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Robert L. “Bob” “Orpalo” “Tudoc” Valerio, 85, died June 30, 2019, in Seattle.
3/23/2019
PoV: Before privatizing API, gov. has questions to answer

By FAITH MYERS

There is a scenario in which privatizing Alaska Psychiatric Institute would be good for the state and patients, but Gov. Mike Dunleavy would have to answer two questions first.

One:“How did Alaska get to the point of a crisis in mental health care?” And two: “How will Alaska raise the quality of care for the approximately 10,000 acute care psychiatric patients annually in Alaska?”

Many of the same reasons given in the 96-page API Feasibility Privatization Study 2017 for not privatizing API could be applied to North Star Behavioral Health, Providence Hospital, Fairbanks Memorial Hospital, Bartlett Hospital in Juneau, etc.

As a patient advocate, I have a different opinion concerning the direction the state is taking to improve the quality of care for disabled psychiatric patients.

Over the past 50 years in Alaska, no single private company has improved the quality of care for psychiatric patients statewide and will not until the Legislature and the governor revise antiquated laws by requiring that all private facilities caring for the disabled adopt best practice in quality of care.

For four hours on March 7 at a House Health and Social Services Committee hearing, I listened to the commissioner of the Department of Health and Social Services and a representative from Wellpath, Kevin Ann Huckshorn, talk about how Wellpath will improve the quality of care for acute care psychiatric patients. But there was no mention of what laws needed to be revised to improve quality of care.

I have a 15-year history of listening to how state officials will improve quality of care for the disabled, starting with the CEOs of the Alaska Psychiatric Institute beginning with Ronald Adler in 2004, who at a board meeting said he would require the total revision of all of API’s patient policies — update them and put them online. Then he changed his mind and said it would happen after the move to the new API hospital. But it never happened. API CEO Melissa Ring gave the same set of promises — going to update all the policies to improve the quality of care for patients. Never happened.

The quality of care for psychiatric patients is governed first by state laws and then by hospital policies. There can be a 100-year-old psychiatric hospital on the East Coast that is far better run and managed than a 20-year-old psychiatric hospital or unit in Alaska. Quality of psychiatric patient care comes down to state laws and policies.

When executives from Wellpath at the House HSS Committee hearing spoke for two hours — in part speaking about quality of care for psychiatric patients, I saw heads nodding in agreement in the audience. But to me, Wellpath was making the same promises that I have already heard over the last 15 years from DHSS and API executives, promises that never improved the quality of patient care.

 Here is what I got from reading the 100-page 2017 API Privatization study: A private company given the contract to run API will in the beginning reduce costs. After they settle in, costs for patient care will go up. Quality of patient care will plateau at mediocre.

It cannot be said enough: It is the laws and hospital policies that create quality of care for acute care psychiatric patients and protection for staff. And it will cost what it is going to cost. AS47.30.660 (b) (13) allows DHSS to delegate its obligations to private facilities with an insufficient state standard of care; DHSS is doing it now with multiple psychiatric units and will do it with the private companies like Wellpath. The Legislature should require word changes in that law now.

 Disabled psychiatric patients do not have a fair grievance and appeal process. AS47.30.847 was passed 26 years ago and needs to be legislatively revised by adding more detail, covering more Trust beneficiaries, and adding more basic rights to reflect best practice.

Until the Legislature revises basic rights and laws to protect disabled psychiatric patients suitable to 2019 standards, API should not be privatized and the quality of patient care in existing private psychiatric facilities and units should have more state oversight.

Faith Myers has a degree in early childhood development and has spent over five months in Alaska Psychiatric Institute as a patient. She now works as a mental health advocate working to change API policies and state laws.