Inadequate Inpatient Psychiatry Staffing and Noncompliance with Inpatient Mental Health Levels of Care at the VA Central Western Massachusetts Healthcare System in Leeds

The VA Office of Inspector General (OIG) conducted an inspection to evaluate a complaint regarding staffing, length of stay, and medical assessments on inpatient mental health units at the facility. Senator Elizabeth Warren referred similar concerns to the OIG regarding the inpatient mental health units. An allegation of inappropriate prescribing practices and identified concerns regarding nurse staffing methodology, recovery-oriented programming, and inpatient mental health levels of care were also reviewed. The OIG substantiated that from October 1, 2017, through September 30, 2019, inpatient psychiatry staffing was below expected staffing levels but was unable to determine if medical provider staffing was inadequate because the Veterans Health Administration (VHA) does not provide guidelines for medical staffing. The OIG did not substantiate patients had increased lengths of stay due to insufficient psychiatry staffing. From October 1, 2017, through September 30, 2019, staff did not complete the VHA-required number of utilization management reviews. The OIG did not substantiate patients remained on the acute inpatient mental health unit after psychiatric stabilization to treat medical issues that were overlooked during the admission process. The OIG did not substantiate that inpatient psychiatrists inappropriately prescribed antidepressant medications and vitamin B12 injections. From 2017 through 2019, facility leaders failed to complete VHA-required nurse staffing methodology. In January 2020, facility leaders approved the nurse staffing methodology. Inpatient mental health unit managers did not ensure the required recovery-oriented programming on Sundays, and programming did not consistently occur when scheduled. Facility leaders failed to convert sustained treatment and rehabilitation and specialized inpatient posttraumatic stress disorder beds to acute or residential beds, which resulted in staff’s failure to complete required utilization reviews. The OIG made seven recommendations related to inpatient mental health staffing, utilization management reviews, medical assessments, nurse staffing methodology, recovery-oriented programming, and inpatient mental health levels of care.