South Dakota Refuses to Seek Accreditation of State Mental Hospital

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July 18, 2016; Argus Leader (Sioux Falls, SD)

High staff turnover and patient-care problems that resulted in a federal plan of correction have plagued South Dakota’s main state-run mental health facility. Calls have gone out for the state to qualify for accreditation either from the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) or the Commission on the Accreditation of Rehabilitation Facilities (CARF). State leaders are resisting, though, holding that self-monitoring based on compliance with federal oversight is sufficient and that independent accreditation is both too expensive and redundant.

The federal Centers for Medicare and Medicaid Services (CMS) inspected the state’s Human Services Center (HSC) in February and found “dozens of problems at the state hospital, including misuse of restraints on patients and a lack of training and education credentials for its top psychiatric nursing manager,” according to the Argus Leader. Inspectors found that the hospital is employing a psychiatric nursing director who lacks the required master’s degree. Further, they determined that “inappropriate delegation of responsibility for patient treatment planning to non-professional unlicensed team members resulted in treatment plans that were not individualized based on individual patient needs.” The paper reported in June that CMS officials accepted South Dakota’s plan of correction that would allow the state to once again be permitted to bill Medicare and Medicaid for patient services.

Governor Dennis Daugaard’s office was apparently confused about the purpose of accreditation, mistakenly conflating Joint Commission or CARF accreditation with commercial services—many of which charge fees to allow their names to be used—that many hospitals promote in their advertising. The paper quotes the governor’s chief of staff:

The governor believes that some private providers seek accreditation for marketing purposes—they are seeking to attract placements from governments or private individuals. Obviously HSC, as a state institution, does not have that need.

The statement did not address why accreditation would be expensive for the state when the state’s position is that the accreditation standards are duplicative of federal requirements with which the state must already comply.

Mental health advocates and medical professionals emphasize the importance of quality services. According to Phyllis Arends, executive director of the Sioux Empire region’s chapter of the National Alliance on Mental Illness, “Saying that it costs too much is an excuse, not a reason. You can’t let money be the deciding factor in whether patients receive quality care or not.” Dr. David Bean, a former head of the state hospital, said:

State hospitals and private hospitals should both be accredited. Patients at both should know that their hospital is meeting that standard. Other state hospitals get accredited, not just because of marketing, but because that’s the quality standard for hospitals.

The state recently hired the mental hospital’s third executive director in five years. On average, since 2009, one staff member has left employment at the facility every three days. An Argus Leader Media investigation earlier this year found administrators struggled to maintain staffing and security amid growing turnover and violence.—Michael Wyland