SUMMARY: The state of Washington last week announced it has indefinitely suspended the license of a registered nursing assistant working in the emergency department of Evergreen Hospital in Kirkland after he was reported for apparent intoxication and impairment by coworkers, then tested positive the same day for alcohol and methadone use, and later failed to respond to state charges of unprofessional conduct. Several new unprofessional conduct cases involving health care workers in Washington have entered the state’s disciplinary pipeline, including a nursing assistant at a Kent adult care family home whose actions allegedly prompted a choking episode involving an autistic, bi-polar resident; a nursing assistant in a Vancouver adult family home who allegedly rubbed a soiled diaper in a patient’s face; and a nursing assistant convicted in December in King County of first-degree theft from a victim described by the sentencing judge as “particularly vulnerable or incapable of resistance.”

BACKGROUND: On March 2, 2011, the Washington State Department of Health published notices of disciplinary actions taken last month affecting individual health care providers. Actions include charges of unprofessional conduct, placing a license or certification on probation or suspension, denying an application for certification or licensing, or lifting terms of probation or suspension. When a service provider is charged with unprofessional conduct, they have 20 days to respond in writing to the Department of Health, and then a settlement process begins. If no agreement can be reached on disciplinary action then the case goes to a hearing. At the department’s provider credential search engine – and using either the individual provider “identifier number” (given in monthly online notices of actions) or the name of the provider – you can check license or certification status, locate case-specific documents, and track outcomes.

KEY LINKS:

• State Disciplines Health Care Providers, Washington State Department of Health, March 2, 2011
• Health Care Provider Credential Search, Washington State Department of Health

KEY FINDINGS:

The Washington State Department of Health last week announced disciplinary actions affecting 27 health care providers. Selected highlights follow.

• The department announced last week that the credentials of registered nursing assistant Scott A. Kjorsvik of Kittitas County were indefinitely suspended in late January after he failed to respond within 20 days to charges of unprofessional conduct at Evergreen Hospital in Kirkland in May 2010. During a regularly scheduled shift in the emergency department, according the health department’s final order in his case, several other staffers noticed he appeared intoxicated and his conduct impaired, and he later that day tested positive in a urinalysis for alcohol and methadone. Although he was entitled to address the charges of unprofessional conduct, he failed to do so within the required 20 days, leading to the suspension of his credentials. (DOH Final Order).
• Registered nursing assistant Nkole E. Mola was charged with unprofessional conduct last month for in February, 2008 allegedly causing an inadvertent choking incident leaving red and gasping for air a patient of the Mountain View House adult family care home in Kent, Wash. who had had autism, bi-polar disorder, aphasia and food aggression issues. The reaction occurred after she approached from behind and subdued the patient, then forcefully removed from the patient’s mouth a cookie that was not supposed to have been eaten. (DOH Statement of Charges).
• Registered nursing assistant Alesha Kay Lair was charged with unprofessional conduct last month after a December 2010 conviction in King County Superior Court for first-degree theft, a Class B felony. The judgement and sentence included the statement that the defendant “knew or should have known that the victim…was particularly vulnerable or incapable of resistance.” (DOH Statement of Charges).
• Nursing assistant Susan Meade has been charged with unprofessional conduct for in February 2009 allegedly rubbing a soiled disposable diaper into the face of a client at the Angel Brook Estates adult family home in Vancouver, Wash., and for between March and April 2009 calling that resident and another derogatory names a number of times. The state Department of Social and Health Services found she abused residents physically and mentally. (DOH Statement of Charges).

SUBSEQUENT COVERAGE: “Nursing Assistant Accused Of Patient Abuse,” KPTV, Portland, Ore., March 14, 2011

SUMMARY: According to a report recently published in a journal of the U.S. Centers For Disease Control, Native Hawaiian and Pacific Islanders in King County, Wash. have significantly higher rates of maternal obesity, smoking during pregnancy, adolescent mothers and little or no prenatal care, compared to Asians in King County. The authors of the report, from Public Health – Seattle & King County, state the findings accent the continued need to report health data for Native Hawaiians and Pacific Islanders separate from Asians, in order to identify and quantify important concerns.

BACKGROUND: Changed federal health reporting standards in 1997 replaced the category “Äsian or Pacific Islander” with two distinct categories, Asian, and Native Hawaiian or Pacific Islander or NHPI. For the recent report published in a journal of the federal Centers For Disease Control, researchers at Public Health – Seattle & King County compared key maternal, pregnancy and birth health indicators for Native Hawaiians versus Asians in King County from 2003 through 2008, excluding multiracial subjects who identified themselves with both categories.

KEY LINK: “Maternal, Pregnancy and Birth Characteristics of Asians and Native Hawaiians/Pacific Islanders – King County, Washington, 2003-2008,” Morbidity and Mortality Weekly Report, U.S. Centers For Disease Control, February 25, 2011. Authors: E. Wong, PhD; and D. Solet, PhD; Public Health – Seattle & King County, Assessment, Policy Development and Evaluation Unit.

KEY FINDINGS:

• Native Hawaiians and Pacific Islanders in King County had significantly higher rates than Asians of maternal obesity, smoking during pregnancy, adolescent mothers, high birth weight and late or no prenatal care. Native Hawaiian and Pacific Islander mothers in King County also had higher rates than their Asian counterparts of being overweight and of giving birth birth prematurely.
• The findings will help identify important health concerns for the NHPI community in King County, and underscore the continued need to measure and report public health outcomes for NHPI population separate from those of Asians.
• Important health disparities exist for Native Hawaiians in other areas including deaths, adverse health outcomes and behaviors which increase health risks such as smoking and unhealthy weight. These data are of “high interest” but not within the scope of the current study.
• Future research should seek to refine the results of the current report, in part by looking at year-by-year data to identify trends and also by examining comparable data for mixed race (Asian and Native Hawaiian/Pacific Islander) subjects so disparities can be better described and responsive programs better designed.

Fr. Maternal, Pregnancy, and Birth Characteristics of Asians and Native Hawaiians/Pacific Islanders - King County, Washington, 2003-2008

RELATED: “Health of Native Hawaiians And Other Pacific Islanders In King County,” Public Health – Seattle & King County, August 2008. (Includes community resources).

SUMMARY: Due to a combination of frequent turnover in the position of city clerk, and the introduction of new billing software which decreased city oversight of utility account classification changes and resulting billing rates, the City of Soap Lake, Wash. failed to collect as much as $515,000 in utility revenues which it was owed, from 2005 to late 2010. The findings come in a state audit issued this week.

BACKGROUND: The Central Washington city of Soap Lake, population 1,790, is governed by an elected seven-member council and mayor. The utilities provided by the city include water, Soap Lake water, sewer, and garbage. For billing purposes, customers are divided into three main classifications, each with a different rate: residential, commercial-residential, and commercial. Different utility rates are charged to each customer classification. This audit is based city on financial records covering the period from January 2, 2008 through December 31, 2009, but the findings extend from 2005 to 2010.

KEY LINK: Accountability Audit Report, City of Soap Lake, Wash., Washington State Auditor’s office, issued February 28, 2011.

KEY FINDINGS

• The city changed its utility rates in 2005 when two related ordinances were passed, but didn’t update account classifications until October 2010, leaving some new revenues uncollected. A combination of frequent turnover in the city clerk’s position in the last five years, combined with the 2008 introduction of new utility billing software which employees failed to master, led to under-billing. The net effect was that city let customers self-report adjustments in the billing category classifications of their properties for five years.
• The audit reviewed 26 adjustments made in 2008 and 2009 and found no supporting documentation other than brief comments. Nine of the adjustments appeared to be not warranted based on histories of the accounts. Untracked adjustments or unsupported variances totaled $112,500 in 2008 and $191,400 in 2009.
• The under-billing may have cost the city as much as $103,00 per year from 2005 through 2010, or $515,000, if the accounts had been properly classified, according to estimates by the state auditor’s office. The city billed $714,000 for utilities in 2008 and $734,000 in 2009. Its annual budgets in those years were $3.6 million and $3.9 million.
• The State Auditor recommends that the City begin the process to properly classify customer accounts immediately, ensure that all City employees have a full understanding of the new billing system, create and maintain documentation to support account classifications, and print and review reports following all account adjustments to guarantee accuracy and completeness.
• The City of Soap Lake responded, conceding the possibility that revenues it was due went uncollected but stating its belief that all accounts are now properly classified. The City also created adjustment logs to manually document account changes. The affected property owners were notified and the City allowed them to offer comments on the situation at several council meetings. The council then approved a new ordinance which more clearly defines the different billing classifications.

SUMMARY: In testimony to a U.S. House subcommittee yesterday, U.S. Government Accountability Office Director of Health Care Kathleen King said the Medicare program is at risk of failure because of waste, mismanagement, and increased demand for services and spending. She testified that of approximately $509 billion Medicare spent in 2010, $48 billion or almost 10 percent was improperly spent; and that Medicare contract oversight will become an even more a pressing challenge. She also highlighted ongoing problems Medicare has in trying to ensure the quality of care for its clients in nursing homes. She testified that the quality assurance problems are due partly to poor guidance and methodology in related oversight surveys for which Medicare contracts with states, as well as sub-par training, staffing and supervision of personnel involved in nursing home oversight, and pressure from the nursing home industry.

SUMMARY: A Seattle City Council staff report ups the ante on the low-end estimates in a January, 2011 analysis from the administration of Mayor Mike McGinn on the annual and one-time net costs to the city of annexing the 3.55 square mile North Highline area in unincorporated King County. It includes the communities of White Center and Boulevard Park, is home to 20,000 residents and borders Seattle on the southwest. The staff report suggests it’s likely more prudent for the council to replace the Mayor’s best-case scenario of $1.8 million more in annual North Highline costs than annual revenues with an “älternative case scenario” of a $4.6 million annual operating shortfall. The report also suggests that the mayor’s $4.7 million best case estimate of one-time North Highline annexation costs be replaced with an alternate case scenario of $8.7 million. Still in place for the council’s review are the high-end estimates identified in the mayor’s report, a $16.8 million annual operating gap and $91.3 million in one-time expenditures, although the council report intimates that $37 million for non-arterial street paving should be shaved off that last number. A council committee and then the full council will decide before the end of March whether to authorize a November election in which North Highline residents would choose whether or not to annex to Seattle. If Seattle fails to annex North Highline, Burien, which borders it on the south, could.

SUMMARY: A recently-issued audit by the Inspector General’s office of the United States Postal Service finds that in the Seattle District, covering Washington and Idaho, mail volume has dropped 22 percent in the last five years and more than 800,000 excess square feet of facility space should be disposed of, saving $26 million over the next 10 years. The USPS Western Area, of which the Seattle District is part, could similarly save $173 million over 10 years. The audit also found that the USPS needs to improve its real estate management system to better identify and dispose of excess property, partly by tracking how long space is underused or vacant, what its condition is, and by marketing it to tenants including other federal agencies.

SUMMARY: The Washington State Supreme Court has reversed a state appeals court which last year threw out a conviction against Arthur C. Russell, convicted in trial court in August, 2008 for first degree rape of a child, a stepdaughter, when the family lived in Bremerton and he worked for The U.S. Navy. The appeals court had held that the conviction was invalid because the jury was not given “limiting instructions” on how it could and could not consider evidence of other alleged acts of sexual abuse by Russell against the stepdaughter in locations outside Washington state including Hawaii, Florida and Indiana. Such evidence is allowed to establish motive and intent, but not character. The Supreme Court overruled the appeals court and affirmed the trial court’s conviction and sentence, stating that because there was no request for “limiting instructions” on the additional evidence, none were required to be given by the trial court.

SUMMARY: Dangerous chemicals are being or could be released from Boeing’s Renton Plant into the soil and groundwater, potentially affecting water quality in Lake Washington and the Cedar River and posing “ä threat and/or potential threat to human health and the environment,” according to a proposed Agreed Order between the Washington Department of Ecology and Boeing. The order was released earlier this month and is likely to be signed after public comment ends March 9. Boeing makes no admissions of fact in agreeing to the draft or final order. A series of interim cleanups have already occurred. According to an Ecology project manager the earlier cleanups addressed much of the soil contamination and some groundwater contamination but the latter still exceeds the most stringent state standards, resulting in the need for the new cleanup plan for which Boeing would pay. The chemicals which are being released or have the potential to be released into the soil and water from the Boeing Renton plant include benzene, toluene, xylenes, methyl ethyl ketone, vinyl chloride, chloroform, acetone, napthalene, tributyl phosphate, arsenic, zinc, mercury, cadmium, chromium, lead, copper, PCBs and cyanides.