Opinion ID: 1301958
Heading Depth: 1
Heading Rank: 4

Heading: staff training and qualifications

Text: While we have focused on the tragic impact of the hospital's Kafkaesque lack of coordination and while we think that treatment would be improved immeasurably through administrative changes alone, we must also recognize the problems created by under-qualified staff. One such problem is illustrated by another example from petitioner R's. case. On her treatment plan under psychiatric problems is listed the fact that she tries to pull her tongue out of her mouth with her hands. This behavior is actually symptomatic of patients who have been on tranquilizing drugs for a long time. The doctors who administered the drugs to her admitted that the drugs were simply a management technique. However, there had been no recognition before the institution of this law suit that her tongue pulling was caused not by any psychiatric problems but rather by her medication. When alerted by the petitioners' expert that this was a fairly common reaction to the drugs, one of the doctors seemed genuinely surprised. The problems created by staff who are under-qualified can also be seen in Ms. H's. case. She is a member of a group at the pre-discharge unit which meets regularly with a bachelor's level psychologist and a psychiatric aide. At these meetings some patients are permitted to talk about their past and some are not. The psychiatric aide was unable to articulate how the distinction is made among patients in terms of who is permitted to talk and how those distinctions relate to the patients' problems or treatment plans. In another instance of amateurish care given the patients, we find that one of the psychiatric problems listed on Ms. H's. treatment plan is stubbornness. Such a term is not generally used in a psychiatric diagnosis of behavior. Even more sorrowful is the fact that while the staff identified one of Ms. H's. problems as fire-setting, there was no documentation of any treatment either suggested or given to address that problem. While it is clear that the hospital is lacking in qualified staff, the addition of more qualified staff would be of little consequence without significant changes in the total administration and philosophy of care at the hospital. With improved coordination there is no doubt that, even with the hospital's limited resources, the quality of the treatment can be improved markedly. Guessing at the real staffing needs of this facility before it undergoes a major revamping in operational procedures would be speculative at best.