Quincy Medical Center psychiatry unit referred to for Squalid conditions, Patient disregard

Inspectors made a surprise visit May 23, responding to concerns about the geriatric unit at the hospital, owned by Steward Health Care. Patients were largely ignored by nurses and other staff members and left in bed without covers and wearing only hospital gowns, inspectors found. Some complained of mean or disrespectful staff members.

In one room, a woman in bed was covered in feces and said no one had answered her calls for help. She told inspectors that one nurse was unkind and that another staff member “told her she needed to take care of herself.”

“The patient in the bed next to her was almost cowering and very frightened,” said the report by the state Department of Mental Health. “The odor coming from this room could not have been missed by anyone in the hallway, yet no one was responding to the patient.”

The facility overall was squalid, with dirty floors, damaged furniture, and missing privacy curtains in patient rooms, inspectors found.

The state closed the unit to new admissions for about a week as the hospital began taking corrective actions. The action came to light this week after Globe inquiries.

Hospital leaders acknowledged serious problems on the unit. In a June 11 letter to the state, Daniel Knell, the Quincy Medical Center president, said the inspectors’ findings were “disturbing and concerning.” Several staff members were terminated, he wrote. Those remaining have gone through patient rights training, which included watching a four-minute video on empathy, and will have ongoing training.

“A change in culture among unit staff is paramount,” Knell wrote.

The unit is licensed for 22 beds and typically serves people age 55 and older with cognitive disabilities or dementia. Patients are admitted or sent by nursing homes for evaluation when they have a change in their mental status or behavior.

Steward bought the struggling facility in 2011, as it expanded its chain of for-profit hospitals in Massachusetts.

The hospital system has “responded with all of its resources” to the state findings, said Lizbeth Kinkead, licensing director at the state Department of Mental Health. But she will be watching for hospital administrators to demonstrate ongoing support for this and other psychiatric units within the Steward chain.

The leadership at the hospital “was a big part of my concern, really: Who was paying attention to this?” she said. “Who was looking at the functions of everybody, up and down the system?”

Kinkead said that putting a hold on patient admissions is “not an unusual event,’’ but does reflect the seriousness of the inspectors’ findings. In a letter to the hospital, she pledged “a vigorous and ongoing review” and asked for weekly progress reports.

Among other problems, inspectors found that the staff was confused about how to access electronic medical records, which include tools for assessing nursing needs and patient safety. For one patient, who inspectors said was depressed, electronic forms were not completed, though the patient had been at the hospital for five days. No hard copy of the patient’s chart was available.

One activity room was used to store furniture. A therapy room was inaccessible to patients, a problem noted in a 2011 inspection but not addressed. Patients told inspectors that scheduled group programs happened infrequently.

Several patients reported that the staff was unkind. “At any given time,” during the visit, the inspectors wrote, “there were two patients crying.”

Knell said in his letter that the hospital’s human rights officer interviewed patients every day in the week after the inspection and weekly since then, to address any concerns. The unit had been cleaned and furniture replaced.

A Steward spokesman declined to say which staff members had been fired, but according to a filing with the state, the program director and the hospital’s chief nursing officer were replaced. Regular training sessions for the remaining staff have been scheduled through September, Knell wrote.

The hospital is working on the changes with the Massachusetts Nurses Association, which represents nurses on the unit. That working arrangement is starkly different from the two parties’ positions in 2011, when Steward fired the staff of an adolescent psychiatry unit at Carney Hospital in Dorchester after incidents of patient sexual abuse and neglect.

The union opposed the firing of members there, and an arbitrator decided that six nurses should be reinstated. The hospital system last month filed suit in federal court, saying that returning the nurses to the adolescent unit would jeopardize improvements made there.

Union spokesman David Schildmeier said the union is meeting regularly with hospital officials. No union members there have been fired, he said.