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Each day on the ward I was being billed a minimum of $1,400 dollars. In fiscal year 1996, gross charges to Woodhull psychiatric patients amounted to $38.5 million, an increase of almost $3 million from five years ago. The majority of that--$27.5 million--was billed to Medicaid, which reimburses at a flat day rate regardless of an individual’s diagnosis or the treatment he receives.
Woodhull hospital has 133 psychiatric beds and, according to the hospital’s most recent cost report filed with federal regulators and the state Department of Health, the hospital admitted 2,047 psychiatric patients in FY 1996, up from 1,624 in FY 1992. As the number of psychiatric inpatients has increased, however, the average length of time that each patient stays has declined, from about four weeks to 22.7 days.
These trends hold true for many hospitals. Experts say that as admission rates go up and lengths of stay decline, the total cost of care should increase. This is because the intensive early stages of hospit
alization are the most expensive, explains Sharon Salit, senior health policy analyst for the United Hospital Fund. The total cost of psychiatric inpatient care at Woodhull has declined slightly, from nearly $24 million to just under $23 million. Why the reduction in cost? As at all of the city’s public hospitals, there have been dramatic staff cuts in recent years. The number of full-time employees in Woodhull’s psych department has dropped substantially, from 244 in FY 1991 to just 177 in FY 1996.
In its last review of Woodhull in October 1996, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a hospital-funded agency, gave the hospital its lowest rating, “Noncompliance,” in two areas: “Assessing Staff Competence” and “Special Treatment Procedures,” which covers psychiatric care and includes an assessment of whether certain procedures like restraint and behavior modification are carried out appropriately. It also covers whether patients’ rights and well-being are protected. Ironically, the JCAHO is often criticized--most recently in a January 1998 report by Public Advocate Mark Green--for being too hospital-friendly and for conducting shoddy or lax inspections.
More recently, the New York State Office of Mental Health issued Woodhull a two-year operating certificate for its Psychiatric Inpatient Unit on December 1, 1997, based on an inspection done 13 months earlier. They gave the facility a clean bill of health.
But there is one other agency that examines the quality of care at mental health institutions in New York State. Three months before my admission, the Commission on Quality of Care conducted an unannounced site visit of two psychiatric units at Woodhull in response to an allegation that the facility was excessively dirty.
The commission chronicled poor physical conditions, patients’ lack of privacy, and insufficient and insubstantial therapy. It detailed inadequate access to recreational supplies and reading material, as well as widespread idleness, adding that few patients participated in groups and others slept long into the afternoon.
Additionally, the report stated that staff distanced themselves from patients and nurses claimed it wasn’t their responsibility to motivate patients to attend therapy sessions.
The report concluded: “Since the hospital’s treatment plans purport to provide more than medication relief of symptoms, the psychiatric units need to address whether its practice of not discouraging patients from sleeping during the day is truly in the interest of the patients or serves the convenience of staff. At a minimum, the Units need to provide additional relevant programming...”
Cynthia Carrington-Murray, Woodhull’s executive director, responded in a letter dated February 23, 1998--the day before I was discharged. Throughout the letter, Carrington-Murray denies the problems. For example, the commission report stated, “Some of the bedroom storage furniture on Unit 5 was broken (some had no doors) and needed a thorough cleaning....” Carrington-Murray responded: “Furniture in patients’ rooms are cleaned regularly.”
In regard to programming, the hospital letter stated that there was in fact adequate therapy, groups and activities available, and that the staff did encourage and explain to patients that they should participate. One of the problems, the director explained, is that patients just refuse. Even so, Carrington-Murray wrote that the hospital had “re-educated all the staff” in motivating patients to participate in group sessions. As for staff-patient interaction, the director wrote: “The nursing station Plexiglas windows do not and should not hinder communication between patients and staff. Nursing staff do interact with patients outside the nursing station....What is important is to ensure that patients do get heard and their needs met in a humane and respectful manner as quickly as possible. We have re-emphasized to staff the importance of courtesy, respect and sensitivity to the needs of patients when interacting with patients from the nursing station.”
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