Many deficiencies noted a year ago in an accreditation survey of St. Elizabeths Hospital, including staff inefficiency, financial waste and inadequate patient care, are still uncorrected, a special consultant for the hospital says in a new report.
The hospital's precarious status with the standard-setting Joint Commission on Accreditation of Hospitals, which will resurvey the facility this week, is one of several major problems confronting the federally run 125-year-old mental facility in Southeast Washington.
Accreditation by the commission, whose members are representatives of the major national medical specialty groups, is not essential, but it lends a facility the prestige that helps attract top quality staff members, training programs and other assets. It can affect the Medicare eligibility of non-government facilities.
Dr. Stanton P. Thalberg, the hospital's accreditation specialist, cited the following problems that could jeopardize continued accreditation:
* Inadequate treatment: The average patient in the hospital receives one hour of scheduled treatment a day, at an average hospital-wide cost of $197 an hour. Thalberg concluded that patients could be placed in a less restrictive partial hospitalization program or in out-patient settings if they were only going to receive an hour of treatment a day.
Moreover, he wrote in a report, no private hospital could survive by offering such limited hours of treatment, and "none, clearly, would be eligible for third-party payment at $150 per day for five hours of treatment per week." Thalberg said he visited patient areas last spring and found many patients sitting idly in day rooms with no staff members present.
* Fiscal wastefulness: An estimated $8.3 million per year in clinical staff salaries is unaccounted for, money that apparently has been allocated for care that patients are not receiving, according to documented staff activities. Thalberg's report underscored that the hospital is subject to budget cuts under the Reagan administration unless funds are better managed.
* Wide disparities in staffing: More than two-thirds of the nurses in clinical divisions are assigned to the day shift, although there is a comparable workload on the evening shift. The schedules were set up this way for no apparent reason other than the staff members' preference for working days. The ratio of patients per physician in divisions providing identical services ranges from eight to 22; the ratio of patients per psychologist varies from 27 to 146; the number of patients per social worker ranges from 12 to 23.
These and other shortcomings, many of them corresponding to problems noted by last year's commission survey team, have been detailed in reports obtained by The Washington Post. Most of the documents were compiled by Thalberg, a hospital surveyor for the commission who was hired a year ago at a $51,000 salary to help St. Elizabeths achieve the accreditation approval it lost in 1975 and failed to regain until 1979. Since then, the hospital has held year-to-year accreditation.
Thalberg's employment ended last week.
Hospital spokesman Harold Thomas said Thalberg's information was collected before last July and "there has been ample time to make changes . . . . Things have changed." Thomas acknowledged that some of the deficiencies remain uncorrected, although efforts have been made to correct them. He said a $66-million construction program at the 336-acre facility will be completed by 1983.
"Overall, St. Elizabeths Hospital cannot -- or has chosen not to -- document that it is adequately utilizing its clinical staff, that it is providing adequate amounts of treatment to patients, that it requires its present staffing level and that it is offering cost-effective services," Thalberg wrote in his most recent report, dated Sept. 28.
He said that St. Elizabeths' parent agency, the National Institute for Mental Health (NIMH), and hospital officials took no actions after receiving his reports and that when portions of his memos to division directors were read, they were "greeted by derision and were summarily discounted and/or discredited. Consequently, the hospital probably remains in non-compliance with the relevant commission standards."
In a June report to NIMH director Herbert Pardes, Thalberg described St. Elizabeths as "teetering between one year and non-accreditation," although he said it probably will be accredited again.
James Pittman, Pardes' executive assistant, said the hospital found Thalberg's report "overcritical," and in reaction commissioned a "mock survey" simulating an accreditation survey last July. Hospital and NIMH officials found the week-long study by the four-member team more acceptable because it was less critical, Pittman said.
Pittman and hospital officials said they are optimistic that the commission survey team will grant at least a one-year extension of St. Elizabeths' accreditation when it makes its report in about three months.
If the accreditation approval is denied, it likely would delay the proposed transfer of the hospital to a public corporation. Legislation for that purpose is currently being written within NIMH, Pittman said.
The plan, as approved by the District government last year, has some mental health advocacy groups worried. The dearth of information on what form the NIMH draft bill will take increases their concerns, some representatives of the groups said. Services to about 15,000 to 20,000 mentally ill, alcoholic and drug-addicted patients now enrolled in various programs or hospitalized are at stake.
Former Department of Health and Human Services Secretary Patricia Harris and Mayor Marion Barry agreed a year ago on a plan that would provide for a federal corporation to run St. Elizabeths and be controlled by a nine-member board of directors accountable directly to the president and to Congress. Three members each would be nominated by the mayor, the DHS secretary and the president and appointed to six-year terms by the president.
Some mental health groups say they are disturbed by some provisions in the tentative plan, including issues of accountability to the city and accessibility to citizens' groups.
Federal officials have refused to reveal, even to D.C. officials, details of the legislation as it is being devloped within NIMH. One official said, however, that the bill could be made public in about a month.
The hospital and NIMH concede they have one other substantial problem -- they have fallen behind their own schedule for removing about 7,000 patients to less restrictive quarters under a 1979 court order, despite substantial efforts toward compliance, according to papers filed last week in the case.