Alaska Psychiatric Institute Director Ron Hale and two other senior administrators with the Alaska Department of Health and Social Services announced their resignation on Sept. 14 following a report on working conditions at the institute.
Anchorage attorney Bill Evans conducted the independent investigation into employee safety and workplace retaliation in cooperation with Attorney General Jahna Lindemuth. The DHSS published the findings of the report on Sept. 12.
The report found the institute to be an unsafe work environment for its employees.
“Through the course of the investigation, it became evident that multiple interrelated problems plague the operation of API and contribute both directly and indirectly to the legitimate perception of an unsafe… work environment,” Evans wrote in his report.
Cultural disagreements over the use of restraints and seclusion are the “largest single issue” to the safety of the work environment at API, according to the report. There is a major divide at API regarding the issue of patient safety weighed against employee safety.
“A large segment of the staff believe that QI [personnel involved in quality improvement] and the administration are being overly zealous in protecting patients and thereby reducing the staff’s ability to maintain safe control of the units,” Evans said.
The report also found that the disagreement results in a major percentage of the staff feeling “unequipped to properly handle a dangerous patient.”
Other prominent problems include ineffective scheduling practices, the frequent use of on-call workers, the qualifications of nurse assistants and the lack of an intensive care and admitting unit.
The investigator, however, did not find proof for allegations of organized retaliation or hostility toward staff members who spoke out about safety issues at API.
Evans interviewed 46 union and DHSS representatives, as well as current and former staff members of API between March and June of 2018. Positions ranging from psychiatric nurse assistants to top level administrators were considered.
The Alaska Department of Labor and Workforce Development, Occupational Safety and Health had already voiced concerns about the institute’s work environment in 2014 and 2017.
API already underwent a plan of correction following those citations, Katie Marquette, communications director at DHSS, said in an email. Additional training and safety equipment were provided.
The hospital also recognized that additional nursing positions were needed to maintain safe staffing levels. After the resignation of the three administrators, DHSS Commissioner Valerie Davidson has now announced Duane Maynes as the new CEO of the institute.
When asked about the safety of current API patients at a press conference, Davidson expressed trust in the care of its “incredibly dedicated” staff.
“I actually would feel comfortable [as an API patient right now],” Davidson said.
Still, she recognizes the need to resolve the safety issues at the institute.
“There is much work that needs to be done to address both employee safety and patient safety at API,” Davidson said. “We are committed to significantly changing the work environment at API… This change can only happen with the full support of API staff.”
The DHSS announced a series of planned changes, including efforts to a new range of behavioral health treatment services across the state. Plans for an increase of psychiatric nursing positions are underway.
“Last session, Governor Walker requested and the legislature approved $3.1 billion for 20 new psychiatric nurse positions and competitive salary increases for nurses at API,” Marquette said.
In cooperation with the Alaska Mental Health Trust Authority, the DHSS will evaluate the feasibility of a separate institution specifically for patients with a history of crime or exceptional violence.
The full report on the investigation and the planned changes can be found at dhss.alaska.gov.