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State budget cuts had adverse effects on patient care, leading to hospital’s decertification Date: 09/23/16

Megan Hart

By Megan Hart

Last December, I was reading the local newspaper before heading to my first day of work at KHI News Service when I came across a few paragraphs about a public notice stating one of Kansas’ two state psychiatric hospitals would lose Medicare payments within a month.

At my previous job, I had covered nursing home inspections, so I was somewhat familiar with how the Centers for Medicare & Medicaid Services handle inspections. From that experience, I knew it was rare for CMS to ‘decertify’ a facility or cut payments. Therefore, I knew something serious must have happened at Osawatomie State Hospital. The issue was even more important because in eastern Kansas most people who are involuntarily committed are automatically sent to OSH. The only other state psychiatric facility covers the western part of the state, and relatively few private facilities take involuntary patients, even if the person has insurance.

For a quick daily story that I wrote with my colleague Andy Marso, I got the CMS inspection report and combined that information with a response from officials in the state Department for Aging and Disability Services. From the inspection report, we learned that a patient had sexually assaulted an employee, and the inspector pointed to a “systemic failure” because other security and medical staff weren’t performing their rounds at the time and had falsified records to say they had.

While waiting for CMS to send the inspection documents, I read through everything my predecessor at KHI (Dave Ranney) had written about OSH, and discovered an inspection in 2011 in which the inspectors did not find any deficiencies (which is relatively rare).

That’s when I decided to look into what had changed in those four years and requested all of CMS’ inspection records for that period.

When investigating state hospitals, start with CMS’ inspection records. The Joint Commission certifies some hospitals but doesn’t make its inspection records available. On the other hand, when CMS responds to complaints and conducts inspections, those records are available to the public. They’re quite dense, but sometimes you’ll find a nugget of news buried in the middle, such as information about a patient’s death. Nothing in these reports identifies personal information, so you won’t be able to find specific sources that way. But the reports offer enough information to determine whether there’s a story worth pursuing.

Fortunately, Ranney had written about mental health, and his stories were useful for context, possible sources, links and documents. I wanted to make sure I had a solid grasp on what was documented, because people have an incentive to spin the details when the press wants to know what went wrong.

Then I set aside some time to go over it all and figure out what specific questions I still had, and who might be able to answer them. Former hospital superintendents and employees were big sources, and mental health advocates and the state employees’ union offered some context.

Also, I found some of my best sources to be hospital staff retirees, because they have firsthand knowledge and were free to speak. Keep in mind, though, that some of them may have axes to grind, either against the current management or against other people you’ve used as sources.

Altogether, the series took about seven months, though the last month or so was devoted to editing. On a project of this size (five major stories), be sure to give yourself plenty of time to plan, write and edit. For a long investigative piece, it’s easy to get bogged down in the details, and that’s where it helps to work with an editor who can help pare away any excess.

The final package covered how mental health reform put strains on state hospitals in the 1990s and on OSH in particular (Osawatomie State Hospital: A leading light for mental health care slowly dims); how budget cuts and increasing numbers of patients caused the hospital to run over capacity (Higher patient count, unsteady state funding made waves for Osawatomie State Hospital); how a plan to reduce state costs with early retirements backfired, and patient care suffered (Staff departures created ‘dangerous situation’ at Osawatomie State Hospital); how two inspections uncovered dangerous situations, which led to the decertification (Patient violence, lack of security checks produced a ‘perfect storm’); and what the state plans to do to fix the situation (Added staff, budget aim to help Osawatomie State Hospital ‘turn the corner’).

Since the series ran in the last week of July, the reaction has been overwhelmingly positive so far. Those in the mental health community thanked us for pulling together the trends they’d observed into an accessible package.

Megan Hart (@meganhartMC) covers health care at the KHI News Service in Topeka, Kan.