In response to the announcement by Finger Lakes Health of their intent to close the Inpatient Behavioral Health Unit in Penn Yan, seven employees of the unit have spoken to Geneva Believer with distressing claims about the circumstances leading up to the closure, including allegations of unfairly denying treatment to soldiers.
Currently, Geneva residents who go the the Geneva General Hospital emergency room and are in need of inpatient mental health care are sent to the Penn Yan unit.
Finger Lakes Health claims that the unit is closing due to a lack of patients and declining insurance reimbursements, but the seven employees say that gross mismanagement is to blame for the closure, and that patients, including soldiers from Fort Drum, are unfairly denied admission to the unit.
Pending Closure Announced
Five days before Christmas, on December 20 2018, a front page story by Steve Buchiere in the Finger Lakes Times (“FL Health plans to close rehab, mental health units”) announced that Finger Lakes Health had notified regulatory agencies including the New York State Department of Health and the New York State Office of Mental Health of their request to close the Inpatient Behavioral Health Unit at Soldiers and Sailors Hospital in Penn Yan.
FLH system spokeswoman Lara Turbide stated that the closing was due to the declining volume of patients on the unit, as well as FLH’s difficulties with being reimbursed by public and private insurance companies.
Turbide further stated that there was no timetable on when state officials might approve the closing, and that local alternatives for inpatient treatment existed in Clifton Springs, Newark and elsewhere.
Shortly after the announcement by Finger Lakes Health, Geneva Believer was contacted by seven current and former employees of the Inpatient Behavioral Health Unit, a group that includes both part- and full-time staffers. The former employees in the group have all left the unit within the last two years, and all seven have requested that their identities be withheld due to fear of reprisal.
“They Didn’t Want to Deal with Them”
According to Turbide, the ten-bed unit is averaging two patients per day.
But the seven employees say that declining volumes on the unit were due to doctors intentionally finding questionable, and potentially illegal, reasons to refuse admission to patients in need.
“I have witnessed patients being declined due to issues with insurance, having legal issues, no housing to go to after admission (either homeless or current housing will not accept them back), having too many medications, and having too many medical issues.”
“(The psychiatrist) would just make decisions based on what they wanted to deal with. (The psychiatrist) has told staff they didn’t want to admit some patients due to not wanting to be called in to work if the patient needed to be restrained.”
“They just simply don’t want to take the patients that will require a lot of work. They want to cherry pick the patients who are straightforward and easy.”
“At the unit in Clifton Springs, they take the mentally ill patients, no holds barred. If you’re sick and in crisis, you qualify for treatment.”
Turbide told the Penn Yan Chronicle-Express that the unit is “certified to provide care to people with mental health diagnosis only and is not allowed to provide care to people who may have an additional diagnosis, such as substance abuse.”
But the anonymous employees believe that they shouldn’t simply refuse admission to any patient with substance abuse under all circumstances.
“If a patient has substance abuse, we can’t treat for that specifically, because we are not followed by OASAS (NYS Office of Alcoholism and Substance Abuse Services), just OMH (NYS Office of Mental Health).”
“The problem was if they saw the substance abuse, they immediately ruled out admitting the patient without considering it all factors involved. They would assume the patients were seeking meds, and that the social worker was lazy and didn’t want to do referrals to inpatient substance abuse facilities.”
Other employees also spoke of the existence of a “don’t admit list,” which provided reasons to decline admission to some patients.
“We declined patients if they were “difficult,” or if the psychiatrist thought they were malingering. We had a list of such patients we were to decline.”
“(The psychiatrist) began to make a list of patients, who mainly had borderline personality disorder, because they didn’t want to deal with them.”
“They Could Not Believe We Refused Their Soldiers”
Perhaps most troubling are the alleged efforts to deny care for enlisted men and women.
Fort Drum is a US Army reservation and home to nearly 13,000 residents (approximately the same population as Geneva), primarily soldiers and their families.
Fort Drum soldiers in need of mental health care go to Samaritan Medical Center, 13 miles away in Watertown, NY. When Samaritan’s 32-bed inpatient mental health unit is full, soldiers in need of inpatient care are referred to other units in the region, including Soldiers and Sailors.
“The social workers at Samaritan would call the unit in Penn Yan directly. After years of taking referrals from them, we got to know them and in chatting they said they could not believe we refused their soldiers.”
“(The psychiatrist) would decline soldiers who were actively suicidal, or had PTSD (Post-Traumatic Stress Disorder) with suicidal thoughts. These soldiers were seeking help before they did something harmful to themselves or others. They had great Tricare insurance. The people at Samaritan Medical Center (in Watertown, NY, near Fort Drum) couldn’t believe we weren’t accepting them because we had beds available and the referrals were appropriate.”
“(The psychiatrist) vocally said they didn’t want to deal with soldiers because (the psychiatrist) felt the soldiers were just trying to get a medical discharge out of the military.”
“(The psychiatrist) is just known to turn away most soldiers for one reason or another. Samaritan has all but ceased sending us their referrals because they just assume that they will not be accepted.”
“Who are we to turn away a soldier that may or may not have legal problems, and just assume that they are attempting to get out of their duties and/or get med boarded out? HOW can we make that determination? We don’t have to worry about not being reimbursed for whatever care we may give to them.”
“We Never Did That”
Finger Lakes Health has cited “reimbursement challenges” as the second reason why the unit was closing.
According to the Finger Lakes Time article, Turbide said that the hospital was having trouble collecting reimbursement payments from both public and private insurers, “including what services insurers are willing to pay for.”
The sources interviewed for this story say that Finger Lakes Health never made it a priority to assist patients in navigating the insurance system, something that’s done at other area behavioral health units.
“Other units like Clifton Springs have people whose only job is to work with the insurance companies to get initial admissions approved, additional days approved, et cetera. We never did that.”
“I know they did not have someone at Soldiers and Sailors who would help someone get insurance. They always told us those employees are at Geneva and we couldn’t do anything about it.”
“The U of R/Strong inpatient unit has multiple people on site who do that as their job. I feel that could have helped especially since Medicaid back pays three months.”
“We are not “in network” for a lot of insurance programs. At a meeting last fall, the manager said she would pursue more info and work to see how we can become a part of the those insurance networks. I thought it was rather funny at the time that the manager said, “If you all have any ideas about this, I would like to hear them.” What in the world was she talking about? That is for management to pursue, not the care staff.”
“This Is Ridiculously Unsafe.”
FL Health also claims that low admission numbers are causing the unit to lose money because the hospital still has to pay for minimum staffing on the unit.
But anonymous employees say that administration has not only allowed dangerously low staffing in the unit, they have ordered it, and there has been at least one recent incident where a nurse was attacked on the understaffed unit.
“One administrator has mandated that if only one patient is on the unit, only the RN (Registered Nurse) works. There is no secretary and no social worker, just the nurse and the patient. This demonstrates a complete lack of knowledge in psychiatric nursing.”
“We know that any patient can “snap” or decompensate at any time. All it takes is a trigger, then the nurse is alone. This is ridiculously unsafe.”
“Just a few weeks ago, a nurse was attacked and strangled, and if the counselor wasn’t there to pull the patient off, I hate to think what would have happened.”
“Having only one RN working with one patient is against OMH regulations.”
“Not Following Procedure”
Although employees were notified of the closing in November, they say they had actually been told about a month earlier, in a meeting with administration, that the unit wouldn’t be closing.
“There was suspicion among the staff that there was something fishy going on. We called a meeting with administration and asked directly if the unit was going to close, and were told directly in response, “NO.””
“Then a month later, BOOM, they tell us we’re closing.”
The employees say when they were notified in November of the hospital’s plan to close the unit, they were told the unit could be closing within about four months. Some employees left and found other jobs, which further reduced the number of available staff on the unit.
“We have a very caring staff on the Mental Health Unit and with news of this closure, many of them have looked for and found other jobs. I feel FLH wants it to appear that this closure had to happen due to lack of staff rather than mismanagement.”
“The reason management and Human Resources told all the mental health staff that they were closing in 4 months is so the staff would panic, which they did, and rush out to get other jobs, which they did.”
“Now that the staff is leaving, FLH can say we can’t take patients because we have no staff.”
“FLH told us they would be attempting to be place us in jobs in the FLH system. Who would want to? Bachelors prepared staff are being offered secretarial jobs, and counselors are being told there’s no need for counselors in the hospital.”
“Staff have sought out and obtained jobs elsewhere, leaving the remaining staff to fill the gaps and work extra hours attempting to compensate, with no recognition, no thank you, and no appreciation.”
Several employees said that they called the state Office of Mental Health and were told that the hospital hadn’t even begun the process to close the unit.
“A couple staff members called OMH and found out that the hospital is not following the procedure for closing a §9.39 unit.*”
“According to OMH the closing was not even discussed with OMH and it’s a process that can take a year, not four months, to make sure that people have services in place.”
“OMH said they can’t just close it down, they have to have a plan for all the different agencies we provide service for. And all those agencies have forms to fill out with a plan were their people would go.”
“The way they’ve treated employees is unreal. They tell us about the unit closing, then give us no updates whatsoever. They just leave us all here wondering what the hell is going on. Many employees are calling OMH themselves to get updates. How sad is it that they have to go to the very top to get information on what’s happening right here?”
*( A §9.39 is a type of emergency inpatient mental health unit overseen by OMH that must abide by specific guidelines)
After they had contacted OMH, employees on the unit say they were confronted by a manager.
“The manager has been calling people into the office and grilling them about who called OMH and what they said to OMH. As you can imagine, this was meant to intimidate the employees and make them fear reprisal.”
“No Effort Whatsoever to Salvage this Precious Place”
Employees also point to a lack of effort and concern on the part of FLH to help or save the unit as another reason for the closure.
“How can we ethically close this unit because of finances? I understand that it is a business after all but how is it this easy? People have a meeting, crunch the numbers, and decide they’re closing with no regard for what that actually means.”
“Did they think to try any other avenues? How about when they’re calling off the staff because of low census, they send those staffers out into the communities, and to different hospitals, with information on what we do, the population we serve, how many beds we have available, and telling them to think of us in the future for patients in need?”
“The Behavioral Health Unit gets no billboards, and no marketing of any kind to help spread the word of the services available. We had a meeting prior to news of the closing with our manager and nursing administration and this was brought up to them. Still, no marketing of this department. They never even tried to do any of our suggestions.”
“From what I understand there was very little done to save or benefit this unit. No effort whatsoever to salvage this precious place. Even the manager who prides herself on being a psychiatric nurse seems all too okay with this closure. I cant imagine that anyone committed to this field is just okay with this.”
“They Did Nothing”
The seven employees say that they have reported all of the above concerns and more to management and administrators at Finger Lakes Health, but nothing has ever been done by management or administration to address those concerns.
“I think we thought what we were doing best when we spoke to people above the unit manager, but that never got anywhere.”
“We have met with higher-ups, expressing our concerns, and they did nothing.”
“Some people may ask why we are going public, as opposed to contacting authorities. The truth of the matter is that we have no pull here. They don’t give a crap what we think, what we feel, how it’s affecting anyone. So, I believe this to be the best course of action in getting the absolute truth out here.”