Hospital fires psych unit staff

Boston’s Carney Hospital fired the entire staff of its adolescent psychiatry unit at the end of May after allegations of abuse prompted an investigation that raised significant concerns about patient safety and quality of care, reported The Boston Globe and the Dorchester Reporter. On July 6, The Boston Globe reported that the state validated three complaints of abuse by mental health counselors plus one complaint of neglect.

The hospital fired 13 nurses and 16 mental health counselors after engaging former Attorney General Scott Harshbarger, now a lawyer with Proskauer Rose LLP, to investigate and report on conditions on the 14-bed locked unit. According to a May 28 Boston Globe story, Harshbarger said in a statement, “Given the serious nature of what we learned while investigating the recent incidents, and recognizing the importance that Carney leadership places on patient care and safety, we have concluded that the unit cannot continue to function as it is currently composed. In our opinion, it would be prudent to replace the current personnel in order to ensure quality care for these vulnerable patients.” In an email, hospital spokesman Christopher Murphy declined to participate in this story.

Since then, the unit is operating with a reduced census per an action plan submitted to the state Department of Mental Health, according to spokeswoman Anna Chinappi. She wrote in a July 11 email that the unit is being staffed with qualified personnel from other Carney units and in-network hospitals (Caritas was recently acquired by Steward Health Care System LLC), plus a new program manager has been hired. The DMH licensing division is monitoring the unit and making unscheduled visits. DMH also requires the hospital to redesign its psychiatric inpatient service training curriculum, Chinappi’s email said.

The hospital is spending $1.5 million to renovate the unit, reported the Globe on May 28. The hospital is also advertising on its Web site for adolescent mental health counselors.

“We are satisfied with the hospital’s plan going forward and confident that the new clinical staff and leadership will assure patient safety and appropriate clinical care,” Chinappi emailed.

Massachusetts Nurses Association spokesman David Schildmeier says the union has filed grievances on behalf of the fired nurses and demanded to review the evidence on which the hospital based the terminations. According to the Globe, the SEIU has filed grievances on behalf of the fired mental health counselors.

“None of the nurses were directly involved in the incidents,” Schildmeier says. “We are hoping to get their jobs back or whatever redress we can.”

A letter from Mass. Nurses Association officials to the fired Carney nurses describes how the nurses used their own money to buy food, games and supplies to make the unit “as homelike as possible for the kids.”

“Nurses put paper over holes in the walls and begged for funding to remodel the unit,” the letter says. “For years the nurses expressed their concerns about the unsafe/unsatisfactory environment and the lack of management leadership…. For the most part the nurses were ignored.”

Judith Shindul-Rothschild, Ph.D., RNPC, was “stunned” when she read about what happened at Carney. As supervisor of the clinical practicum at Boston College School of Nursing, she has placed student interns on Carney’s adolescent unit for years because the staff served as exemplary role models. She says that inpatient adolescents can be a challenging, high-risk population that requires more experienced staff than an adult population to keep a unit safe and therapeutic.

“It’s unusual to fire an entire staff,” Shindul-Rothschild says. “But the responsibility for adequate staff [on a unit] is a management decision, not the rank and file who have no control.” In fact, the hospital did fire two management-level employees: the vice president of patient care services and the nurse manager of psychiatry, according to the Mass. Nurses Association letter.

Shindul-Rothschild points out that any institution looking to reduce errors and fix problems must look inward to its own system for answers.

“You can push every nurse and mental health worker out the door, but if you haven’t changed your fundamental factors, you’re destined to repeat the same mistakes,” Shindul-Rothschild says.