Idaho health care facility inspectors threatened three times in six months to revoke a state-run treatment center's ability to take Medicaid patients unless it fixed problems that reportedly posed an immediate threat to residents.
Jamie Newton, administrator of the Southwest Idaho Treatment Center in Nampa, in turn questioned whether Idaho Department of Health and Welfare surveyors were treating her facility fairly. She appealed one part of a February inspection to an independent review board — a rare step for the Nampa facility.
The inspection results add to a string of troubles at SWITC, which Health and Welfare also operates.
The center, formerly the Idaho State School and Hospital, is a large campus with about 25 residents. It provides assessment, training and treatment to people with developmental disabilities and mental illnesses, to help them transition into living in their communities.
Some of the residents can be aggressive against employees and each other. Up to 40 percent of the center's staff members file injury claims every year, and turnover at SWITC is double the rate across other Health and Welfare job sites.
Understaffing and other issues led to police investigations and threats of lawsuits at SWITC last year. Several employees were let go, the family of a resident who died in 2015 sued over his death, and relatives of another man found dead last August filed a tort claim alleging neglect and abuse.
During three different inspections conducted since last fall — Sept. 20, Feb. 2 and Feb. 22 — state Facility Standards inspectors concluded SWITC had put certain residents in "immediate jeopardy." In each case, they said they would be forced to work with the federal Centers for Medicare and Medicaid Services to revoke SWITC's provider agreement unless the immediate threat was fixed.
The Statesman was unable to interview Newton for this report — a message seeking comment was forwarded to Health and Welfare spokesman Chris Smith. But Newton's letters in response to the inspection reports illustrate her concerns with the process, and how she has responded to the problems the state raised.
Smith said any violation is a concern for Health and Welfare, but SWITC is currently in compliance.
"(SWITC's) work can be difficult and challenging, but IDHW is committed to providing a safe place for the residents as they receive treatment as well as staff," Smith said Friday. "Our processes and policies support that mission. The facility also is currently fully licensed at the federal and state levels with no conditions or citations."
Health and Welfare Director Russ Barron is forming an advisory board for SWITC in response to the center's issues, Smith said. The process is early: Smith said the details of the group's capacity and authority are still being determined, and no members have been selected yet.
Many of the state inspectors' concerns involved protecting residents from themselves or others. In the September inspection, surveyors concluded SWITC did not have the proper plans or training in place to intervene when certain residents tried to physically harm each other.
Survey reports from Feb. 2 specifically referenced the care of a 26-year-old resident diagnosed with severe epilepsy, bipolar disorder, osteoporosis of the spine and a history of self-harm, among other issues. The resident, identified only as "individual No. 9," was supposed to wear a helmet and eyeglasses. (The reports use numbers rather than names for the residents to preserve their privacy.)
During the inspection, the staff allowed the resident to shower alone with his helmet off. At the time, a staff member told the surveyor that the helmet was for self-protection from him "banging his head" and he didn't need it for the shower, according to a copy of the report. But, that individual's bathing skills plan said staff was supposed to be present at all times during bathing because of the resident's "history of seizure disorder and instability."
Other employees who worked with resident No. 9 told the surveyor they believed he didn't need to be watched while showering. The surveyor asked the shift leader about the discrepancy; the shift leader looked at the resident's care plan, told the surveyor "you're right," and then told staff to go into the bathroom with the resident.
Combined with other concerns, the inspector determined SWITC 's seizure care program, bathing program and behavior plan for the resident were not sufficient to keep him safe.
Newton responded Feb. 9, writing that staff training and updates to the resident's care plan would fix the problem by Feb. 12.
She continued: "While we don't dispute the ultimate finding of Immediate Jeopardy related to Individual #9, there are several concerns with the way the survey was conducted."
Those included the surveyor's transparency. A four-hour delay between the surveyor noticing the situation involving resident No. 9 and telling administrators about it hampered SWITC's ability to fully address the problem that day, Newton wrote.
"The declaration of immediate jeopardy could have been resolved swiftly on that day avoiding a protracted period where the facility is under the view of having clients in 'immediate jeopardy' and the negative publicity that might follow," Newton wrote.
Her letter suggests the inspection results were originally much worse. "Inaccurate and incomplete" investigations into fights between two other residents almost also led to an "immediate jeopardy" label, Newton wrote.
After more discussion, those concerns were dropped, apparently because SWITC had already revised its policy on altercations before the inspectors even arrived. Newton ended her letter by thanking Facility Standards for fixing her concerns and creating a "fair and accurate" final report.
A second inspection done on Feb. 22 found SWITC was still out of compliance on issues such as client records, client protections and communication with client guardians. Administrators and legal guardians were not always told in a timely fashion of problems involving residents. Staff documentation claimed certain residents were given their medications on time when that wasn't actually the case.
Most notably, inspectors concluded SWITC staff didn't properly handle major incidents, ignoring or remaining unaware of specific instructions for what level of force and restraint was appropriate for each person in SWITC's care.
They often returned to whether staff members used acceptable techniques to restrain a resident who broke into an office, threw items around, tried to hit and bite an employee, and spit on one employee's face. In a correction plan that Facility Standards received April 20, Newton wrote she was "surprised" to see that case referenced because the surveyors didn't ask her about it. "Therefore," she wrote, "I was not afforded the opportunity to be asked and answer questions about this investigation."
Newton's strongest objection involved a Feb. 13 incident between residents "No. 10 and No. 11." Resident No. 11 had a long history of attacking resident No. 10, according to the inspection report.
During one incident, resident No. 11 began yelling at No. 10. Two employees briefly linked arms with No. 11 to guide him away.
The problem: No. 11's care plan specifically warned against physical interventions because of medical concerns.
The surveyor watched video of the incident twice with Newton. According to the inspection report, she told the surveyor that while brief, the incident was a type of physical restraint not allowed for No. 11.
But that's incomplete, Newton wrote in the correction plan. "What it doesn't go on to say is that I approached the survey team on 2 separate occasions following that and stated that I had watched the video several more times, paying close attention to what staff were doing, and that I didn't think it was actually a restraint after all," she wrote.
Newton also complained that inspectors did not interview the two staff members who were involved in the interaction. Other employees who were asked about the incident were not shown the video, she wrote, and later changed their minds about what happened after viewing it.
Newton appealed the conclusions about residents 10 and 11 to the state's independent review board.
That board is made up of other providers who are not state employees, said Smith. The independent dispute resolution process was established in 2006; this was the first time SWITC had used it since 2008.
Ultimately, the appeal was unsuccessful. The board held a hearing May 16 and announced that it agreed with the state inspectors the following day.
Newton's changes otherwise appear to have addressed the inspectors' concerns. On April 25, Facility Standards did a follow-up inspection and said SWITC was in compliance with the rules. While there, a surveyor investigated two other complaints and could not substantiate either one.
SWITC was still in compliance as of Thursday.