Plan gives DHS more oversight in state mental health services

Hospital administrator
Since taking over as the Minnesota Security Hospital administrator last fall, David Proffitt has been scrutinized for patient treatment and the workplace environment at the hospital. Proffitt resigned from the position in late March.
MPR Photo/Jeffrey Thompson

Top officials at the state Department of Human Services will have greater involvement in the oversight of state-operated mental health services under a restructuring plan announced Friday.

The restructuring comes shortly after the Office of the Legislative Auditor began a yearlong audit into the wide range of mental health clinics, treatment programs, and facilities known as State Operated Services. The programs include the Minnesota Security Hospital, the St. Peter facility for those deemed mentally ill and dangerous.

The facility has come under scrutiny in recent months for licensing violations and staff turmoil, culminating in the forced resignation of Minnesota Security Hospital administrator David Proffitt in late March.

State Operated Services now reports to Maureen O'Connell, the assistant commissioner for the department's Chemical and Mental Health Services Administration, who reports to Deputy Commissioner Anne Barry. Starting April 25, State Operated Services will report directly to Barry, who reports to DHS Commissioner Lucinda Jesson.

Barry said the move creates a clear separation from DHS officials who work on policy issues and department employees who provide direct care to patients. The move also creates a more streamlined operation, which will allow DHS to respond promptly to any recommendations from the Office of the Legislative Auditor, a nonpartisan office that evaluates state agencies and programs, Barry said.

"There's a very direct route to leadership here, and changes can take place pretty quickly," she said.

Barry said she will continue to make weekly visits to the Minnesota Security Hospital to monitor the facility's progress in meeting licensing standards. The department's licensing division placed the facility on a conditional license in December after an inspection found problems with the facility's policies on the use of restraints.

Inspectors found that employees too often used restraints on patients and uncovered an incident in which employees removed a patient's mattress and did not return it for nearly a month.

The Minnesota Security Hospital also received surprise visits in March from the state Occupational Safety and Health Administration and the Joint Commission, the group that accredits health care facilities.

The OSHA inspection came in response to a concern about worker safety at the facility, where employees have said they face dangerous working conditions. Chuck Carlson, the president of AFSCME local 404, the union that represents direct care employees, said workers have been punched, spit on and kicked by patients over the years.

DHS officials learned today that the facility will not receive any citations related to the visit, Barry said.

Although the OSHA inspection did not result in any citations, the Joint Commission inspectors found five areas of "insufficient compliance" by the facility, including psychiatry staffing levels and documentation of the assessment of factors that might decrease the risk of suicide.

The Joint Commission's report called the facility's psychiatry staffing "minimally adequate." The site visit occurred several weeks after all of the facility's top psychiatric staff departed to protest Proffitt's leadership style. DHS officials ordered Proffitt to either resign or be fired in late March.

Barry said the department is hiring at least one full-time psychiatrist and has brought in four other psychiatrists, including a new medical director, to provide treatment to the facility's nearly 400 patients.

Current staffing levels allow patients to see a psychiatric provider as often as twice per week when needed, DHS spokesperson Patrice Vick said. Patients who are more stable see a provider every three months at a minimum.

Barry said the facility will also improve its assessment of factors to reduce the risk of suicide and is preparing a response to the Joint Commission explaining the steps the facility is taking in response to the inspection.

Hospital at Risk:
Danger and Dysfunction at the Minnesota Security Hospital
State facility for the mentally ill risks losing license over turmoil
―Published: Feb. 28, 2012
Data: Violence, restraints common at Minnesota Security Hospital
―Published: Feb. 28, 2012
David Proffitt, head of Minnesota Security Hospital, resigns at state's request
―Published: March 27, 2012
Former Minn. Security Hospital leader's 'extremely assertive' style rankled some
―Published: March 28, 2012
State failed to review troubled past of ousted Minn. Security Hospital administrator
―Published: March 30, 2012
Auditor to look at agency's hiring practices in wake of Proffitt dismissal
―Published: April 2, 2012
Former Security Hospital head still getting paid
―Published: April 12, 2012
After complaints, MN Security Hospital inspected
―Published: April 13, 2012
Plan gives DHS more oversight in state mental health services
―Published: April 20, 2012
Funding for St. Peter hospital renovations in doubt
―Published: April 27, 2012
Security hospital worker 'emotionally abused' patient
―Published: May 1, 2012
Security Hospital in line for fraction of funding request
―Published: May 4, 2012
State investigating Security Hospital's handling of missing patient, stabbing
―Published: May 9, 2012
Investigation shows complexity of caring for the state's most violent and mentally ill adults
―Published: June 8, 2012
DHS confirms resignation of executive
―Published: Aug. 23, 2012
More injured employees, fewer doctors at Minnesota Security Hospital
―Published: Aug. 29, 2012
Minn. moves mentally ill patients to avoid legal action
―Published: Dec. 14, 2012