Hospital care questioned

Two weeks into the transition, hospital leaders and Department of Health and Hospital officials say that everything is going smoothly with the changeover of Southeast Louisiana Hospital from public to private ownership under the Meridian Behavioral Health Systems.

But social worker Monique Bradberry, who worked at the hospital for three years before quitting last week under the new management, has a different view.

Amid hundreds of layoffs, Bradberry, who has a master’s in social work from Tulane University, said she was one of the lucky ones to be rehired by Meridian. She wasn’t worried about a $5,000 decrease in annual pay, she said, but was just happy to have a job.

Kathy Kliebert, deputy secretary of DHH, said that of the 320 full-time employees under Southeast, about 125 were rehired. The number of beds was reduced from 176 to 58, with the shifting of beds to other state and private providers.

Bradberry returned to work Jan. 2, and the word she used repeatedly to describe the atmosphere was “chaotic.” She knows that any transition will bring challenges, she said, but was concerned about starting work with patient charts that were entirely blank. Fortunately, a colleague had the files on a jump drive, and they began the process of re-entering all the information, including patient history, legal status, assessments and interventions, she said.

Despite a very difficult first day, Bradberry said she wanted to give it time.

Richard Kramer, CEO under Southeast and now CEO of Northlake Behavioral Health System under Meridian, said that any major transition, especially from state-run to privately run, requires a conversion period to smooth out changes in procedures and policies.

“Overall it has gone very well,” Kramer said. “The priority is to provide good patient care.”

Kramer said that all information that was available under the state is still available and accessible, but there was some tedious work required in the transfer.

But Bradberry said that working in the unit with the patients, she didn’t see things going very smoothly. When dealing with mentally ill clients, any source of stress can alter their mental status, Bradberry said.

“It wasn’t just a chaotic situation — it was dangerous,” she said.

The following day was just as chaotic, Bradberry said. “Things started coming unglued,” she said.

Bradberry said that clients started to “decompensate,” a term that refers to the failure of defense mechanisms and the exacerbation of the mental disorder. Bradberry said patients were crying, punching walls, acting out and were “unorganized in their thoughts.”

Kliebert said every day brings challenges in this field of work and there was “absolutely nothing out of the ordinary” related to incidents during the transition.

Kramer also said that they have not seen an increase in patients acting out or an uptick in incidents of concern.

Kramer described good continuity with the staff who remained working directly with the patients — “the same people working in the same capacity,” and praised the dedication of the remaining staff.

Kliebert said that as part of the cooperative endeavor agreement with the state, Meridian is guaranteed payment for a certain number of beds for the uninsured. Monitoring the services being delivered to make sure they are at the same or increased level of quality is also part of the agreement she said.

“Everything that they were doing Jan. 1 was done Jan. 2,” Kliebert said.

Bradberry said she was asked to work on Jan. 6, a Sunday, and was placed in the admissions office where she learned the process of proactively filling beds, such as make calls to emergency rooms to let them know that beds were available .

She said she was offered a position to work in admissions full time, but she wanted to work directly with patients. Issues with patient care were what prompted her to quit, she said.

When the hospital was public, Bradberry said, there were four group therapy sessions each day: addiction services, psychology services and two groups with social workers. There were also individual sessions as needed.

Bradberry said a large percentage of the patients struggle with addiction disorders.

Under Meridian, Bradberry said, addiction services and psychology services disappeared.

Although she is also a licensed addiction counselor, she said she was still pressured to take a job in the admissions office and was told that Meridian would be hiring more social workers.

Kliebert said part of the requirements for the agreement with Meridian is that it cannot stop therapy or change treatment plans. She said she has not received reports of changes in treatment plans, and that to maintain accreditation, Meridian must meet the requirements of the cooperative endeavor agreement.

Kramer said that as of now, there was a reduction in addiction specialists but that the services are being covered in other ways under the current structure.

The elimination of an addiction services position doesn’t equate to the loss of the services, he said. “They just receive it in a different way,” he said.

Kramer said the hospital is working with Tulane University to fill vacant spots for psychologists, and he believes those jobs will be filled in the near future.

On Jan. 8, Bradberry quit, saying her reasons for doing so centered on increased chaos and decompensation among clients.

She also said she felt pressured to discharge patients before they were ready.

Bradberry said it often takes several days to try new medication and determine its effectiveness. When patients relapse, everything changes, she said.

“They seemed like bean counters,” Bradberry said of new employees in the admissions office and the pressure to fill beds and turn them around quickly.

The patients were “basically being housed for three days and discharged,” she said.

Bradberry said the change that really pushed her to leave was the decrease in therapy, which she said also led to an increased reliance on medication.

Kramer said the hospital’s programming is still being adjusted, and that the final programming is not in place.

“The evolution will continue,” he said.

Kramer said there are things to work through, but that the most critical piece is meeting the standards of patient care.

But Bradberry said she didn’t see the same commitment to the patients while working in the trenches.

“The patients weren’t receiving treatment,” she said. Those services were there for a reason, she said, and they “totally went away.”