ITHACA, NY – In September, the Tompkins County Mental Health Clinic was the subject of an audit that resulted in a six-page report detailing 13 separate citations for substandard care.
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The New York State Office of Mental Health (OMH) periodically performs re-certification visits to mental health service providers before reissuing to them an operating certificate. The audit was performed in September and completed in February.
Due to it’s numerous areas that “need improvement,” the Tompkins Mental Health Clinic failed the audit and has been placed on “focused provider monitoring” by OMH. Focused provider monitoring is put in place when an agency is “determined to be at significant risk” and will continue until the clinic can “demonstrate the ability to sustain compliance.”
For the duration of this process, the OMH Field Offices for Western and Central New York will provide technical assistance to help the Tompkins clinic reach compliance goals. OMH will not consider requests for expansion of services for Tompkins County Mental Health services.
The three primary issues highlighted by the OMH report are as follows:
- The clinic did not report multiple serious incidents to OMH, including two deaths, three suicide attempts, and two cases of criminal behavior.
- The clinic has clinicians assigned to at least 11 schools across four schools districts, with caseloads averaging 25-30 students each. Additionally, the clinic has not submitted applications to establish satellite offices at each school, as required. This has been an ongoing issue noted by OMH after visits in 2006, 2007, 2010 and 2014.
- The visit turned up nine instances of repeated concerns, which were supposed to have been addressed after being pointed out in 2014.
Many of the repeated offenses deal with poor screening for things like alcohol, tobacco and drug abuse, self-harm, violence. In some cases, forms for recording these issues are left blank entirely, while in others it is indicated that no follow-up assessment was performed in cases of people with notable histories of one of the above.
Citations for each of these issues indicate that Performance Improvement Plans (PIP) were put in place. In each case, “there was evidence that the plan had been implemented, but it was not sufficient to achieve compliance in this area.”
Another repeat issue was finding the key in the lock of the medication refrigerator. The last repeat citation was for drawing and storing blood without having a clear policy or procedure.
Kimberley Klimowicz, a former Community Mental Health nurse at the clinic, told the Voice that the leadership at the clinic just doesn’t take these issues seriously enough.
“The leadership even before my time didn’t take these issues seriously. They’ve been kicking the can down the road, saying they’ll address these issues but there’s no followup, no administrative support,” said Klimowicz.
“The staff who have direct patient contact operate in a bubble. It’s very autonomous. The problem is that it’s not standardized, so it’s not meeting the standard of care,” she added.
Klimowicz says that issues as seemingly simple as proper documentation are important for accountability reasons. “If someone commits suicide, we have to ask if we could’ve done anything differently. It’s about accountability and making sure serious issues don’t repeat themselves,” she said.
Klimowicz suggested that the continuing issues may be because some of the more veteran staff who have worked there for over 10 years are resistant to new policies and more paperwork.
She also highlighted another of the major issues in the audit: lack of comprehensive treatment plans for clients. Some of the clinic’s treatment plans clients were deemed substandard because “objectives were not measureable and focused only on symptom reduction or compliance, which is not person-centered or recovery-oriented.” One example cited gave a patient a goal of “improve mood, reduce anxiety and reduce paranoia.”
“A cookie-cutter plan of care does not involve the client,” said Klimowicz. “Their needs and personal life goals are important in how care is delivered.”
County officials respond
In a press release on Monday, the Tompkins County Mental Health Department addressed these concerns.
The Mental Health Department is underway with the preparation of a required performance improvement plan and Frank Kruppa, newly appointed head of the Department, has ensured the licensure of the school counseling program a top priority, the release said.
“I do not believe the audit represents a reflection of the quality of care provided by the County Mental Health Department, but rather our need to improve our processes and documentation in a manner compliant with regulations,” said Public Health Director Frank Kruppa. “As many of the changes recommended by the State are already in progress, I’m confident we will rapidly, and permanently, resolve the administrative deficiencies cited by the State.”
County Administrator Joe Mareane expressed confidence in the Mental Health Department’s ability to promptly resolve the issues cited by the State. “With our dedicated staff and the strong leadership now in place, we will achieve the improvements sought by the State. The Department will use the audit to add focus and urgency to the work already underway to bring our systems and procedures to the same level of excellence as our client care.”
Klimowicz said that she felt that it would require some outside motivator to drive change at the clinic. She suggested that the Tompkins Legislature, which has oversight of the clinic, should make a greater effort toward accountability by being more transparent and communicative with the public.
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