While not all the problems at the county-run Meadowview Psychiatric Hospital in Secaucus have been resolved, the facility has made significant progress, according to the Carol Ann Wilson, acting hospital director.
Last month, the Hudson County Board of Freeholders held back funding for continuing operations at the hospital for 2004 until they were apprised of conditions and progress there.
While Wilson is expected to issue a formal written report on the operations shortly, she appeared before the Jan. 20 Freeholder Caucus to answer questions about the facility.
Approximately 80 patients currently reside in the county-run facility. The facility suffered serious problems in the early 1990s when the level of care caused it to lose its state funding and license. The county contracted out services in 1995 to a variety of vendors for psychiatric and other services. Among those hires was Janus Solutions, a consulting firm that was charged with helping to restore the lost funding and prepare the facility and staff to meet standards of accreditation.
In 2001, Janus Solutions issued a report that was particularly critical of Hudson County Psychiatric Services, the principal provider of psychiatric services at the hospital, a firm owned by Dr. Oscar Sandoval.
Last June, after a federal investigation, former County Executive Robert Janiszewski admitted seeking payments from Sandoval from about 1995 on to obtain and keep the contract. Sandoval in 1999 began cooperating with FBI agent eventually, leading to Janiszewski’s arrest. While Sandoval claimed the Janus Solutions report was skewed against him as part of an effort by Janiszewski to get even, hospital professionals said recently that many of the report’s claims were real.
“These were problems that predated my taking over [approximately a year ago],” Wilson said, though she indicated that there was significant progress in addressing patient care since then.
In late 2001, Correctional Health Services took over psychiatric and other operations at the hospital on an interim basis, later winning the contract for services there.
In her comments to the freeholders Tuesday, Wilson confirmed some of the successes in Janus Solution’s report, noting that the hospital is currently licensed and meets state and federal standards for operations.
Wilson, however, noted that changes in federal regulations would require more work in obtaining accreditation from the Joint Commission on Accreditation of Health Care Organizations.
Janus Solutions was in part hired to help the facility get JCAHCO accreditation. In late 2000, skeptical freeholders began to question delays in getting this last piece in place, threatening to cancel Janus’ contract. The Janus Solutions report citing all the problems at the hospital was part of the justification for the delays.
Janus could get contract again in future
Wilson said Janus is currently not under contract with the county to continue the process, although County Administrator Abe Antun would not rule out rehiring the firm to continue the accreditation process.
“We wanted to wait until we had a permanent director at the hospital,” he said.
Wilson has been in the capacity as acting director for about a year, and has been reviewing applicants for the permanent post. She said a new director will be named shortly, and the decision as to when to begin the accreditation process again would likely be made within 90 days.
But Wilson said conditions for JCAHO accreditation have changed since the county shut down Janus’ operations last year, and that much more work will have to be done in order to obtain the accreditation. She said new federal regulations have to be met. While the facility will not be set back to where it started, more than previously presumed will have to be done to meet the new standards.
She said she anticipates applying for the accreditation in 2004, and that there are periods in spring and later in fall when the county will have to act.
Wilson said Janus has obtained pre-certification for the facility, and that remains in place.
But Freeholder Barry Dugan was concerned that the county had spent a lot of money over the years, only to be set back. “Are we now back to square one?” he asked.
Wilson said there is work to do, but that much of the groundwork Janus Solutions already did is still valid. She said, however, there areas such as treatment, medical issues and certification of doctors that must be addressed before the hospital can obtain its JACHO accreditations.
Janus Report showed areas of concern
Janus Solutions issued its report on conditions at the Meadowview Hospital Psychiatric Unit in August, 2001, and cited number of areas of concern.
Tom Blatner, President of Janus Solutions, said in the Janus report that prior to his company coming on board in 1995, the hospital was not certified by the Federal Health Care Finance Administration and was not accredited by the Joint Commission on Accreditation of Health Care Organization. Until the company’s contract was terminated and ceased operations in late 2002, the company had reopened admissions, regained and maintained state funding, and expanded the number of licensed beds. Janus also had coached the hospital staff through HCFA certification and writing policy and procedure manuals for the hospital. Janus Solutions also helped the hospital achieve pre-certification for JCAHO.
“However, we have served as consultants to the hospital and have no line of authority or operations responsibilities within the hospital,” Blatner wrote in his introduction to the report. “From the day that the hospital received initial accreditation to the present (2001), we have advised county officials, including the Board of Managers, that the accreditation was at risk.”
Members of the Board of Managers were appointed by County Executive Robert Janiszewski and include various key officials including the county administrator and the director of the county’s Department of Human Services.
During the period of the report, the county had contracts for specialty services at Meadowview. There was a contract with Hudson County Psychiatric Associates for five psychiatrists, and a contract with the Rossi Psychological Group to supply one full-time and one part-time psychologist.
Hudson County Psychiatric Associates is owned by Dr. Oscar Sandoval, from whom money was extorted by County Executive Robert Janiszewski to get and maintain his hospital contract.
Sandoval claims the report was done at the bequest of Janiszewski to “get even” for the role Sandoval played in Janiszewski’s arrest and later conviction.
But county officials say the report has merit and became a map for corrections later accomplished by Correctional Health Services – which picked up the contract after the county discontinued Sandoval’s service.
The Janus Solutions report focused primarily on Sandoval’s services, although it did briefly praise Rossi Group in several areas.
Reviewing the operations
In reviewing the operations – which were largely run by Sandoval’s staff – Blatner wrote that there was “an absence of a documented track record of evidence to support implementation of a sound clinical program.”
The report said operations conducted at the hospital in 2001 had “a minimal amount of programming and services” on the residential units and rehab services. Many of the rehab and psychological treatments were cancelled during periods covered by the report.
“Staff were seen observing rather than interacting with patients,” wrote Art Ring, an independent professional brought in by Janus Solutions for the study, noting the lack of clinical model and leadership to care for patients.
There was, he wrote, “too much of the attitude that the hospital and its patients existed for the convenience of the staff.”
Ring also noted the following: a lack of basic safety hardware in some locations; warm temperatures in storage that could compromise medicines; staff smoking in some areas; and unacceptable health standards in kitchen areas. Physicians, during the term of the time of the survey, were not around a lot, and communication was poor with the staff on some issues, he said. Patient records seemed in disorder, and in some cases showed an abnormally low record of problems with medicine. (Generally, institutions record overdoses and other problems with dosages, and Meadowview’s rate of recording them seemed low.)
Dr. Jeffrey Geller of the University of Massachusetts Medical School was even more critical of the operations at Meadowview, citing lack of staff accountability, lack of activities, lack of scheduling reports, health violations, lack of doctors, no treatment plans, cancelled programs, and other issues. Dr. Geller also said patients hung around the halls unattended, nurses failed to sign forms as to when medicine was given, and nurses were, at times, not available.
The most serious criticism, however, involved the alleged overprescribing of drugs. Dr. Geller said that 53 of 76 patients at the facility were stable enough to be placed in the community outside the hospital, yet were being prescribed types and levels of drugs typically used on people at the height of crisis.
Dr. Geller also noted that “the [psychiatrist’s] notes do not provide the rationale for what the psychiatrist is doing,” and “there appears to be some role confusion as to the distinct roles of the medial physician and the psychiatrist.” –Al Sullivan