Alaska Ombudsman releases damning report into API patient care, ‘toxic work environment’

JUNEAU, Alaska (KTUU) – The Alaska State Ombudsman has released a damning report into the state’s only psychiatric hospital, detailing how patient treatment plans have not met federal regulatory requirements and that there has been a “toxic work environment” for the hospital’s employees.

The investigation stemmed from an anonymous complaint letter written in November 2020 about the Alaska Psychiatric Institute, which detailed 13 specific allegations. Health Commissioner Adam Crum issued a lengthy response to the ombudsman’s report, saying it raised many “questions and concerns,” but he insisted that changes have been made.

“There is no question that the work is complex and difficult and we take these obligations seriously,” he said. “We thank the ombudsman’s office for their work and role in state government but believe the report issued fails to fully outline the current work environment and to recognize changes and improvements that have happened and continue to happen at API over the past few years.”

Kate Burkhart, the state ombudsman, is skeptical, saying the agency has made general statements about how improvements have been made when it comes to patient treatment plans instead of providing a detailed explanation of how that has been done.

“They have asserted that things are much better. I’m not sure the evidence supported that,” she said. “But, that’s what they asserted.”

When Gov. Mike Dunleavy took office in 2018, the hospital was plagued with problems. It was on the verge of losing its certification and only had 20 staffed beds. Last month, it had increased that to 55 staffed beds.

“One of the promises I made when I ran for this office was to ensure that government works for the people,” Dunleavy said about API during his State of the State address last month. “Thanks to our health department, we turned that situation around.”

Despite the issues raised by the ombudsman, Jeff Turner, a spokesperson for the governor’s office, said on Wednesday that Dunleavy stands “by his statements on API.”

Burkhart said her office received 163 complaints and reports of harm involving patients at API in 2021, compared to 15 the year before. The majority of those complaints were for patients allegedly harming other patients.

She said those complaints come in on a rolling basis as part of mandatory reporting requirements and that the more-than-tenfold increase in complaints is an “indicator of concern.”

“The majority have to do with patients’ behaviors in the hospital and whether they are violent or disruptive or they’re self-harming or harming to others,” Burkhart said. “That is an indication of whether the hospital is able to provide the service those folks need to manage their symptoms.”

There has been one marked improvement at API since a previous ombudsman’s investigation into the hospital was launched in 2018. Burkhart said this time around, investigators did not find evidence of unlawful seclusion and restraint procedures being used on patients.

“That’s great, that is great,” she said. “There are still deficiencies in the planning and treatment of patients. And it would be great to see improvement.”

Federal regulations lay out requirements for active and individualized treatment plans for patients at psychiatric hospitals. The ombudsman looked at dozens of patient files in early 2021 and found persistent problems.

The report said there were “cookie-cutter” treatment plans used for a majority of patients and many were not having adequate treatment time with qualified physicians.

“Of the patient records reviewed by ombudsman investigators, 61% of the treatment plans lacked any reference to psychosocial treatment services – services provided by licensed providers, such as mental health clinicians, psychologists, occupational therapists, etc.,” the report says.

The report also says that hospital management gave “misleading” information to staff and the API Governing Body about patient treatment plans, despite knowing they didn’t meet federal requirements. Deputy Commissioner Clinton Lasley says that is “not completely accurate.”

“The API Governing Body has been fully aware of the work and the improvements that need to happen within the hospital,” he said.

The Alaska Department of Health and Social Services and the ombudsman’s office worked together while the yearlong investigation took place. Lasley says the agency accepted Burkhart’s findings into deficiencies with the hospital’s treatment plans last year and it has strived to make changes.

“We’ve taken that very seriously over this past year as these have come to light and really worked hard within the Alaska Psychiatric Institute to make corrective actions to improve those treatment plans,” he said.

Another area of concern is the workplace environment for API staff. The ombudsman says the hospital’s CEO, Scott York, inaccurately stated that there were no complaints made against management of discrimination or bullying.

Those complaints are confidential and the specific details are not included in the report, but, it describes that multiple allegations of bullying and racial and gender-based discrimination were made against management that were never investigated.

Lasley said the hospital’s management has strived to make improvements to fix a “toxic work environment” at API.

“We continue to look at ways to improve on the way we do business at the hospital. And making sure that we’re really looking, not only at serving patients but really looking at the well-being of the people who are serving them,” he said.

Burkhart stressed that rank-and-file staff are trying their best despite the challenges at the hospital.

“There are lots of folks who get up every day and go to work at API and try to deliver the best care possible given the environment and the resources they have,” she said.

The report concludes that the problems at API are not “novel” and that the ombudsman investigated “nearly identical complaints just two years ago.” Burkhart said that her office doesn’t have an enforcement arm and that it’s up to the administration and the Legislature to decide what happens now.

Copyright 2022 KTUU. All rights reserved.

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