New curb on Brookline mental health hospital
State finds risk at facility, bars admissions
State regulators have prohibited a Brookline psychiatric hospital from admitting any patients, citing deteriorating conditions and an immediate risk to patient safety.
Health officials took the unusual action Thursday against Arbour-HRI, part of a chain of mental health hospitals and clinics that has been repeatedly cited in Massachusetts and other states for understaffing and poor training of workers.
Inspectors made a surprise visit to Arbour-HRI in October, after receiving a report about a female patient being forcibly searched, an incident that state Mental Health Commissioner Marcia Fowler described in an interview Monday as “a very serious human rights violation.” The inspectors identified a range of problems, including dirty conditions and untrained or inexperienced staff, she said.
As an initial step, the Department of Mental Health slightly reduced the number of patients that the 66-bed hospital was allowed to treat at a given time. But when Arbour-HRI did not properly address the problems that regulators had identified, the state halted admissions altogether.
Lizbeth Kinkead, the department’s licensing director, wrote to Arbour’s owner, Universal Health Services, that she was concerned that patient care at the hospital was “substantially compromised.”
In addition to noting the hospital’s unsatisfactory plan for correcting its problems, Kinkead cited anonymous complaints and photographs received by the agency that “appear to show inappropriate staff behaviors and unsafe practices.” The photos showed a soiled mattress pad that was being reused and inappropriate language written on a whiteboard.
The hospital, which reported a 32 percent profit on operations last year, has until the end of the month to submit a proper plan of correction or the department will begin the process of suspending its license, the letter said.
Arbour-HRI is part of Arbour Health System, which operates seven inpatient facilities and 13 clinics in the state. Universal Health Services, a public company with nearly 200 psychiatric centers around the country, owns Arbour Health.
Arbour Health System spokeswoman Judy Merel said the hospital was working on a new corrective action plan to be submitted to the state before the deadline. Its first plan, submitted Nov. 15, was deemed by the state to be insufficient. She said it is “not uncommon” for regulators to ask for more information after the first plan is submitted.
But the Department of Mental Health issues a freeze on admissions only in very serious cases. It took that step earlier this year, for example, when inspectors found that patients at Quincy Medical Center’s psychiatric unit for seniors were neglected and lived in filthy conditions, a situation Fowler said has been rectified with state oversight.
Fowler was pointed in her criticism of Arbour-HRI officials. The problems inspectors found indicate a “lack of leadership and oversight of that facility,” she said. The first improvement plan was so poor, she said, that it appeared hospital administrators “really seemed to miss the point.”
The department’s letter notifying the hospital of the admission freeze was sent a day after the death of Arbour-HRI patient Lori Ann Durant, a 46-year-old woman originally from New Bedford who had complicated mental health and medical issues, including chronic lung disease.
Fowler said the death was not part of her department’s investigation and the timing of the letter was coincidental. The state Disabled Persons Protection Commission, which typically shares its results with Fowler’s office, received a report about the case and plans to investigate, said deputy executive director Emil DeRiggi.
Durant, once a competitive roller skater and a postal carrier, was admitted to the hospital to have her psychiatric medications adjusted after staff at the group home where she lived noticed she had become agitated, her parents said in an interview.
Arbour-HRI “accepted her in the morning, and she was dead in the evening,” said her father, John Durant. “Something doesn’t seem right there.”
He said his daughter’s medical conditions, while complex, had been controlled with medications and proper care. The family does not know the cause of death and is awaiting the results of a toxicology report.
In an e-mail to staff Friday, hospital chief executive Patrick Moallemian expressed concern for the family of the patient, whom he referred to as “Ms. D,” and praised the staff for doing “a tremendous job of caring for our patient with utmost compassion, professionalism and 100 percent following their training and good instincts at the time.”
The union that represents nurses and mental health workers at the hospital expressed support Monday for the state’s move to freeze admissions.
Jeff Hall, spokesman for Local 1199 of the Service Employees International Union, said members have been telling hospital administrators for years that the facility was understaffed, needed security guards, and lacked the necessary doctors and other medical resources to meet patient needs.
“The appeals by health care workers for improved conditions and staffing at Arbour-HRI have been repeatedly and chronically disregarded by Arbour and its parent company Universal Health Services,” he said in an e-mail.
State regulators have identified staffing problems elsewhere in the Arbour Health System. Citing state reports, the Globe reported in June that Arbour had allowed therapists who lacked required training or supervision to treat patients at outpatient clinics that serve large numbers of poor people. Separately, Arbour Hospital in Jamaica Plain was found to have too few nurses during four consecutive inspection cycles. The same hospital was cited for staff failures related to two questionable deaths.
After each violation, the state approved the company’s plan of correction with little acknowledgment that problems had been repeated despite promises to fix them.
Dr. Sheldon Schwartz, an internist who worked at Arbour-HRI for several years, said in an interview that he repeatedly called state regulators earlier this year to express concern about patient safety at the hospital. He said administrators were cutting corners and failing to provide timely care to patients. He also complained to hospital administrators, but said nothing changed.
Schwartz was suspended from his part-time work at the hospital earlier this year and later resigned. Hospital officials did not respond to a request for comment Monday night on Schwartz’s case.
If the state accepts Arbour-HRI’s revised plan to improve conditions, Fowler said, the hospital’s progress will be monitored with regular inspections for weeks to come.