Montana to audit end-of-life care at state mental hospital

July 5, 2019 GMT

BUTTE, Mont. (AP) — Montana plans an audit of operations in a wing of the state psychiatric hospital after The Montana Standard reported concerns the hospital is not equipped to care for patients with dementia and some are not receiving adequate end-of-life care.

Gov. Steve Bullock called for the independent review, but noted the courts commit some dementia patients to the Montana State Hospital and the state has no option but to treat them.


Psychiatrists Christina Quijano and Christine Daly spoke of several concerns including a lack of therapy groups and activities geared toward patients with dementia.

Quijano told the Standard that administrators also pressured them to quickly get “do-not-resuscitate” instructions from new patients on the unit for people with long-term psychiatric disabilities. She said the forms also included a non-standard question about withholding antibiotics. The question has been removed.

Bridgitt Erickson, a staff attorney for Disability Rights Montana, said about two-thirds of the unit’s patients are receiving end-of-life care outside of a hospice setting.

“It’s not really treatment,” she said. “It’s not really hospice.”

Craig Fitch, the acting director of the Montana Mental Disabilities Board of Visitors, said the psychiatrists were working on the Spratt unit late last year, at a time it had “really fallen apart a tiny bit.”

Quijano was fired in December and shared an unsigned email with the Standard criticizing her “unprofessional demeanor” and “unsolicited negative comments.” Daly left in January after she was assigned all 46 patients in the Spratt unit and hospital administrators did not respond to her requests for additional help.

“I felt like something — a bad outcome was possible,” Daly said. “And I was concerned about my own medical license.”

Sheila Hogan, director of the Department of Public Health and Human Services, pushed back against the complaints.

“It’s disappointing that a couple of individuals are mischaracterizing the complex nature of care for patients at MSH,” she said.

However, after a federal Centers for Medicare and Medicaid Services inspection was complete administrators brought in consultants, conducted audits, eliminated some staff members and restructured the treatment plan for some patients, Fitch said. The hospital is now doing an adequate job and its care meets licensing requirements, he said.


Advocates with Disability Rights Montana said the standards are higher.

“I don’t think the law says, ‘Do your best,’” said Bernadette Franks-Ongoy, the organizations director. “I think you need to do what you’re legally responsible for doing.”

“And even if they are under difficult conditions, they have to figure out a way to do it right,” she said.

Fitch said Spratt still needs to improve.

“I think Spratt was definitely not the best unit for a couple-of-year period there — and for pretty much the 17 years I’ve been working here — but even at Spratt I don’t have any residual, strongly held concerns about how people get treated overall,” Fitch said.

The Montana State Hospital’s admission policy states: “Patients with primary dementia diagnosis or clinical presentation are not treated at MSH.”

Jon Ebelt, spokesman for the health department, said some of Spratt’s dementia patients have been denied care at other nursing facilities and were court-ordered to the state hospital.

Zoe Barnard, administrator of the state’s Addictive and Mental Disorders Division, said she believes Spratt has “provided the medical care that is necessary to meet the needs of the patients who are committed here.”

Bullock told the Standard he’s asking Hogan to find an outside expert to review the unit. No timetable has been set.


Information from: The Montana Standard, http://www.mtstandard.com