A staffing and management crisis at Bartlett Regional Hospital is resulting in “inhumane treatment” of behavioral health patients, which is putting other patients and staff “in harm’s way” due to violent outbursts and other problems, according to a doctor and board member at the hospital.
The problems, which have been similarly cited by other people affiliated with the hospital, include what Lindy Jones, a doctor at the hospital for 30 years and board member, called an “inordinately high rate” of employees in certain departments leaving. He said they are citing a multitude of management problems such as “unrealistic demands,” “threats of retaliation,” and receiving “different and less desirable” contracts than promised when hired.
Jones detailed his concerns in a letter presented and discussed at the board’s meeting last Tuesday, and in an interview with the Empire. The behavioral health situation became particularly acute on July 17 due to an unavailability of psychiatrists, which several officials at Tuesday’s meeting said was anticipated months in advance.
Bartlett CEO David Keith, a primary target of the accusations made in the letter, and some other hospital leaders pushed back aggressively at the issues raised by the doctor, arguing while individual incidents and the overall situation with behavioral health care at the hospital are concerning, many of the allegations are overstated, misleading or false.
The hospital, owned by the City and Borough of Juneau, has experienced leadership turmoil since its former CEO was fired two years ago, and some of the issues raised by Jones have been discussed since at least early June in response to an anonymous letter by a person claiming to be an employee sent to hospital officials and Assembly members, according to comments at Tuesday’s meeting and hospital documents.
One thing Keith and Jones agree about: Bartlett is going through something they haven’t experienced in their respective long careers.
“Inadequate and inhumane treatment”
Jones said a crisis-level problem currently exists when people experiencing behavioral health issues arrive at the hospital and qualified psychiatric staff is absent.
That means leaving behavioral health patients in the emergency room or admitting them to the general medical care area, where they can pose a risk to employees and other patients, or holding them in what Jones said is usually a small “psychiatric evaluation room” with a mattress bolted to the floor.
“There is either a security guard or sitter outside the room to prevent the patient from escaping,” Jones wrote. “Inside the room, there is no bathroom, no TV, and nothing on the walls. Patients need to be escorted to the bathroom down the hall in front of all the other patients in the department and receive minimal if any psychiatric therapy or medications.”
If behavioral health patients are admitted to the medical floor, they are “guarded by a security guard or sitter and they receive little or no psychiatric services,” according to Jones.
“Our hospital would never allow provision of such inadequate and inhumane treatment of any other health related condition,” he added. “Unfortunately, given the inherent bias that goes along with mental health issues, we are allowing this to occur in our hospital.”
Keith, while addressing many of Jones’ allegations at Tuesday’s meeting, was not available for an interview, according to Erin Hardin, a spokesperson for the hospital. Board Chair Kenny Solomon-Gross also referred questions to Hardin.
In a statement responding to written questions submitted by the Empire, Hardin acknowledged “unfortunately, at times, we have patients who present to our emergency department in which a safe disposition for discharge is unavailable.”
“This results in patients either being held in our emergency department or admitted to the floor, which their admission is left to the discretion of the admitting provider, in collaboration with the ED provider, on the best plan of care,” the statement by Hardin notes. “Frequently these patients present with suicidal or homicidal ideations, which until stabilized, requires measures to ensure their safety and the safety of others. We treat all patients with the utmost care and respect.”
The hospital’s bylaws require nurse practitioners to be supported by an active staff psychiatrist in order to provide care to behavioral health patients. Recently — and especially since July 17 — that has been a problem, said Nicholas Rosenfeld, a doctor and Bartlett’s chief of staff, during Tuesday’s meeting.
“We ran into an issue where we were going to run into a gap where there was not going to be a psychiatrist in town for the entire service,” he said. “Which means that the nurse practitioners cannot see patients without a collaborating physician. This is a big emergency.”
Hospital officials knew about the situation a couple of months in advance, Rosenfeld said.
“We’ve had some great physicians who stepped up and continued their contracts month by month to fill that gap,” he said. “But they gave us a hard stop on the 17th of this month that we knew about two months ago. And we saw this coming and we were hopefully going to get another physician in here in time for that to cover that gap. But that didn’t happen.”
A possible solution discussed by Keith and some other hospital leaders is hiring temporary employees known as locums — a person who can stand in temporarily for someone else of the same profession, especially a cleric or doctor — to fulfill critical-need positions. Bartlett currently requires an exemption for locum psychiatrists performing duties such as supervising nurse practitioners to be approved by the hospital’s Credentials Committee, a rare occurrence, while Keith said the practice is widespread elsewhere.
“Why we do this, there’s no rational reason other than for reasons I don’t understand,” he said. “There are good locum physicians that we can get in here to fill the gaps, we should not have to go to medical staff to do that. You want an administrative solution, then give the administration the tools to do its job.”
Bartlett currently has two locum psychiatrists and two nurse practitioners to care for behavioral health patients, according to the hospital’s statement by Hardin.
“This has left two locum psychiatrists with the full-call burden, which is unsustainable,” the statement notes. “Over the next several months we have four additional psychiatrists joining our behavioral health team.”
“End of the road” employees
Getting staff at Bartlett during a nationwide shortage of healthcare workers has been a major challenge the past few years, and the idea of increasingly and consistently using locums is a concern to some hospital leaders.
“What happens is that the cream of the crop is taken by the private companies,” Rosenfeld said. He said that leaves hospitals such as Bartlett with often less-than-ideal options.
“In the two years I’ve been here, what I’ve seen is that we run into these issues and the administration comes saying ‘we have to have this person in the hospital right now, please approve them as quickly as humanly possible,’” he said
Jones, at last Tuesday’s meeting, said during his long career at Bartlett “we have seen physicians who have come to the end of the road, because there isn’t any other place that they can practice.”
Keith — who has more than three decades of administrative healthcare leadership experience in multiple states, including hospitals in Anchorage — said he believes Bartlett needs to change its bylaws to allow more leeway and authority for locums when necessary. Among other things, he said, locums can’t currently sign off on a nurse practitioner providing care without a waiver from the hospital’s board.
“I think it’s archaic. I think it’s unnecessary. I think it needs to be scrutinized. And I’ve yet to find another facility that does that,” he said.
Jones said the current shortfall would exist even with such changes because “the problem is recruitment and retention of psychiatric workers.”
That is caused by a wider range of problems beyond the situation at Bartlett, Keith said.
“It’s not something I can fix,” he said. “The lack of psychiatrists, the lack of personnel, the lack of training institutions, the lack of availability, the lack of telemedicine and the lack of many, many things, makes this a huge challenge.”
Keith said he is working with medical officials in Fairbanks and Anchorage, and at SEARHC and JAMHI Health and Wellness in Juneau, to collectively solve these issues.
Accusations of mismanagement
Jones, in his letter, stated the staff shortage in key areas at the hospital such as clinical technology, human resources and psychiatry are experiencing “an inordinately high rate of attrition” for multiple reasons related to top management.
“These include lack of supportive, consistent and nurturing leadership, threats of retaliation for perceived performance shortfalls and placement of unrealistic demands on employees,” he wrote. In addition, there are “frustrations like being promised job details at a meeting with our CEO, then receiving a contract which is different and less desirable, including pay levels significantly lower than previous pay for the same work and pay lower than Juneau’s market dictates.”
Keith, during last Tuesday’s meeting, said the hiring process is transparent and he is not directly involved with contract negotiations with potential employees.
“I can tell you those contracts have been offered to those folks,” he said. “Whether or not they accept it or not is on them, not on us. The fact that the physicians here locally want something beyond that, I’m sorry, but I will not sign a contract that will be outside the fair market value, period.”
John Tarim, a psychiatrist who joined Bartlett’s staff in May of 2021 and worked intermittently until last December, said in an interview Monday he was expecting to return to the hospital this month as an independent contractor, but has not done so because of disagreements about compensation and other issues.
“I basically just told them I would be willing to come back for the same contract,” he said, adding that instead the hospital is offering an employee position that essentially would mean more work for less pay. He also questions how the hospital’s leadership is determining local fair market value.
“I’ve been kind of a little turned off by all this hospital drama and problems with administration,” he said. Among the issues, ”I think them attacking things like fair market value, especially without sitting down and having a discussion with us about it didn’t make any sense. And, again, if they had done that, from the beginning, I think we would have all been happy, even working for less money.”
Tarim said he is still willing to return to work and could be available this week, but is waiting to hear from the hospital’s management about the terms he’s seeking.
The hospital’s statement by Hardin notes that overall staff at the hospital has remained stable compared to historical averages the past two years, “despite the ‘great resignation’ that hit our counterparts across the state and nation.” It also notes the “administration has not received any verifiable information regarding retaliation, and if received, would follow existing HR processes that ensure employees are protected.
Appealing to higher authority
Some of the concerns have been shared with members of the Juneau Assembly, which has little authority over the hospital besides appointing its board of directors, who then pick the CEO, said Carole Triem, the Assembly’s liaison to the hospital board before she resigned. She said typically the Assembly will have joint meetings at scheduled periods with “empowered” local boards such as the hospital’s, but such as the hospital boards, but “we kind of got off that schedule.”
“I would imagine the first step might be another joint meeting,” she said. “I think the Assembly has the power to remove board members if this simply feels like that kind of change needs to happen. I think that would be a pretty drastic measure.”
Triem said the Assembly could tell the board “to do something about the CEO, or we’re going to get rid of the board. And we’ll put people in there who will do what we ask.” But she said more likely “I think it would probably start with more of a conversation with the board and asking for them to do certain things.”
Triem said she wasn’t at every board meeting during her time as liaison, but those occurring toward the end of her time on the Assembly were primarily focused on budget matters.
The Assembly’s current liaison to the hospital board, Michelle Hale, was at last Tuesday’s meeting, but said Thursday she is still “coming up to speed on trying to figure things out and understand things.” While she said the issues raised are concerning, she also believes it’s important to let the hospital board exercise its authority as intended.
“These problems are really difficult and they’re hard to sort out,” she said. “And let me tell you they’re a lot harder to sort out when people jump out of their lanes and start trying to micromanage.”
Issues with top leadership arose in September of 2021 when the CEO at the time, Rose Lawhorne, resigned after six months in the position for having a relationship with a subordinate. On the same day, Bradley Grigg, the hospital’s chief behavioral health officer, resigned and was later arrested for allegedly stealing $108,000 from the hospital. Chief Financial Officer Kevin Benson resigned in January of 2022, and the same month Chief Operating Officer Vlad Toca departed the hospital.
Keith became the hospital’s current CEO in August of 2022. Lisa Petersen, a board member and assistant director of nursing at the hospital, said during Tuesday’s meeting it’s important for leaders currently there to resolve both the immediate care issues and the bigger disputes to prevent further instability.
“I realized that people may disagree on how things are happening or how things are going forward,” she said. “But the thing we have to remember is that this is our leadership team, and we’re gonna have, we’re gonna be going through the process of finding another one, if we can’t find a way to work together.”
• Contact Mark Sabbatini at email@example.com or (907) 957-2306.