Day 14 in the Hospital

Mason has now been at Mason General Hospital (MGH) for 14 days without a medical condition. Again, he is receiving services best provided in a home-like environment. The long holiday weekend is over and so, presumably, DSHS administration and staff are now back on the job and able to resume work on Mason’s case. We have had no communication from the DDA since Thursday of last week. I am thankful to the many folks who have reached out via social media to shine light on this shameful abdication of responsibility. Most of all, I am thankful for the nurses and other staff at Mason General Hospital who continue to attend to Mason’s needs 24/7. They have been forced into this situation but perform their roles with compassion and expert skill.

How have we gotten to the point in Washington State that a critical access hospital has become the de facto housing facility for DSHS/DDA clients in crisis? Essentially, emergency departments are required by law to perform a “medical screening exam”. This law (EMTALA) requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate. If no emergency medical condition is found patients are generally discharged. In Mason’s case we could not discharge him without the help of someone to care for him. This would be considered an “unsafe discharge” and the hospital would be responsible for anything that happened to him. Of course, this discharge is only theoretical as we would never put Mason and others like him in this situation. Since DSHS/DDA has failed to find housing for Mason, we are now in a position of providing it for him. These state agencies are well aware of the laws and are using them to force hospitals to become part of the housing “crisis plan”. Where does that leave hospitals such as ours that don’t have large facilities that can absorb the needs of such clients? “Housing” is not a reimbursable diagnosis and so it is very likely that MGH will receive no funds to cover Mason’s stay. Anyone who has received a hospital bill knows how much this means. This is not to mention the 24/7 security that has been hired by MGH which would not be covered even if there was a medical condition that we were treating.

As of this writing I have not heard of any progress on the part of the state agencies. As for MGH? We continue to do what we do best in addition to doing what DSHA/DDA is supposed to do best.

Christmas Eve

Still no progress on getting Mason into a home for the holidays. It appears that he will be spending them in his hospital room. The nurses got him a Wii game console and are planning a party tomorrow. I have received many requests regarding how folks can help out. There will be a box inside the main hospital entrance at Mason General Hospital where people can leave gifts and well-wishes.

Thanks to all who have expressed their intent to help!

Stuck in the Hospital, Mason’s Story

My name is John Short and I am an Emergency Medicine Physician at Mason General Hospital in Shelton, Washington. The following is my first-hand account of an ongoing injustice perpetrated by the WA state government against a disabled person:


Mason.jpg


 

“Mason”* has been abandoned by DSHS and the State of Washington at Mason General Hospital (MGH) in Shelton, WA since the 12th of December, 2018 when he was brought to the emergency department for behavioral problems (no medical problems were apparent). He has been a client of DSHS and the Developmental Disabilities Administration (DDA) since he was a child. He moved from another part of the state 2 days before being taken to the ER. Unfortunately, the residential facility that had accepted him found that they were unable to continue to take care of him. They requested help from law enforcement and the Designated Crisis Responder (DCR). The residential facility believed that Mason was being taken to a psychiatric facility. Instead, as part of this process, he was taken to Mason General Hospital to be assessed for potential medical causes of his long-standing behavioral issues. Of course, none were found and medically he was “cleared”, a phrase indicating that there were no serious medical issues causing these behaviors. At this point, most people are either released home either to family or caregivers. Some are transferred to a facility appropriate for his level of care.

Unfortunately for Mason, he lives in Washington State. What happened next unfortunately seems a common practice by DSHS and the state’s Developmental Disability Administration  (DDA). Mason has lived in the hospital almost two weeks now. His first six days were spent in the chaotic environment of the emergency department where lights are on 24/7, it is noisy, and it is potentially dangerous. He had to be confined to his own room for his safety. Other patients came and went as they pleased. No progress was made regarding finding Mason a home. On December 16th I was finally able to reach Kristine Pederson, the Region 3 administrator of the DDA. She assured me that work would begin last Monday morning on Mason’s case but she also told me that there were at least 5 other DDA clients awaiting placement in housing. We heard nothing that Monday but on Tuesday we held a telephone conference with members of our hospital administration, representatives of the medical staff, a State Attorney General, myself, and several DDA staff. During that and the meetings that followed in the subsequent days, we were informed that there was no progress on finding a home for Mason and that the state would no longer be accommodating our request for further daily updates.  We were given the impression that there would likely be no progress on Mason’s case until after the holiday. Of course, unlike hospitals, the state is unavailable on weekends and holidays, even in crisis situations. We proposed to discharge Mason and take him to a DDA office. At this point in the conversation, a DDA staff member said that we would be met with the charge of “unsafe discharge”, a blatant reminder of who holds the upper hand.

Mason has been receiving excellent care at Mason General Hospital. The staff are compassionate, caring, and excellent at their jobs. While these things are true, it has not been without a significant cost to the hospital district. The hospital has had to hire 24/7 security simply to attend to Mason. As a critical access hospital, MGH is allowed a limited number of inpatients at any given time. This means that Mason is occupying  a bed that is meant for acute care patients in critical need of medical services. While he is with us, Mason is being given his medications, food, a bed, television, internet access and the care of wonderful people. These are services that the state should be providing in an appropriate homelike setting in the community.

We are approaching Christmas, and, in all likelihood, Mason will be spending it confined to a hospital room in a hospital, MGH. Is this really the role of an acute care hospital? As a vulnerable person, someone who needs care, is this the way that Mason deserves to be treated?

Washington state is simultaneously failing to take care of its most vulnerable populations  and putting undue strain on medical institutions, reducing their ability to do the jobs they are normally tasked with. While the primary goal of this discussion is to place Mason in a safe and comfortable permanent living situation, this is unfortunately not an isolated incident. A serious conversation regarding DSHS crisis response policy is necessary to ensure that no one ends up falling through the cracks in the system in the future. In the mean time, given the state’s level of concern for Mason, perhaps Mason General Hospital is the best place for him.


Interested in learning more about this crisis? Read Stuck in the Hospital by the Office of Developmental Disabilities Ombuds.

Would you like to help “Mason”? Make a complaint to the Ombuds Office.

Please also forward a link to this post to everyone you know.

Want to make Mason’s Christmas a good one? Contact me.


*Pseudonym and gender have been assigned to protect the identity of the individual involved.