-of-factly talked him down, as if it were just another day on the job, which of course it was.
Simultaneously, we heard “Code Blue” — medical emergency — elsewhere in the hospital. It seems the patient I had just seen on a verbal tirade had punched another patient right before returning to the unit I was touring. When I visited the site of the patient injury, I saw doctors, nurses, and attendants administering first aid to the injured patient, while keeping other patients calm. Paramedics arrived and took the injured patient away (he turned out to be all right), the police were called and came to conduct their interviews, and staff left the scene of the incident with paperwork in hand. Staff couldn’t have responded more professionally.
Honestly, I could not do that work for one day, let alone year after year as many of our staff do. The DPC is like any institution staffed by human beings. On those infrequent occasions when an employee acts inappropriately, we move to separate them as quickly as possible. But overall, the vast majority of our staff deserve our thanks and our praise and deserve to be paid appropriately, including, if necessary, the overtime without which we cannot staff the hospital.
As I said at last week’s public hearing, I fervently hope that any criticism of our problem employees will be put in the context of the good ones. Our employees, particularly those who provide direct patient care, have among the toughest jobs in society, as they care for patients who are at once vulnerable and challenging and who cannot be cared for by anyone else. Morale at the hospital has suffered greatly as our dedicated staff believe they have been tarnished unfairly, not just by the actions of a few, but by unsubstantiated allegations and even complete falsehoods. I hope you will bear in mind that in today’s health care job market, our doctors, nurses, and attendants can work elsewhere, perhaps at higher pay and in nicer quarters. We’ve worked very hard — and with some success — to improve the reputation of the DPC to be able to attract and retain the best staff we can. Going forward, my fear is not that my management team and I will receive public criticism; it is that the perception of the DPC has degraded for no good reason. If that continues, and the staff begins to leave us, we will have lost everything we have gained over the past seven years. The losers will be the citizens of Delaware who need inpatient psychiatric services. Nurse and attendant vacancies have risen over the past three months of negative publicity, and we will continue to monitor vacancies closely to see if this is normal fluctuation or a trend.
Let me spend a few minutes, then, on some DPC basics. You should already have received the same four handouts we gave the House Committee, so Representative Maier, sorry, you’ve seen this before. If anyone does not have their copies with them, I have extras. The first provides an overview of the hospital. A few items are of particular note. We have a current census of 240-245, located on the seven units described there.
Staff FTEs are 562, of which 416 are direct patient care staff (nurses and attendants). 86 percent of our patients are involuntarily committed, with the rest voluntarily committed. Let me briefly describe the admissions process. There are two primary ways for a patient to be admitted to the DPC. The first way to gain admission is through a referral from a community hospital. When a person is considered a danger to himself or another person, a physician can initiate an involuntary commitment to an inpatient setting. Typically, the patient is placed in a community hospital for short-term treatment. If the patient does not respond to treatment within 14-28 days, the patient is then transferred to the DPC for a longer-term stay. The second way that a patient gains admission to the DPC is through the Division's program that supports consumers with frequent hospitalizations. Patients, who have a history of multiple hospitalizations, are permitted direct admission to the DPC for treatment.
The second handout deals with our criminal background check process. I’m not going to read the narrative, but please note that Delaware law does not currently require CBCs for hospital employees, only those of nursing homes and other long term care facilities. The DPC is a hospital, not a nursing home. The narrative explains that we are doing CBCs on all employees anyway. We have suggested to the House committee that they may wish to look at this area themselves, and it may be one for you to examine as well.
The third handout provides, in graphic form, our regulatory, accrediting, certification, and monitoring process. As you can see, no less than eight organizations provide outside scrutiny of some form or another. The DPC is a hospital that is accustomed to being reviewed by independent bodies — and that’s as it should be.
The fourth handout is a two-page chart detailing the investigation process conducted by the DPC and the Division of Long Term Care Residents Protection. As you can see, it’s fairly detailed. Investigations are conducted by trained investigators, not by management. All substantiated investigations, and any others featuring significant allegations even if unsubstantiated, go to the Department of Justice for final review. Please note that the hospital, the Division of Long Term Care Residents Protection, and the Department of Justice conduct separate reviews of incidents - again, that’s as it should be.
When the newspaper articles end, the legislative hearings conclude, and the various investigations are over and done with, no evidence will be found that DPC records were destroyed, because none were. The DPC will continue in full regulatory compliance and with full funding from the federal government, it will continue to be accredited, and it will continue in its affiliation and collaboration with Jefferson and Johns Hopkins.
We’ll be in satisfactory shape from a regulatory point of view. Unlike six years ago, we won’t be in danger of losing federal funding. Unlike six years ago, we won’t have patients without psychiatric disorders at the hospital. Unlike six years ago, we won’t have one-fifth of our shifts short-staffed. Unlike six years ago, we won’t have gone eight years without opening any new group homes or other community placements.
But when the media coverage ends, the DPC will also still have 200-plus extremely ill patients who require 24/7 care, for weeks, months, or even years.
How we can best care for those patients, and in what setting or settings, is something that hasn’t been explored in the media or in the public hearings. That is where you on this panel can play a valuable role. The history of the DPC, during my tenure and the tenure of all my predecessors, is that it gets a lot of outside attention when there’s a headline and very little outside attention when there is no headline. The current media and legislative focus appears to be on isolated incidents and employees rather than possibilities for further improvement.
That’s why I’m very pleased that the Governor has created this body, very pleased that you have all agreed to take time from your busy schedules to serve on it, and very pleased that you will be conducting this review.
There are many important issues to be examined, some of which were covered in the Governor’s Executive Order. The DPC is now as small as it was in the 19th Century — could it be smaller still? Is our unit structure optimal? Clearly a lot of compassionate care is being delivered, but is it the most effective care? Are we using the best medical practices? Should staff wear uniforms? Should the state construct a new facility? As to this last question, I’d be less than honest if I didn’t say I speak for the entire hospital management and staff when I say that I hope you will conclude, as we have, that a new physical plant is overdue. The discussions about these and many other issues may not generate headlines, but that doesn’t mean that they aren’t important.
We look forward to providing you with any information you need to answer these and other questions. |
