Dartmouth-Hitchcock Under Fire for Psychiatric Hospital Staffing Levels

Concord Monitor
Published: 5/4/2017 12:07:08 AM
Modified: 5/5/2017 12:36:00 PM

Concord — Gov. Chris Sununu told New Hampshire Hospital CEO Bob MacLeod to resign on Wednesday morning after state officials found that, since November, Dartmouth-Hitchcock has been violating its contract to fully staff the state psychiatric hospital.

“We’ve been paying for psychiatrists that haven’t been there,” Sununu said.

He called the situation, and the way it came to light, “deeply disturbing and troubling.”

Ten psychiatrists currently work at the hospital, while the contract calls for 12. New Hampshire Department of Health and Human Services Commissioner Jeffrey Meyers said he discovered the violations after Executive Councilor Chris Pappas raised questions about staffing during the council’s last meeting.

The positions became vacant when psychiatrists were promoted to management positions and were not replaced.

Councilors have received regular reports on the staffing levels at New Hampshire Hospital since the contract was put into place last year. But those reports, prepared by New Hampshire Hospital officials, had the wrong benchmark for staffing levels — showing that 10 was the maximum number when it was supposed to be 12.

“What has been brought to light to us is that those reports that have been given to us are absolutely wrong,” Sununu said on Wednesday. “They’ve been wrong in terms of the amount of staffing we were led to believe was required, as well as the amount of staffing that they currently have.”

In a statement released late Wednesday, Dartmouth-Hitchcock said it has been transparent with the state about staffing levels at the hospital.

“From the inception of this contract to provide clinical psychiatric services at NHH, Dartmouth-Hitchcock has provided the State, including through weekly reports, current and projected staffing levels and any projected deficiencies,” the statement said. “Throughout the course of this contract the State agreed that the staffing levels have been appropriate and the patient care is high quality. That is why we were surprised, and deeply troubled, to receive the Commissioner’s letter last evening and to learn of the statements made at this morning’s meeting of the Executive Council.”

Dartmouth-Hitchcock said that any suggestion that it “has not been completely forthcoming” with the state is inaccurate.

D-H seeks a meeting with Sununu and Meyers to discuss future plans.

The statement concludes: “Dartmouth-Hitchcock has been, and will remain, fully committed to the care of the State’s most vulnerable citizens, and we look forward to working with interim CEO Donald Shumway in continuing to provide that care at New Hampshire Hospital.”

The two executive councilors who represent the Upper Valley said following Wednesday’s disclosures that their primary concern is whether patient care has been compromised by Dartmouth-Hitchcock’s staffing levels.

Republican Executive Councilor Joe Kenney, whose district includes most of the Upper Valley, said Jeffrey Meyers, the state’s commissioner of the Department of Health and Human Services, allayed his concerns about patient care on Wednesday when he told councilors that it had not been affected by staffing levels.

But Executive Councilor Andru Volinsky, a Concord Democrat whose district includes Charlestown and Unity, said he needs some additional assurance that patients weren’t harmed because of how the hospital has been staffed.

“I want a clear determination that patient care was not affected,” he said.

Volinsky said he was not willing to take Dartmouth-Hitchcock’s word for it and he would like a third party review of patient care, perhaps including a review of their charts and evaluations.

He said he also would like to know who is responsible for the staffing error and how it might be prevented in the future.

Moving forward, Kenney, a Wakefield, N.H., resident, said he would like to find a way to improve communication between Dartmouth-Hitchcock and the state.

Somehow the numbers that were being reported to the council on a regular basis didn’t match up with what was going on at the site, he said.

A discrepancy he said was due to “either a lack of communication or someone is not being truthful.”

Kenney said it is up to Sununu, Meyers and the attorneys for both the state and D-H to determine what the truth is.

“I’m here to listen (and to) understand where the breakdown occurred,” he said.

Kenney noted that D-H has a new director of communication, former WMUR anchor and political director Josh McElveen who started last month, and the organization will soon have a new chief executive.

Neither councilor speculated as to why this problem occurred. Both said they were looking forward to Dartmouth-Hitchcock’s response.

The Department of Health and Human Services has given Dartmouth-Hitchcock until Tuesday to come up with a plan to come into compliance with the contract by bringing staffing levels to the required 11 full-time equivalents and to ensure a geriatric psychiatrist is on staff. D-H also will be required to provide the names and hours of any practicing psychiatrists on staff, Kenney said.

In future contracts the council considers, hospital-related and others, Volinsky said he plans to ask questions about planned layoffs, changes in financial numbers and quality control issues.

In doing so, he said, he hopes to “manage to be more forward thinking and maybe a little more defensive.”

Hospital officials also pushed back on Sununu’s statement that he will be looking at getting money back from the hospital for the missing psychiatrists.

“It is critically important to note that the agreement with the state is a ‘fixed price’ contract, and D-H has only been paid by the state through January of this year,” officials wrote.

Pappas, a Democratic executive councilor from Manchester, said he noticed a long-term pattern of lower staffing levels as he reviewed the reports.

Pappas said it was “disturbing” that the staffing deficiency was caught only because he happened to find it. He said he didn’t know whether the hospital was misrepresenting the numbers.

Sununu said it was not clear to him whether Dartmouth-Hitchcock or New Hampshire Hospital erred in preparing the reports.

“I think the folks at Dartmouth-Hitchcock, they’re the ones making the report, the folks at New Hampshire Hospital as well,” Sununu said. “Whether nobody noticed or nobody cared to say anything, I don’t know, to be honest. Either way, there’s a problem.”

Meyers said he brought the issue to the governor on Tuesday.

The state has issued a notice of noncompliance to Dartmouth-Hitchcock; the hospital has five days to respond, Meyers said.

In the meantime, DHHS is considering a review to determine whether the staffing deficiency affected the quality of care, the commissioner added.

“We have no indication that there was an impact on the quality of care for the patients of New Hampshire Hospital as a result of the staffing deficiency, but we may take a look at that,” Meyers said.

The state’s contract with Dartmouth-Hitchcock to provide psychiatric services to New Hampshire Hospital has been marred by controversy from the beginning, after a labor dispute resulted in the departure of nearly a dozen medical workers. As a former executive councilor, Sununu said he was hesitant to vote for the contract, but ultimately did.

The day after the contract was voted on last year, D-H announced a round of layoffs; however, the number of job cuts ended up being far fewer than expected.

Pappas and Sununu both said each incident represents a breach of trust.

“If you take a step back, there’s really a malpractice that was done when Dartmouth-Hitchcock decided not to negotiate the terms of employment with the professionals that were there at the facility,” Pappas said. “Now here you have another instance where there wasn’t communication, potentially they weren’t being honest with the state with what they needed to provide. We’re going to need some answers on this.”

Sununu said he’s requested that the Attorney General’s Office do a review of the state’s contract with Dartmouth-Hitchcock to explore what additional action could be taken. He added he has had trust issues with the hospital “from Day One.”

“They have a lot of work to do, to earn the trust not just of myself but also this entire administration,” Sununu said. “We have huge concerns. To work with the state, you have to be transparent, you have to be open, you have to be a partner.”

Valley News staff writer Nora Doyle-Burr contributed to this report.

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