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State outlines complaint against Gulf Bend mental health unit

Victoria Advocate (TX) - 8/31/2014

Aug. 31--State regulators are holding Gulf Bend Center responsible for a contract they say it has yet to meet.

After opening a $1.2 million mental health unit at Citizens Medical Center in January, Gulf Bend is looking for ways to come into compliance with state standards on staffing, safety, medication management and treatment.

The unit stopped accepting patients Aug. 15, and until those issues are resolved, no patients can be admitted.

Carrie Williams, director of media relations at Texas Department of State Health Services, said the formal review speaks for itself.

"What this is about is patient safety," Williams said. "We're not going to compromise patient safety. We are going to hold them accountable to the standards they signed on to."

Since Jan. 6, the unit has seen 73 patients.

According to a formal review conducted by the Department of State Health Services, the only registered nurses associated with the unit were the house supervisors with Citizens Medical Center. They did not document assessments for clients, develop nursing care plans or communicate with physicians to obtain orders for medications or treatments.

The review included clinical records that showed a patient took the wrong dose of a prescribed medication, and "none of the individuals had received an assessment on their ability to self-administer their own medications."

The review also indicated the center did not have enough staff for timely assessments.

"They signed a contract with us," Williams said. "You can't agree to the terms, take the dollars and then not live up to the terms you agreed to. We're holding them to the standards they signed on to meet."

The unit is designed to provide emergency stabilization to people who are in a behavioral health crisis. The facility is supposed to be secure and protected, clinically staffed and psychiatrically supervised, according to its contract.

"That was not happening, and that could potentially be dangerous to the patient," Williams said.

Gulf Bend Executive Director Don Polzin said the unit was leveraging resources already available at the hospital -- the outcome was the same.

Citizens Medical Center provided space on the sixth floor of the hospital for the six-person outpatient extended observation unit as well as a nursing staff.

In turn, Gulf Bend Center provided licensed counselors and social workers to assess and treat patients with behavioral health issues. Diagnoses and treatment by a psychiatrist are available as needed by televideo.

By using the hospital's staff, Polzin expected the unit to meet the grant requirements for a 25 percent match through in-kind donations. He estimated that sharing resources freed up about $400,000 for other mental-health projects.

Williams said the unit is a place for people who are having psychiatric crises.

"This is not a place to cut corners," she said.

Gulf Bend has the resource capacity within its center and budget to address staffing, Polzin said.

Staff developed a plan of action Wednesday to present to the Department of State Health Services. Once that plan is approved, the center could resume accepting patients within the next week, Polzin said.

All of the corrections need to be made before the facility can reopen, according to information from the state.

Under the revised plan of action, the observation unit is making changes to the number of nurses assigned to the facility and their frequency of involvement. It also deals with having a psychiatrist available as required, Polzin said.

"I feel good about where we're at," Polzin said.

Polzin and his staff said Tuesday the extended observation unit is an innovative idea the state has yet to catch up with.

Williams said that's not the case and Gulf Bend's characterization of the situation and review "was incredibly misleading."

"We're all for innovation, but patient safety comes first," Williams said. "Extended observation units are something we're very used to contracting with. ... It's innovative if you're following the standards and truly operating an extended observation unit."

The Department of State Health Services contracts with eight other extended observation units across Texas.

Victoria is not alone in the need for mental health services.

The National Alliance on Mental Illness estimates Texas's mental health system provides services to only 21 percent of adults who live with serious mental illnesses in the state.

Of Texas' 24.3 million residents, close to 833,000 adults live with serious mental illness and about 288,000 children live with serious mental health conditions, according to reports by the National Alliance on Mental Illness.

The local and state goals for the extended observation unit are the same: to serve the patients and the community.

The Department of State Health Services tries to provide every opportunity for programs to be successful in their efforts to take care of people in need, Williams said. However, the state may recoup funds in penalties or sanctions for noncompliance with contractual terms or performance measures.

Gulf Bend did return unspent funds to the state.

Williams said the state has every intent of assisting the center in developing and operating a successful program to serve people in need.

"If it's done right, it's very beneficial in helping people meet the right level of care, but it has to be safe," Williams said.

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(c)2014 Victoria Advocate (Victoria, Texas)

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