Critics say mental hospitals need independent investigators

More often than not, investigating allegations of abuse and neglect by psychiatric patients in Michigan hospitals is just a part-time job.

Records from the Michigan Department of Health and Human Services show that nearly two-thirds of all private hospitals that treat psychiatric patients had employees assigned part-time — not full-time — to investigate complaints about mistreatment of patients.

Advocates say some hospitals need to spend more time investigating allegations of abuse, neglect and other types of mistreatment.

Michigan law requires private hospitals to conduct a prompt, fair and thorough investigation when psychiatric patients complain that their rights have been violated, a system known as beneficiary rights.

State law prohibits a director of beneficiary rights from having a direct role in patient care to avoid conflicts of interest. But nothing prevents a beneficiary rights investigator from also working in quality control or risk management in a hospital, said Jonathan Bennett, former director of beneficiary rights at the Northern Lakes Community Mental Health Authority at Traverse City and now an Independent Patient Advocate. .

“The rights protection system is inherently fraught with conflicts of interest,” Bennett said. “He lacks the independence to conduct investigations without undue pressure.”

Bennett added that patients need strong rights protections because they are particularly vulnerable — they may have attempted suicide or are having suicidal thoughts, delusions or aggressive behavior.

And while beneficiary rights officers only spend a fraction of their time protecting patients, Bennett said, “they’re not there to talk to people and preemptively look at the kinds of violations that may be happening.” .

Thousands of people in Michigan are hospitalized each year for mental illness or other psychiatric disorders and are entitled to protection while admitted. State records show there were more than 70,000 admissions to licensed private hospitals last year and more than 8,000 admissions to the five public psychiatric hospitals.

The Free Press also found that the hospitals with the most patients do not always have a full-time beneficiary rights officer. According to state records, three of the 12 hospitals with the highest number of admissions in fiscal year 2021 had someone assigned part-time to look after beneficiary entitlements.

Still, some hospitals or psychiatric units with fewer patients had someone assigned full-time to rights investigations, according to figures compiled by the state’s Office of Beneficiaries’ Rights.

By contrast, 44 of the state’s 46 community mental health agencies, which oversee behavioral health services, had at least the equivalent of a full-time rights officer, state records show.

Lynn Sutfin, spokesperson for the Michigan Department of Health and Human Services, said hospitals spend less time working on consumer rights than community mental health agencies across the state. But she cited the small number of beds in the psychiatric units of some hospitals. She said the state’s Office of Beneficiary Rights is “currently evaluating” rights systems in private hospitals.

“The decision on how to allocate duties within the Beneficiaries’ Rights Office is an internal staffing decision made by each hospital based on various staffing factors,” said John Karasinski, Michigan’s director of communications. Health & Hospital Association.

“Internal hospital staff are mandated by state law to report and investigate allegations of rights violations. The percentage of an employee’s responsibilities explicitly to the rights of beneficiaries does not indicate the ability to ‘an establishment to respond appropriately to allegations of rights violations,’ Karasinski said in a statement.

Mark Reinstein, who retired in 2020 from the Mental Health Association of Michigan after 18 years as president, said state officials should investigate unequal staffing. Low staffing levels, Reinstein said, may indicate that a hospital is not taking the rights of beneficiaries seriously.

He said hospitals should not be allowed to be both “judge and jury” in abuse cases.

In addition to private hospitals, Michigan has five state-run hospitals. The state’s Office of Beneficiary Rights investigates patient complaints at these hospitals.

But even then, there were problems. In a 2014 report, Michigan’s Office of the Auditor General found that the state’s Office of Beneficiary Rights failed to initiate an immediate investigation as required after receiving complaints alleging abuse and neglect in these hospitals.

In its response to the audit, the Department of Community Health said the state’s Beneficiary Rights Office met with its field staff to ensure they understood the rules. The office has also revised its procedures to clarify and update the investigation process.

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Just as staffing levels vary from hospital to hospital, the number of investigations also varies. Three hospitals conducted no investigations in fiscal year 2021, while two hospitals did more than 100, according to state records.

Hospitals intervene on behalf of patients three times more often than they investigate rights complaints, according to state records for fiscal year 2021.

Choosing to intervene rather than investigate can only happen when the facts are clear, the remedy is readily available, and the incident does not require disciplinary action, such as in cases of abuse and neglect, according to the state.

The case of a Taylor couple alleging abuse also shows that the success of a beneficiary rights claim can depend on which part of the hospital a patient enters for treatment.

In interviews, Jennifer Land, a 38-year-old artist and mother, said she suffered from anxiety in May 2021. The pandemic had dragged on for over a year, and she felt isolated. Her therapist suggested she see a doctor, and her husband, Chris, drove her to Beaumont Hospital in Taylor, which had a psychiatric unit.

According to the couple, Jennifer’s medical records show she suffered from post-traumatic stress disorder related to abuse in her childhood and teenage years. As a result, it is triggered by scrubbing people.

“It’s loud, she’s scared, she’s upset,” Chris Land said in an interview, adding that he approached a nurse who screens people before they go to the ER and asked, ” Can I talk to someone, take them somewhere quiet?”

Christopher Land, of Taylor, holds hands with his wife, Jennifer, at their home Wednesday, March 30, 2022. The Lands say they don't understand why Jennifer was ineligible for beneficiary rights protections under the mental health code when she was in the emergency room of a hospital.
Christopher Land, of Taylor, holds hands with his wife, Jennifer, at their home Wednesday, March 30, 2022. The Lands say they don’t understand why Jennifer was ineligible for beneficiary rights protections under the mental health code when she was in the emergency room of a hospital.
Ryan Garza, Detroit Free Press

Chris said he was so upset by his wife’s treatment that he called for Jennifer’s release. That didn’t happen, so he went home and, in the middle of the night, started researching the state mental health code. Jennifer Land was released the following day.

He filed a complaint about his wife’s treatment at Beaumont Taylor. Chris Land argued in an email to Beaumont that staff caring for Jennifer failed to heed the couple’s warnings that she was going through a traumatic event in the ER because of her PTSD.

He told the Free Press that his wife was interviewed in a crowded hallway surrounded by other patients with no regard for her privacy or the protection of her mental health information.

“Beaumont staff chose to ignore us and treat my wife as if she was incompetent and had no idea of ​​her own condition,” Chris Land said in his email to Beaumont. “They didn’t see her as someone who deserved to be treated with respect or to make accommodations for her condition. Instead, they chose to see her as just a scared animal to be herded and confined… .”

Beaumont replied that the hospital had investigated the couple’s allegations and concluded that Jennifer’s care was appropriate. He also noted that she was treated in the emergency room, which is considered outpatient care.

“Michigan’s mental health code only affects beneficiaries who are admitted to an inpatient mental health facility,” Beaumont told Chris Land in a letter dated Sept. 3, 2021.

Chris Land also filed a complaint with Michigan’s Department of Licensing and Regulatory Affairs. In January of this year, the department concluded that Jennifer Land had been held against her will by Beaumont. But LARA said it was not a violation of state law.

Christopher Land, of Taylor, stands next to his wife, Jennifer, in the kitchen of their home Wednesday, March 30, 2022. The Lands say they don't understand why Jennifer was ineligible for beneficiary rights protections under the mental health code when she was in a hospital emergency room.
Christopher Land, of Taylor, stands next to his wife, Jennifer, in the kitchen of their home Wednesday, March 30, 2022. The Lands say they don’t understand why Jennifer was ineligible for beneficiary rights protections under the mental health code when she was in a hospital emergency room.
Ryan Garza, Detroit Free Press

In a statement, Beaumont Health spokesperson Mark Geary said, “None of the allegations resulted in a breach. We support the team that provided care for this patient.”

The Lands said they do not understand why Jennifer Land did not qualify for beneficiary rights protections under the mental health code since she had a telehealth visit with a psychiatrist while she was in the hospital emergency room. Jennifer said the psychiatrist told her she would be prescribed psychotropic drugs which she could not refuse. She was held in the emergency room for about 24 hours and injected with drugs against her will.

Speaking about her experience at Beaumont, Jennifer Land said, “You violated our family’s ability to trust when we ask someone for help.”

Contact Jennifer Dixon: 313-447-1654 or jbdixon@freepress.com

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