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Operations Overhaul at State Psychiatric Hospitals

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    Five months after federal regulators blamed Terrell State Hospital for the death of a patient, state leaders are overhauling operations at the 10 psychiatric facilities in Texas.

    The Austin American-Statesman reports the overhaul includes top bosses visiting patients; the regular inspection of how well doctors are performing; and revamping the way problems are identified and solved.

    They also say they have tackled major deficiencies identified during two federal investigations at Terrell State Hospital, such as substandard nursing care and filthy conditions.

    The state hasn't yet addressed a lack of independent oversight in the way the hospitals review the death of a patient, but that may happen in the future.

    "The reviews are thorough, but we're looking at how we can make them more rigorous and objective by adding a layer of outside review," said Carrie Williams, spokeswoman for the Department of State Health Services.

    Williams said state administrators are exploring ways to bring independent scrutiny to hospital death reviews, but she could not provide details because those discussions are ongoing. The goal is to ensure the hospitals are not the only ones evaluating their work, she said.

    Death reviews are internal assessments of how and why patients die in state psychiatric hospitals. In April, the American-Statesman published a report stating that those reviews regularly cleared doctors of any mistakes or lapses in medical care even when those same reports pointed out clinical problems.

    The Statesman focused on the case of Ann Simmons, a 62-year-old Pittsburg woman who died last year at Terrell State Hospital after spending 55 hours in restraints. The death review found no faults in the medical care that she had received. But Medicare investigated after learning about the case from the American-Statesman and disagreed with the death review's findings.

    The federal agency ruled Simmons died because of Terrell's faulty medical care. The hospital has been ordered to make extensive changes by Oct. 18.

    State officials say they've used their experience with Terrell to make reforms aimed at protecting patients at all 10 psychiatric hospitals.

    Williams said hospital system leaders will conduct in-depth assessments at each hospital once a year. In the past, state leaders have relied mostly on information provided by hospital superintendents.

    "They'll be walking through the hospitals, eating a meal with patients, going through the admissions process, talking to patients and staff at all levels, walking around campus, reviewing the environment," she said.

    The state has also hired several people to improve hospital services, Williams said. That includes a new hire focused on how the hospitals handle unusual incidents, such as escapes, unexpected injuries and serious incidents of violence.

    The hospital division is also changing the way it tracks system-wide data. The state already collects volumes of information in areas such as abuse, neglect, restraints, medication errors, admissions and injuries. Now the state is going through it more carefully, tracking problems, developing solutions and communicating more effectively with the hospitals, Williams said.

    Additional changes are taking place at Terrell State Hospital because of two Medicare investigations prompted by the Statesman's report: one into the Simmons case, the other into overall conditions at the hospital.