November 6, 2007
Psychiatric Center Task Force Subcommittee Hears Recommendations for Improvement from Advocacy Group
Wilmington – The Disabilities Law Program, a State patient advocacy group, presented a Delaware Psychiatric Center (DPC) Task Force subcommittee charged with reviewing reports from regulatory agencies that visit and monitor the facility, with their list of ”high priority” recommendations for improvements. The recommendations and testimony were provided by DLP staff attorney Eliza Hurst at the subcommittee’s Tuesday morning meeting in Wilmington.
The list of six recommendations from the DLP include: 1) overhauling the DPC’s seclusion and restraint practices by among other things, mounting cameras in seclusion rooms and strengthening Delaware’s restraint law; 2) providing the DLP with copies of investigations regarding patient incidents, allegations of abuse, neglect, death, seclusion, restraint, and other patient mistreatment; 3) involving outside stakeholders in the review process of incidents involving allegations of patient abuse or neglect by reforming the Human Rights Committee; 4) formalizing a mortality/morbidity review committee; 5) promoting outside oversight of patient care practices by contracting with an independent monitor; and 6) bolstering hospital leadership in an effort to reduce staff turnover and make patient care, recovery oriented.
When asked which recommendation she feels is the most important, Hurst responded that getting copies of investigations regarding patient incidents and allegations of abuse and neglect, without having to ask for them would be the most helpful. She said it would allow the DLP to better track trends occurring in the DPC and assist them in providing recommendations for improvement to DPC staff much sooner.
Subcommittee member, and Task Force co-Chair Rita Landgraf and State Representative Pam Maier expressed concern that there seems to be no clear cut method for accountability when recommendations are made to improve patient care.
Subcomittee leader Dr. Harold Rosen thanked Hurst for her “well thought out” recommendations and suggested many of them could be achieved by forming an oversight committee. He added that a concept called “shared decision making” which involves using a team approach to patient treatment is gaining momentum across the country and could aid in improving patient care as well as staff recruitment and retention.
Subcommittee members next had the opportunity to ask questions of Dr. Gerald Gallucci, the Medical Director for the Division of Substance Abuse and Mental Health, Dr. Karen Kovacic, Chief of Psychiatry at the DPC, and Dr. Lawrence Markman, DPC Chief Physician on how DPC physicians and psychiatrists fit into the performance improvement process.
Dr. Galluci said that many of the physicians sit on committees that discuss issues related to performance improvement. He also explained that Dr. Markman recently began a monthly physician’s roundtable so that staff doctors can talk about areas of concern. There is also a daily report of patient incidents that is available to all physicians.
The subcommittee members expressed concerns that there is no clear cut organization chart that indicates who reports to whom or to which individuals on staff incident information should be provided, so that not all patient incidents are being shared as widely as they should. They also shared concerns that there does not seem to be a clear, written directive to help educate staff on how to reduce the use of seclusions and restraints.
Dr. Kovacic said that in her unit, K-3, she has a daily meeting with staff on each patient so that everyone is well informed. Rep. Maier said she feels this should be done on all units hospital-wide.
The doctors expressed their own frustration with the staff vacancies and the length of the hiring process, particularly for upper level positions. Such vacancies put a strain on the remaining physicians to do the work. Dr. Markman said that he’d like to see more aggressive recruiting and marketing to fill staff vacancies. When asked, during public comment, if physician salaries are comparable to those in other states, Dr. Kovacic said she believed they are in the mid-range of psychiatrist salaries nationwide, but that the State’s benefit package should be highlighted to applicants.
The next meeting of the full nine member DPC Task Force is scheduled for November 16th from 1- 4 p.m.
Members of the public are invited to attend, and are urged to continue checking the DPC Task Force website for updates. The website is available at www.dpctaskforce.delaware.gov.
Governor Minner created the nine-member DPC Task Force on August 17 to examine opportunities for continued improvement at the DPC. The group is charged with reviewing key areas of the DPC and its operations and making recommendations regarding hiring procedures, training, professional development opportunities for staff, and potential designs for a new facility.
The Task Force is due to make recommendations to Governor Minner no later than December 15, 2007.
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