LITTLE ROCK — The State Hospital fired two employees Wednesday for failing to properly monitor patients after a female patient’s allegation that a male patient raped her in an adult psychiatric unit there April 30.
Questions about whether the reported assault will affect the hospital’s fight to maintain its status as a Medicaid provider and the millions of dollars of annual funding that comes with it remained unanswered Wednesday.
“We take this very seriously,” said Amy Webb, a spokesman for the Arkansas Department of Human Services, which oversees the Little Rock psychiatric hospital. “If we feel there’s a situation where employees are not properly monitoring patients or ensuring the safety of the patients, that’s serious to us.”
The two fired employees were behavioral-health aides who violated hospital policies related to patient monitoring, Webb said. She would not identify the employees pending appeals of the terminations.
Hospital leaders disciplined three other employees on the unit without firing them, Webb said. She would not elaborate.
Since the episode, the hospital has required workers to check on their patients and document conditions every 15 minutes, a task workers previously completed hourly.
Dee Blakley, a patient advocate with the federally funded Disability Rights Center of Arkansas who has called what happened “predictable and preventable,” said Wednesday that she is not satisfied with the hospital’s response.
“The failures at the Arkansas State Hospital are systemic,” Blakley said. “You can’t just place that on the line staff, which it seems to me is an oversimplistic view and what they are trying to do right now.”
The “line staff” are workers such as aides who have the most direct interaction with patients. On the day of the assault report, an aide did not ensure that a coworker monitored his patients when he took a break, Blakley said.
A female patient reported that a male patient entered her room the afternoon of April 30 without her permission and forced her to have anal and vaginal sex. Security videos show the male patient peering around the hallway to look for staff members before he entered the woman’s room, Blakley said.
Complaining of pain, the female patient was transported the UAMS Medical Center’s emergency room, where nurses completed a rape examination and collected her clothes as evidence, according to a report completed by the State Hospital’s internal Police Department.
Blakley, who is completing a separate investigation on behalf of the Disability Rights Center of Arkansas, said Wednesday that some staff members knew that the male patient accused in the reported assault had a history of “sexually inappropriate behavior” during previous admissions to the hospital, but they failed to communicate that to their peers.
The man, who was admitted to the unit less than a week before the reported rape occurred, had been “stalking” the female patient throughout the weekend, but weekend staff members failed to warn a shift of workers who started their workweek that Monday, when the reported assault occurred, Blakley said.
A social worker walking through the unit as the events reportedly occurred did not believe another female patient who first reported what was happening, Blakely said.
After the alleged assault was reported, the social worker told a nurse that a patient “had told him that ‘there was a man in that room with his penis out,’” the nurse said in her witness statement.
That social worker told the patient to tell another staff member, the nurse’s statement said.
The Human Services Department is investigating the events and the staff’s response. The “root cause analysis” investigation will determine whether policies were followed correctly and whether what happened could have been prevented.
The department has not confirmed that sexual assault occurred, but it has turned its preliminary police file over to Pulaski County Prosecuting Attorney Larry Jegley, Webb said.
The department has also reported the events to the federal Centers for Medicare and Medicaid Services, which will determine later this year whether the hospital can continue to receive Medicaid reimbursements.
The hospital’s $46 million budget for fiscal 2012, which ends June 30, includes $3,842,499 in Medicare funding and $8,276,565 in Medicaid funding.
The hospital lost its “deemed status” as a Medicaid provider last year after federal site reviewers documented four situations of “immediate jeopardy,” or conditions and treatment that threatened the health and safety of patients, dating back to 2010.
Those incidents included the improper restraint of a suicidal child, who bloodied his face by banging it into a doorjamb while he was held in a seclusion room.
Another report documented patients fighting while others blocked doorways so workers couldn’t intervene, and told of one patient collecting rocks in his clothing in preparation for a “riot attempt.”
The hospital signed a special last-minute agreement with the Centers for Medicare and Medicaid Services in July 2011 after the agency threatened several times to pull the hospital’s Medicaid funding.
Under the plan, called a systems-improvement agreement, the hospital will regain its deemed status as a Medicaid provider if it can implement a plan created by third-party consultants to the satisfaction of federal inspectors who will complete an unannounced review sometime before the end of July.
Medicaid spokesman Bob Moos of the federal agency said in an e-mail last week that the agency has received updates as Human Services Department administrators investigate the woman’s rape report.
“We continually review all incidents and events at the hospital to assess its ability to come into full compliance with our programs,” he said. “We expect a prompt and comprehensive resolution to any substantiated findings affecting the quality of care.”
The last rape at the State Hospital was in 2010, Webb said.
Blakley said administrators completed an “action plan” after that rape that included plans to lock patient rooms and train workers to better monitor patients.
“They don’t learn from previous incidents,” she said. “They get a lot of pretty words on paper, and then they say, ‘Phew, that’s over,’ and they move on.”
Webb said the hospital is committed to thoroughly investigating the events.
“We’re trying to do everything we can to ensure that patients are safe,” she said. “That is our priority, and we are working toward that everyday.”
Front Section, Pages 1 on 05/24/2012