Psychiatric hospitals ailing, report says Internal review says budget cuts hurt treatment


A report based on an internal review of the state's psychiatric hospitals concludes that budget cuts and hiring freezes have led to inconsistent treatment of patients, longer hospital stays, and an increased risk of mistakes in the giving of medication.

Because of financial problems, "custodial care is becoming more the norm rather than active treatment," says the report prepared by the state Mental Hygiene Administration.

The report describes the majority of those who work in the hospitals as "professional, caring and constantly challenging themselves."

"By necessity the facility staff have focused their attention on the safety, comfort and basic level of functioning of patients," the report says.

The Mental Hygiene Administration, trying to stave off cuts in its fiscal 1992 budget, yesterday presented the 13-page document to the Health, Education and Human Resources subcommittee of the Senate Budget and Taxation committee.

Among the report's conclusions:

* Staffing levels are inadequate, creating unsafe working conditions and hindering attempts to meet accreditation standards. For example, to plug staffing gaps, nurses, are sometimes assigned to areas outside their expertise and that heightens the risks of errors in treatment and medication.

* Preventive maintenance and upkeep of buildings is lacking. A patient was burned at one facility by steam venting from an outdated system.

* The quality of care is inconsistent due to a lack of ongoing training for staff members and a high turnover in some positions.

Administration director Stuart Silver said one of the state's six biggest regional hospitals, Spring Grove in Catonsville, is without accreditation. This renders it ineligible for up to $1.5 million in federal reimbursement. The other five big hospitals are accredited, but "only by the thinnest margins," he said.

The state's nine psychiatric hospitals house an average of 2,000 patients.

Gov. William Donald Schaefer's budget request for fiscal 1992 would give the administration $308.9 million, a 2.6 percent cut from fiscal 1991 that would require a loss of more than 500 workers. Much of the reduction is expected to come from an ongoing effort to move patients out of hospitals and into alternative and community-based programs.

A legislative budget analyst recommended another $2 million cut to be achieved largely by requiring employees who now work 35.5 hours each week to work 40 hours. The longer week would allow for a reduction of 75 employees, the analyst estimates.

The administration claims the longer workweek would not produce those savings because many of the workers are in patient-care positions which cannot be cut as easily. And Silver said the organization is already understaffed.

Subcommittee chairwoman Barbara Hoffman, D-City, said the agency should seek more money from Schaefer.

"I think the governor needs to look at the budget as a whole and move some resources from agencies where services are not so critical," she said.

Nelson J. Sabatini, acting secretary of the Department of Health and Mental Hygiene, which oversees the Mental Hygiene Administration, said the governor may provide the agency with some additional workers. The hires will come from a pool of emergency positions Schaefer wants to maintain in the budget.

"The governor has said he wants to talk to me about the staffing needs of these facilities," Sabatini said.

"We have a good hospital system and the governor is committed to it," Sabatini said.

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