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HARRISBURG — A state-run psychiatric hospital with a long history of struggling to employ enough workers is now so short-staffed that it risks violating federal requirements for patient care, Spotlight PA has learned.
In an emergency request, the Department of Human Services said Torrance State Hospital in western Pennsylvania was operating short-staffed essentially every day because it can’t recruit enough aides, and doing so could put funding for the hospital in jeopardy.
An outside expert who reviewed the department’s request to hire a staffing agency said its description of conditions at the hospital raised serious questions about risks for both patients and staff.
“If my kid was working there, I would be really concerned,” Joel Dvoskin, a psychologist in Arizona and a former president of the American Psychology-Law Society, told Spotlight PA.
Torrance is one of two state psychiatric hospitals that provides treatment to criminal defendants with mental illness, and it has a history of staffing issues.
A 2016 report from Pennsylvania’s auditor general said under-staffing there led to excessive overtime costs — more than $14 million over three years — and put patients at increased risk from accidents and oversights. During a visit in 2018, federal inspectors cited the psychiatric hospital for not having enough nurses and aides available to care for patients, which inspectors said hindered quality care and created a safety risk. In two separate 2019 visits, federal inspectors said the hospital created a safety risk when it failed to have at least one registered nurse on each ward at all times.
And now, as a surge in coronavirus cases is straining hospitals across the country and forcing health care systems to compete for a limited number of workers, the psychiatric hospital in Westmoreland County can’t recruit enough aides.
These aides, employed by the Department of Human Services, typically earn salaries in the mid-$30,000 to mid-$40,000 range, according to the state’s PennWATCH website.
“We are exhausting our overtime options and mandating staff to work,” the department wrote in a Dec. 2 staffing request. “Despite these efforts, we are operating below appropriate levels.”
The department asked to pay an estimated $20,000 to a temporary staffing agency to provide aides for 60 days. In the request, administrators said they closed one patient ward on weekends and some weekdays, and they have required employees to work extra hours.
“They’re running out of gas,” said Dominic Sgro, regional director for AFSCME District Council 83, which represents about 400 workers at the psychiatric hospital. “Just like every other health care facility, they’re running them into the ground basically.”
The request noted the shortage led Torrance State Hospital to run a treatment program designed for young sexual offenders with two aides for every 19 patients. The department said there’s no federal requirement for the number of aides it needs to have, but it prefers to operate the program with one nursing staff member for every four patients.
A spokesperson for the Department of Human Services acknowledged the state wasn’t meeting that four to one ratio, but didn’t provide details on current patient ratios beyond what was in the emergency request.
Despite the recruiting challenges, the department spokesperson, Ali Fogarty, said the hospital has managed to keep safe staffing levels at the hospital.
Still, Dvoskin warned that staffing shortages at psychiatric hospitals mean there are fewer people to provide direct care and fewer opportunities to prevent conflicts among patients from escalating into violence.
“There’s a whole bunch of ways that being understaffed makes it more dangerous,” Dvoskin said.
Dvoskin has served as an expert witness for the ACLU of Pennsylvania in a lawsuit that began in 2015 against Gov. Tom Wolf’s administration over admission wait times at Torrance and Norristown state hospitals. Dvoskin has also served as a consultant for many states on how to manage prisons and mental health facilities.
He cautioned against blaming Torrance for the latest staffing problems, saying that the coronavirus is causing havoc in nearly all aspects of the healthcare industry.
Other state-run facilities are also turning to temporary staffing agencies.
The Department of Military and Veterans Affairs received approval from the Department of General Services on Nov. 25 to spend an estimated $100,000 for emergency nursing staff for one year at Hollidaysburg Veterans’ Home. A “lack of nursing staff is causing health & safety concerns for all residents & staff,” the department’s request said.
The Department of Corrections received approval on Dec. 2 to spend an estimated $176,400 over seven months to pay contracted counselors for extra work, including helping prepare meal trays and providing some outpatient services to inmates. SCI Chester needs the help because the coronavirus has led to a large number of staff members calling off, according to the department’s request.
And the Department of Human Services received approval to spend an estimated $5 million on nurses and aides at White Haven Center, a Luzerne County facility that serves people with intellectual disabilities. In 2019, the Wolf administration announced plans to close White Haven, along with a similar center in Venango County, by 2022.
Since then, workers have been quitting White Haven and finding other jobs. The coronavirus has made the situation worse.
“We are in dire need of staff,” state officials wrote in the staffing request.
At Torrance, problems with staffing are not new. Staff members told state auditors that “Torrance is short staffed and has been for years, contributing to poor employee morale, and a tired, fearful staff,” according to a 2016 report. Those employees were afraid to go to work because mandated overtime meant they didn’t know when they would be able to return home.
The state approved hiring more workers. But investigators with the Centers for Medicare & Medicaid Services found staffing problems in 2018 and 2019.
In June 2019, one registered nurse told investigators that she had 51 patients between two wards. Inspectors said the hospital should have assigned one nurse to each of those wards.
“My time was split pretty evenly between the wards with a lot of back and forth,” the nurse said, according to an inspection report. “Definitely staffing is rough up there.”
Despite the staffing problems described in the June 2019 report, a federal spokesperson said the hospital had made necessary changes. Fogarty said the hospital submitted a plan of correction, met federal requirements, and expects its next federal inspection early next year.
John Hargreaves, director of volunteers for the Pennsylvania Prison Society, said he was concerned the department’s emergency staffing request described closing a ward. He said that move forces more patients into another ward and makes it harder to keep people socially distant.
“You want to spread people out,” Hargreaves said.
Dvoskin called closing a ward a “pretty extreme step” because of the disruption it causes, especially given the increased risk from the coronavirus.
“It’s something you would not do, if you had any other option,” he said.
Fogarty, the spokesperson for the Department of Human Services, said the program for young sexual offenders, described in the staffing request “has not been consolidated since early October, but consideration has always and will continue to focus on following [personal protective equipment], social distancing, and other mitigation guidelines.”
She said other members of patient treatment teams, such as social work and occupational therapy staff, have worked in aide roles to help cover wards.
While the vacancies at Torrance State Hospital aren’t a direct result of the coronavirus pandemic, the pandemic has created new challenges, Fogarty said.
The hospital faces increased competition for workers from both public and private health care providers. And some staff members can’t work because they’ve tested positive for the coronavirus or need to quarantine after being exposed to it.
As of Friday, the psychiatric hospital had 16 current positive coronavirus cases among 683 workers, and 24 current positive cases among 277 patients, according to state data.
Another state psychiatric hospital, Wernersville in Berks County, had even more. About 16 % of patients, or 41 out of 260, were positive for the coronavirus.
The Department of Human Services’ emergency staffing request said it selected HCA Staffing, based in Indiana County, to provide the aides. Even though the state has struggled to recruit workers, the staffing agency’s director of operations, Larry Manners, said he expects his agency could fill the slots.
Sgro, the union rep, said he supports any move to give aides a break.
“They’re working their fingers to the bone to try to make sure there isn’t a health risk.”