The Free Press, Mankato, MN

September 26, 2013

Sheran holds hearing on state hospitals, clinics

"Scathing" auditor's report listed 20 recommendations for state

By Dan Linehan

---- — ST. PAUL — Initial efforts to reform Minnesota’s state-run health care facilities got a hearing Thursday by legislators looking for evidence that the Department of Human Services is making changes recommended by an auditor.

Sen. Kathy Sheran, a Mankato Democrat, called her committee together to discuss the Office of the Legislative Auditor’s report, released in February. The report, which Sen. Carla Nelson, R-Rochester, called “scathing,” includes 20 recommendations for the department.

The first one sought to clarify who, exactly, was responsible for problems at state-run hospitals, clinics, group homes and other facilities.

“There’s confusion in who’s responsible for what. There’s this kind of a concept going on,” Sheran said, pointing in different directions.

An existing body, called the State-Operated Services Governing Board, created more confusion than clarity, Sheran said, and has been eliminated.

Instead, accountability lies with the human services department itself, specifically with Anne Barry, deputy commissioner for direct care and treatment.

“I’m the responsible accountable person in that structure,” Barry told the committee.

In March 2012, the Legislative Audit Commission asked the legislative auditor to review state-run facilities. These are different from privately run but state-financed entities, such as many group homes.

The commission wanted to evaluate how the state manages its facilities, and whether their occupants would be better served elsewhere, among other questions.

The state provided direct care to about 12,500 people in the last fiscal year, DHS said, but only about 600 people are served by the state’s two biggest hospitals on any given day, according to the report.

According to the report, Minnesota has 10.4 patients in state-run hospitals per 100,000 residents, much lower than the national average of 17 per 100,000.

The St. Peter Regional Treatment Center includes both the Minnesota Security Hospital, which treats the mentally ill and dangerous, and part of the Minnesota Sex Offender Program. The sex offender program was not evaluated by the auditor this time (it was evaluated in 2011) because it is run by a separate branch of the Department of Human Services.

Though the human services department cooperated with the auditor’s investigation and actually agreed with his findings, the report found plenty of room to improve.

One of its recommendations: The state should develop ways to measure its performance and plans to meet its goals.

For example, length of stay in state hospitals remains an issue. The auditor found that, as of last September, nearly 40 percent of the beds in an Anoka hospital were occupied by patients who no longer need medical care.

Barry suggested that part of the problem is there are often no better places to put these patients, but said the department is looking for answers.

“We’re going through clients in our whole service system to say, ‘Are there other places this person can live?’” she said.

Another persistent problem at state-operated health care centers is injuries. Assaults in state facilities skyrocketed by 70 percent in 2012, to 1,969.

The report noted there was an increase immediately after the January 2012 turnover in psychiatric staff.

Steven Pratt, the medical director at the Minnesota Security Hospital in St. Peter, said negative news stories have made it difficult to hire psychiatrists.

The shortage in psychiatrists has led to a dip in therapy at the security hospital, the report said, to about an hour a day, a level the auditor found insufficient. The department agrees, and Pratt said Thursday he’s made improvements in medication and therapy levels since he was hired in January 2012.

Barry, the DHS official, also discussed the department’s response to recently reported problems, including a bureaucratic lapse that led to a security hospital patient being released on a Minneapolis street corner about two months ago, according to a Star Tribune story.

Barry said DHS has hired a “root cause analysis expert” to get to the bottom of what went wrong. She said legislators could see the report when it was finished.

Sheran praised the analysis, saying when things go wrong at a medical facility, it is usually the result of several failures in a system, not a simple mistake by one person.

It became clear before the hearing ended that the committee wouldn’t have time to answer all of its members’ questions. About 75 minutes into the two hours allotted for this subject, the committee had only discussed two of the auditor’s 20 recommendations.

Sen. John Hoffman, DFL-Champlin, suggested the department focus on a more bottom-up approach to policymaking by including line staff in decisionmaking.

In the end, part of the solution to improve state-run hospitals might be to get even more people out. In 1960, about 16,000 people lived in state facilities, compared to fewer than 1,300 today, according to the report.

“We get a lot of pushback every time we want to site a facility in a community,” Barry said. However, "living in the community has to be the goal for our state.”