Salem-based Oregon State Hospital has hired consulting firm Chartis to address safety violations at the facility after three patient deaths and the discovery of other deficiencies by CMS, the Oregon Capitol Chronicle reported Sept. 23.
The hospital will pay Chartis up to $1.7 million to develop a plan of correction after two hospital-written plans were rejected by federal regulators. Chartis' representatives include two physicians, four registered nurses, a quality and patient safety expert and a physical environment specialist. They will arrive at the hospital Sept. 24 and stay through March 31. The company comes "highly recommended" and has experience working with large forensic state hospitals, Sarah Walker, MD, interim superintendent and chief medical officer, said in a staff memo shared with Becker's.
"They have a 100% success rate of helping hospitals come back into compliance," Dr. Walker said. "I think of bringing in this particular consulting team in the same way as an athletic team hiring a coach. Top performers in other fields bring in people to observe their performance and provide advice and guidance as to how to improve. In my view, this is no different."
Chartis will help the hospital change from reactive to proactive approaches to monitoring and quality, as well as implement sustainable policies and procedures and develop strategies for data transparency, according to the memo.
Since September 2023, the hospital has received three immediate jeopardy warnings from the state. The first was issued in September after a patient escaped the facility. The second was issued April 29 following a visit during which inspectors found emergency supplies and equipment spread among four locations in its admission area. The hospital resolved both immediate jeopardy warnings. The third immediate jeopardy warning was issued in May following a patient overdose death. The survey also found deficiencies in continuous rounds, viability checks, patient monitoring, screening of visitors, supervision of patient visits with family and friends, and quality of incident investigation and response.
"[T]he reality is that bad things can happen in any hospital," Dr. Walker said in the memo. "We've seen that this year, and I’m not trying to minimize how awful those incidents were. But we can't go back in time or make those things un-happen. What matters is what we do about it, what we learn from it, and what we put in place to prevent something like that from happening again. "
Oregon State Hospital is run by the Oregon Health Authority and houses more than 500 mental health patients.