Anchorage, Alaska (AP) - Federal investigators found more than 80 substantial deficiencies at the Alaska Psychiatric Institute from July to December, the worst record in the nation during the seven-month period.
The Anchorage Daily News reports each deficiency chronicled by investigators from the Centers for Medicare and Medicaid Services was deemed an "immediate jeopardy" to patient safety.
Federal inspectors visited API last summer and put the institution under a plan of correction after documenting what it called failed practices.
Continued non-compliance brought inspectors back late in 2018 and on Monday.
Findings from 2018 included incidents such as an adult with an intellectual disability and "intermittent explosive disorder" being strapped onto a restraint table and briefly left alone, crying, in a dark room.
One patient drank hand sanitizer at least five times while being given "alone time" in an exercise room, leading to hospitalization for vomiting.
The newspaper said a staff member was recorded kneeling on the chest of a patient being strapped into restraints and grabbing another by the neck and head, putting the person at risk of injury.
A plan to correct problems is underway, said Albert Wall, deputy commissioner of the Alaska Department of Health and Social Services.
"I'm already seeing a turnaround," he said. The department will soon announce good news about API, he said.
The Centers for Medicare and Medicaid Services acts as a federal oversight agency. The agency in extreme cases can take away a hospital's ability to receive money from Medicare and Medicaid.
"That's a big stick," said Rosemary Gibson, an expert on health care and the author of "Wall of Silence," a book about medical errors. "It is very rare for CMS to do that."
API's record normally would put a hospital on track for decertification, according to experts. However, Alaska is experiencing extreme mental health treatment issues and API's diminished capacity is putting limits on addressing problems.
Some of API's units have been closed because they could not safely be operated with low staffing. Anchorage police last fall began dropping off civilly committed people in psychiatric crisis at the jail because all hospitals were full.
"They would have to be pretty desperate to shut down the state's only psychiatric hospital," said Dave Fleurant, executive director of the Disability Law Center of Alaska.
Kristi Brooks, a former protective services officer at API who left in early December, said the federal inspectors' findings do not paint a complete picture of API.
"The staff was set up to fail," she said.
Employees often were confused about what was unacceptable when dealing with violent patients, Brooks said.
"It felt like everyone's hands kept getting slapped but no one was told when they did wrong," she said. "We would be told there were CMS investigations, that we were cited. But no one would come out and say what those were and what needed to be changed."
Workers at API find themselves in an impossible situation, said Doug Carson, a business agent with the Alaska State Employees Association, which represents API's unionized employees.
"It creates a situation where workers don't feel like they can do anything to protect themselves," Carson said.
Anchorage mental health advocates Faith Myers and Dorrance Collins the experience of psychiatric patients could be improved by giving them a functional system to pursue grievances. If patients could have concerns taken seriously, they say, the hospital would have more accountability to the people it's supposed to serve and not just regulators.