State psych hospital no longer at risk of losing federal funding

Jackie Spanjers
Jackie Spanjers, president of the American Federation of State, County and Municipal Employees Local 1307 Union, shows a legislative committee an alarm that staff at Anoka-Metro Regional Treatment Center use to call for help when dealing with aggressive patients on March 17 in St. Paul.
Riham Feshir | MPR News

Minnesota's second-largest psychiatric hospital is no longer at risk of losing federal funding after it reached a deal to correct safety and patient care issues.

The Anoka-Metro Regional Treatment Center and the Centers for Medicare and Medicaid signed an agreement earlier this week that requires an outside consultant to conduct a review of the hospital.

The independent consultant will be tasked with examining the governance and leadership structure, patient rights under federal insurance standards, use of restraints and the treatment of individuals with prior criminal history.

Anoka-Metro has been under intense scrutiny since the Centers for Medicare and Medicaid Services interfered last year to investigate noncompliance with federal rules that govern patient rights, record keeping and nursing services.

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Centers for Medicare and Medicaid officials has been negotiating with the Minnesota Department of Human Services, which runs the hospital, for several months to come up with the agreement.

Staff at the hospital have continuously voiced concerns about an unsafe work environment at Anoka-Metro especially after the so-called "48-hour rule" went into effect in 2013. The state law requires the Department of Human Services to transfer jail inmates with mental illness to the hospital within two days of a judge's order.

Jackie Spanjers, president of the American Federation of State, County and Municipal Employees Local 1307 Union, was a nurse who was injured on the job herself. She said the agreement, which requires federal oversight through 2018, is a good step toward compliance.

"We can't do it on our own," she said. "It's not something that they're going to let anybody here do alone."

Federal documents show the Centers for Medicare and Medicaid investigated the facility for serious allegations regarding physical and chemical restraints, along with medication management.

In one incident, a patient diagnosed with chronic schizoaffective disorder and bipolar disorder, came out of her room "entirely naked and was screaming and yelling," according to the documents. She argued with staff, refused redirection but finally agreed to go to a seclusion room. Later, the patient got more agitated and threatening.

The patient refused to accept treatment for fear of side effects like "significant hypothermia," according to the documents. However, she received antipsychotic medication anyway despite a court order that bans the use of those drugs.

A psychiatrist told investigators the orders weren't documented properly and were on separate forms, the CMS documents say.

Problems with record keeping are one of the issues Anoka-Metro is grappling with. Spanjers said some staff at Anoka-Metro have been working mandated overtime, while others have quit. The hospital lacks the training necessary to provide individualized care, she added.

"If we're working with a client that has triggers that could set them off," she said, "if that's not listed, it sets all of us up."

Earlier this month, a man carrying lighter doused himself with gasoline in the lobby of the hospital, threatening to light himself on fire. Police said he was asking for better housing and social services care. A doctor managed to talk him into leaving the building.

Emily Johnson Piper
Emily Johnson Piper
Riham Feshir | MPR News

Besides the systems improvement agreement, Department of Human Services Commissioner Emily Johnson Piper has previously said fixing problems at Anoka-Metro is a top priority for her. She and Gov. Mark Dayton have called on legislators to approve a $177.3 million package of improvements for state hospitals and mental health facilities, including $30.3 million for Anoka-Metro.

Part of the proposal would free up 20 beds used by patients in the competency restoration program at Anoka-Metro. The program treats people charged with a crime, but found incompetent to stand trial.

Funding would also add cameras, personal alarms and renovated courtyards to provide secure spaces.

The human services department has also been focusing on hiring more staff. A job fair in February drew 300 applicants and filled more than 50 positions, according to DHS.