BY DION LEFLER
http://www.kansas.com/mld/kansas/news/16509766.htm
LARNED - Inspectors found a variety of "inhumane" conditions at Larned State Hospital, including filthy living areas, frigid showers and a lack of supervision that contributed to a patient's death, a Kansas Department of Health and Environment report shows.
In addition, a private national agency that conducts oversight of thousands of hospitals has reduced Larned from full accreditation to conditional status until problems that its own inspectors found are corrected.
Larned, about 25 miles southwest of Great Bend, confines some of the state's most mentally troubled people.
Some are committed because they are considered a danger to themselves or society. Some sex offenders are sent there after serving prison time.
The KDHE report was based on November inspections triggered by numerous complaints from patients.
The report "indicates a number of issues, violations of both federal and state law," said Joseph Kroll, director of KDHE's Bureau of Child Care and Health Facilities. "I think the report speaks for itself."
The report said, "Throughout the hospital, the governing body failed to assure that patients received care in a safe, clean and comfortable environment."
Hospital superintendent Mark Schutter said he thinks the report overstates some of the problems.
However, he said, "Whatever has been cited, we have addressed or are in the process of addressing if it takes a longer period of time to do that."
SRS responds
The Department of Social and Rehabilitation Services, which runs Larned and other state mental hospitals, contends that KDHE overstated the problems.
"I think some of the terminology and things they use makes it a little more inflammatory than what you'll see out at the institution," said Ray Dalton, SRS deputy secretary for health care policy.
In a written response, SRS asked that KDHE tone down the description of Larned's cleanliness and questioned whether regulations require providing hot water for showers and hand-washing.
KDHE refused to rewrite the report. The agencies are close to settling on a final plan to address the issues and prevent
recurrence, officials said. KDHE expects the problems to be corrected within six months and will reinspect the facility, Kroll said.
A tour by an Eagle reporter and photographer Thursday found that many things cited in the KDHE report -- such as grease-crusted dining tables, dust-clogged ventilators and 3- to 5-foot-long cobwebs in the pool area -- are cleaner now.
Most showers and sinks checked during the tour dispensed warm water. In some sinks, however, the hot water button did not work or the pressure was so low that water trickled down the outside of the faucet instead of running into the sink.
Accreditation at stake
Before November, Larned hadn't undergone a state inspection since 2000, Kroll said.
The hospital is accredited by the Joint Commission on Health Care Organizations. "Because of that, they're not routinely scheduled for inspections by the state," he said.
The report cites 10 ongoing complaint investigations.
The joint commission inspected Larned in August after it also received complaints. The facility had last been inspected and reaccredited in 2003, said Char Hill, a spokeswoman for the body.
The joint commission's survey is not a public document. However, the commission published requirements for Larned to reattain full accreditation that include improvements in food preparation and distribution, better medication storage and administration and improved infection control.
Patient's choking death
The most serious finding in the KDHE report outlines the case of a female patient who choked to death April 1.
The unidentified woman had a number of health problems, including a swallowing disorder called "Level III dysphagia."
According to the report, the woman was to be placed on a special diet of soft foods in bite-size pieces that would not clump in the throat, eliminating sticky foods and most bread and cereal products.
The woman had a history of rummaging food from trash cans and hoarding food, the report said. The week before her death, she complained of something in her throat and coughed up "two medium-sized pieces of ham."
On the morning of April 1, the staff found the woman in an unresponsive state with food lodged in her mouth.
"Staff identified the mass as pancakes," the report said. "Breakfast that morning consisted of pancakes and syrup."
SRS officials would not comment directly on the woman's death, but they provided a copy of the agency's written response.
It said staff members had taken several actions to reduce the risk to the woman.
Those included routinely removing trash from areas where she was present to prevent foraging, occasionally separating her from other diners so she could be watched while eating and, sometimes, locking her room while she was out of it to prevent her from stashing food there, the SRS response said.
The response cited a manual of the Chicago Dietetic Association that included allowances for some bread foods, including pancakes, in the diet for Level III dysphasia patients.
Some citings now clean
The KDHE report also cited "multiple unsafe, unclean and unsanitary areas."
Among the examples from dining areas:
• "Multiple areas of splattered food on the walls and ceiling."
• "Several tables had a buildup of greasy substance thick enough to scrape up with a fingernail."
• "A microwave with dried food on the interior, a stove with a dirty oven and a buildup of dust and grease on top of the refrigerator."
• "Each of three dining areas contained greater than 50 ceiling tiles with large... greasy areas. Most of these greasy, discolored tiles also contained dried, flaking butter... over the tables where the residents eat."
The Eagle's tour of the cited areas found that the splattered food had been cleaned from the walls and the greasy buildup had been removed from tables. Cooking equipment appeared to have recently been cleaned.
The butter on the ceiling tiles remained.
Schutter said patients, many of them juveniles, flipped butter pats at the ceiling to try to make them stick there.
He said the staff plans to replace the acoustic tiles but is trying to find a material that will be easier to clean.
Many of the tables in the dining areas have been refinished to eliminate cracked Formica that exposed the wood underneath and created areas that could not be properly sanitized, he said.
Hot, cold water
The KDHE report also said Larned "failed to provide humane treatment regarding the temperature of water for showers and handwashing."
In several of the showers and sinks cited by inspectors, water temperatures ranged from about 60 to 77 degrees, the report said.
In one building, however, the water ran at a scalding 124 to 135 degrees in showers and sinks.
Fixtures are mainly push-button and don't allow the user to adjust the water temperature.
In its response, SRS repeatedly disputed KDHE's findings.
"Larned State Hospital would like it noted that a laser temperature device was used to test water temperatures," the response said.
The state hospital engineers said the device could not accurately measure running-water temperature, especially in the showers, the response said.
The KDHE report quoted an e-mail from a hospital staff member complaining about cold shower temperatures in one building.
"All shower water in the East 1 shower room is cold or cool," the staff member wrote. "I wouldn't take a shower in here, it's too cold for me."
SRS' response requested KDHE remove multiple references to low water temperatures from its report.
"Despite an extensive review of industry standards and regulations, we find no established temperature ranges suggesting a 62-degree handwashing temperature is unacceptable or inhumane," the response said.
Even so, documents attached to the correction plan show a number of work tickets have been issued to the hospital's plumbing department to raise the water temperatures.
Hospital officials said part of the problem, particularly with older buildings, is that the hot-water supply pipes are long. As a result, a shower or sink has to run a long time to come up to temperature.
Leo Herrman, administrative director of the hospital's sexual predator program, said the hot water system is set to deliver water at 105 degrees.
"That's the standard for institutions because you don't want people burning themselves, plus it's an energy measure," he said.
Plans are in the works to raise the temperature another 2 to 5 degrees at KDHE's request, Schutter said.