An impossible situation: Managing Connecticut Valley Hospital
At the November 13 public hearing on the issue of patient abuse at Whiting Forensic Institute, I sat and listened with great interest, and sadness, to the questions that the Public Health Committee posed to the Department of Mental Health and Addiction Services (DMHAS) and the department’s responses.
As the Public Health Committee continues the process of reviewing the events that occurred at Whiting, it must expand its focus on what the committee and the General Assembly will do to drive the type of change necessary to restore the public’s confidence in Connecticut Valley Hospital (CVH) and Whiting Forensic Institute.
DMHAS, nor for that matter any state agency, is not capable of efficiently operating a health care facility like CVH in today’s health-care environment.
I come to this conclusion based upon my experience as former commissioner of the Office of Health Care Access, and my 40+-year career in the creation, design and delivery of behavioral health services in Connecticut.
As DMHAS deputy commissioner in 1995, I was one of the leaders overseeing the closure of Fairfield Hills Hospital and Norwich Hospital. Along with those closures came the strategic consolidation of inpatient services at Connecticut Valley Hospital.
At that time, both the department and the legislature determined that one consolidated, well-staffed and well-designed facility could provide “state of the art” care to people with serious behavioral health issues.
What I learned from that process was just how difficult that task could be when working within the “state system” as it relates to human resource management, purchasing, construction, billing and quality assurance.
These issues are again in the forefront because of Public Health Committee scrutiny of CVH operations.
The cost of care at CVH seems to be a mystery, but that is a byproduct of the state “system.” One would think that DMHAS should know the cost of care at CVH— it should be at their fingertips. Instead, the legislature will need the Office of Fiscal Analysis to determine it. Why? Because the reality of it is that DMHAS does not have control over the true expenses of service at the hospital.
That is a result of how state agencies operate —costs allocated by the Comptroller, Department of Administrative Services, Office of Policy and Management, revenue recognized by the Department of Social Services, etc. Budgeting practices that confound explanation make managing facilities like CVH nearly impossible.
Cost is just one component of value, quality being another.
Legislators have been surprised to learn that CVH is not licensed as a hospital. Though licensure of and by itself is not the sole indicator of quality, it does provide a framework for review of operations and conformance with acceptable industry standards.
For CVH to be permitted to operate without licensure is dangerous and wholly unacceptable. I can assure you that any provider, whether a non-profit or commercial enterprise, attempting to operate inpatient services in Connecticut without a license would be shut down by the Department of Public Health, and rightfully so. So, why should CVH be allowed to do so?
Ongoing training for the staff at CVH is essential to keep their skill set up to best practice standards. Upon closer examination, the Public Health Committee will find that training after the initial six-week orientation of unit staff is minimal, if existent at all. This is because of cost, collective bargaining issues, a lack of resources, and emphasis by management.
On managing the human resource issues, including recruitment, staffing, overtime, and progressive discipline, this much is clear:
No facility or state agency that is hamstrung by collective bargaining agreements will be operated efficiently or effectively. I have never seen one that is. If there is such an entity, it should become the model that the state tries to replicate at CVH.
Now that the legislature has identified these and other issues related to CVH/Whiting, it is the legislature that must find a solution. DMHAS by itself will not be able to fix the systemic and pervasive issues that have been uncovered as a result of the criminal investigation or the legislative inquiry.
DMHAS has no control over the collective bargaining issues that make managing the operations of the facility so difficult. They have little to no control over expenditures on the campus for capital improvement. They have virtually no control over the DMHAS budget— that is determined by the OPM and the legislature. It is unclear if DMHAS even has the statutory authority to seek licensure as a hospital.
Given these realities, can we really expect DMHAS to fix these problems? Of course not.
It’s been estimated that a bed at CVH costs as much as $560,000 per year. For that kind of money, Connecticut should have a facility that is state of the art, with well-staffed units and optimally trained staff. It should deliver care that is recovery focused. It should create a therapeutic milieu that is “best practice” oriented and is the envy of every other state in the nation. A state hospital that inspires hope, recovery and wellness.
Currently we have none of that. But we could, if out of this tragic and horrible situation, a new course is charted.
Raymond J. Gorman is President and CEO of the Connecticut Mental Health Affiliates.
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