To: Chief Executive Officers and Chief Operating Officers of Psychiatric Hospitals
Please share with appropriate staff
From: Shirley Prasad, JD | Policy Director, Government Affair
ShirleyP@wsha.org | (206) 216-2550
Subject: Increased Washington State Department of Health oversight and enforcement abilities of psychiatric hospitals
This bulletin is to inform psychiatric hospitals (those licensed under chapter 71.12 RCW) about House Bill 2426, which increases the Washington State Department of Health’s (DOH) oversight and enforcement abilities of health care facilities. Throughout the legislative process, WSHA, with substantial input from the psychiatric hospitals, worked with the DOH and legislators to negotiate significant amendments to the original bill.
Beginning March 25, 2020, the DOH’s oversight and enforcement abilities of psychiatric hospitals includes the following:
- DOH may offer or the psychiatric hospitals may request technical assistance to help comply with licensure requirements;
- DOH may utilize a broad array of enforcement tools with psychiatric hospitals that fail or refuse to comply with licensure requirements – within specific parameters (that were negotiated by WSHA);
- Psychiatric hospitals may utilize a robust due process framework to appeal the imposition of any DOH enforcement tool;
- DOH will post online information about inspections, investigations, enforcement actions and resolutions;
- For newly established or acquired psychiatric hospitals, the DOH will conduct increased oversight. There is no provisional licensure requirement; and
- Within three days, psychiatric hospitals will report to the DOH certain patient elopements and patient and staff deaths.
House Bill 2426 increases the DOH’s oversight and enforcement tools over psychiatric hospitals. However, both the legislature and the DOH intend to expand oversight and enforcement tools to other health care facilities, including acute care hospitals (those licensed under chapter 70.41 RCW).
Review the bulletin and share with appropriate staff. Please engage with WSHA once the DOH begins its rulemaking process regarding civil fines.
Overview – Key Elements of New Law
In 2019, the Seattle Times published a series of articles highlighting patient safety and quality of care issues at psychiatric hospitals licensed under chapter 71.12 RCW. In response, the DOH cited a lack of oversight and enforcement tools over the hospitals. As a result, Governor Inslee requested that the legislature address this in the 2020 legislative session. With legislative interest in the House and the Senate, a bill was introduced in each chamber, which called for expanding the DOH’s regulatory authority.
Through the course of the 2020 legislative session, WSHA worked with legislators and the DOH to address some critical issues in the original bill. This included establishing parameters when the DOH may use certain enforcement tools, eliminating the provisional licensure requirement for new hospitals, adding context and process to what inspection and investigation information DOH must be post online, and working through reasonable new reporting requirements.
Technical Assistance to Psychiatric Hospitals
The DOH may offer or any psychiatric hospital may request technical assistance. This is to help ensure that psychiatric hospitals are continuing to comply with all applicable state laws and regulations. The only time the DOH will not provide such assistance is during an inspection or during an investigation.
DOH Enforcement Tools
When the DOH finds that a psychiatric hospital has failed or refused to comply with applicable statutes or regulations, it may take on or more of the following enforcement actions:
- Impose reasonable conditions on a license (may include correcting deficiencies within a specific amount of time, training, or hiring a DOH-approved consultant if the psychiatric hospital does not have internal resources).
- Assess civil fines of up to $10,000 per violation (not to exceed $1 million) or $10,000 per day a psychiatric hospital operates without a valid license. The DOH will establish regulations detailing specific fine amounts in relation to the severity of the non-compliance.
- Impose a limited stop placement if the DOH finds an immediate jeopardy to patient health and safety. Immediate jeopardy is defined as when noncompliance places patients at risk for serious injury, harm, impairment or death. The DOH shall conduct a follow-up inspection within five days or within the time requested by the psychiatric hospital.
- Impose a stop placement if the DOH finds an immediate jeopardy to patient health and safety and is not confined to a specific patient category or area of the psychiatric hospital. Immediate jeopardy is defined as when noncompliance places patients at risk for serious injury, harm, impairment or death. The DOH shall conduct a follow-up inspection within five days or within the time requested by the psychiatric hospital.
- Suspend, revoke or refuse to renew a license.
Due Process for Psychiatric Hospitals
- When the DOH imposes license conditions, limited stop placement, stop placement, or suspends, revokes or refuses to renew a license, the psychiatric hospital may appeal the decision. Notice and the hearing will be governed by Washington’s Administrative Procedures Act.
- The DOH may immediately impose license conditions, limited stop placement, stop placement or license suspension if it finds that psychiatric hospital non-compliance results in immediate jeopardy to patient health and safety, pending an appeal hearing.
- When the DOH immediately imposes conditions on a license or suspends a license, a psychiatric hospital is entitled to a show cause hearing within 14 days of making the request. If immediate jeopardy is not found, then the license condition or suspension will be immediately overturned. If immediate jeopardy is found, then the license condition or suspension will remain in effect pending a full hearing.
Inspection and Investigation Information Available to the Public
Currently, the DOH posts online a psychiatric hospital’s inspection and investigation reports (dating back to 2015). Beginning March 25, 2020, the DOH will (as resources allow) post online the following information about psychiatric hospitals and residential treatment facilities:
- Inspection and investigation statements of deficiencies;
- Plans of correction;
- Notice of acceptance of plans of correction;
- Enforcement action; and
- Notices of resolution.
The DOH will eventually post the above information for all health care facilities, including acute care hospitals.
Newly Established or Acquired Psychiatric Hospitals
For any newly established or acquired (after July 1, 2020) psychiatric hospital, the DOH shall, during the first two years:
- Provide technical assistance;
- Perform at least three unannounced inspections; and
- Conduct additional inspections as necessary to verify the psychiatric hospital is complying with all licensure requirements.
Newly established or acquired psychiatric hospitals are not subject to a provisional license.
Reportable Patient Elopements and Deaths
Within three days, psychiatric hospitals must report to the DOH every patient elopement. Elopement is defined according to the National Quality Forum – when an admitted patient who is cognitively, physically, mentally, emotionally and/or chemically impaired wanders, walks, runs away, escapes, or otherwise leaves leave a psychiatric hospital or the grounds of a psychiatric hospital prior to their scheduled discharge unsupervised, unnoticed and without staff knowledge.
Within three days, psychiatric hospitals must also report to the DOH the following patient or staff death:
- Patient death associated with an elopement;
- Patient suicide;
- Patient death associated with a medication error;
- Patient death associated with a fall;
- Patient death associated with the use of physical restraints or bedrails; and
- Patient or staff death resulting from a physical assault.
Review Oversight, Licensing and Enforcement Statutes of All Health Care Facilities
Before the end of 2020, the DOH is to review the statutes of health care facilities licensed by the DOH. The DOH’s goals are to evaluate the level of existing oversight it has over those facilities, identify opportunities to consolidate that oversight, and examine standardizing licensing and enforcement requirements across facility types. The DOH is to work with stakeholders, including WSHA to make recommendations for the 2021 legislative session for a uniform health care facility enforcement act.