There are numerous employees that are subject to a felony for not reporting a bruise that may be d/t abuse or neglect of a child or adult, but yet no one protects the same clinical or admitting staff that try to share all the changes made by facility/nursing mgt resulted in medical negligence and deaths of patients. In fact, no one ever finds out because the legal system covers it all up. God help us...there are numerous patients and families that are truly vulnerable and there was legislation enacted with regards to patient rights to help with these vulnerabilities--yet HIPAA and other laws that were intended to protect patients rights--keep the world from ever being finding out about all the issues that really exist in the hospital and behavioral health world. Patients are admitted that do not meet criteria, or some of the staff --especially in behavioral health--are not licensed or trained adequately enough--resulting in numerous issues. These issues are not going to go away by changing the rules...they are worse than ever, and the new rules for behavioral health need to be more strict---similar to a hospital--yet someone needs to share why hospitals don't report incidents? Also--what about fines? The State of AZ is in dire straits financially, yet numerous hospitals, special hospitals and behavioral facilities are non-compliant. There needs to be a system for fines which shows Arizona is serious about protecting the people that are admitted into these hospitals and programs for treatment. Administration and nurse leaders need to be held accountable, similar to other clinical staff for making decisions that result in bad outcomes up to and including medical negligence and death. Why is it a felony for those of us that miss a bruise, but these individuals keep their jobs...and continue their legacy? Change the rules...add laws in to protect the public, because each and every one of us at some given point in time are going to be a patient--either of a hospital, special hospital or other type of health facility or service line.

Why is the emphasis on changing the education and experiencial requirements of the BHT being so heavily look at, and not all clinical disciplines? In my experience as a masters prepared hospital administrator, nurse, regulator, and college level faculty member—“The residential and special hospital license for behavioral, LTACH and other service lines needs to have more strict requirements for OTHER clinical staff [i.e. physicians, NURSING, and therapists], NOT necessarily the Behavioral Technicians.

I have worked for numerous entities that have non-ACLS competent physicians and nurses overseeing clinical operations and codes; young nurses with little experience [and not more than a 2 week critical care course] working in and overseeing ICU level care in an LTACH [which houses trauma cases, burn victims and the more critically acute ill patient], and when it comes to behavioral health services, it is even worse—a 2 or 4 year bachelors prepared human services education with no real counseling experience overseeing counseling services and anger management/chemical dependency group therapy [and in some cases, groups are actually facilitated by BHTs with no true education of any kind]? It is no wonder recividism is so high. The whole special hospital, residential, and assisted living/long-term care system is plagued with lack of education, experience and hundreds and hundreds of medical negligence/death issues. The community is made aware of these issues as public information under the “ADHS Enforcement Actions section of licensing services. Imagine what is really happening out there, that is not reported and what would happen if the rules are minimalized.

I have personally witnessed “In the special hospital and all inpatient psychiatric settings [residential, geriatric, and psych acute all levels], the chief clinical nurse is not ACLS nor a truly competent nurse that other nurses could mentor from, and that same technicality exists for therapists. I suggest that Nurses, especially that directly oversee clinical operations at the Manager/ Director level on up need to have a minimum of five years recent bedside experience, a current license as a registered nurse [RN], and at minimum BSN degree. For a Chief Clinical or Chief Nursing Officer—that current clinical experience should also include an additional five years experience and education in regulatory and operations management for the chief nursing role [maybe an MSN, MBA, MHA, or MPA because of all the quality and regulatory experience required to operate a facility or health service safely]. The same for therapists in behavioral health [most of which already require Masters level degrees], because numerous therapists have been grandfathered in with little to no real experience of any kind—especially with regards to anger management, chemical dependency, geratrics, therapy of all kinds—and more.

I suggest a full audit of the general and special hospital, residential and other licensing classes with a snapshot of the Enforcement Actions over the last 5 years, and a review of licensing issues/citations because that will validate the seriousness of safety concerns and the lack of education, experience. The same applies to code facilitation for the most serious issues—in many of the special hospital and residential settings, the Medical Staff are not ACLS nor have any code competencies been validated of any kind. If the medical staff, nurses and therapists can get around these requirements, it is no wonder that there are so many care issues. The population admitted into the special hospital and residential settings are some of the most vulnerable, so this should really be investigated by the State of Arizona.

A regular hospital does not report critical incidents yet, so it would be difficult to measure an acute care hospital against all the information available in the special hospital, residential, and assisted living license classes—but hospitals and health facilities of all kinds should be report critical incidents and sentinel events. I have assisted many of special hospital and residentially licensed facilities that are clinical operations and regulatory nightmares, and I for one would never allow my loved ones to be treated in most of these facilities. Not to mention, there should be collaboration with DES for the Title 6, Chapter 6 home and community based licensed services to standardize counseling and nursing care in Arizona. The CPS parent-aide program oversees families that are losing their children due to abuse, addiction problems, etc---and most of the time “Not one licensed therapist is involved in the treatment and evaluation of these cases. Not to mention, the DES mandated caregiver certification for Attendant Care, Respite and other services is not provided by clinically licensed staff—so how could a Caregiver identify skin integrity, or other behavioral or acute care conditions?”

The BHT designation should incorporate validation of training, external of the facility, and all should be certified like the CNA by the State of Arizona [this way these employees truly get the training because I promise you many of these facilities are not really providing it]. A BHT should not be overseeing counseling groups of any kind that is not a Masters prepared therapist at minimum [how would they be qualified?]. Any one providing clinical supervision or nursing oversight as a chief nurse should be ACLS with ten years current clinical/nursing experience. There are too many chief nursing leaders that have not practiced nor been on the floor clinically in decades, and some of these nurses are truly seriously clinically incompetent—so how can they mentor their staff. These chief nurses need to have clinical competencies validated just the way their staff have to meet these requirements. It is happening with clinical supervision in behavioral health for a therapist, but for some reason there is no accountability for nursing nor continuing education requirement in Arizona. Same for physicians and other clinical disciplines with regards to code competencies, and facility/CMS policies.

The quality, risk and compliance oversight role should change to include anyone with the nursing/clinical foundation for these leadership positions is okay, but should include ten years validated experience to include regulatory/operations oversight with bachelors or masters level degrees in business and public administration. The quality, risk and compliance role is a critical role where a 2 year or bachelors level nurse are not qualified to oversee the operations and regulatory piece. How would these young nurses have obtained the administrative and regulatory experience, and why would a nurse be more qualified than any other clinical discipline? This in itself is unsafe, discriminatory, and would create a definite problem with regards to an imbalance in operations oversight where other clinical input is just as important as the nursing input.

Also, masters level social workers, lab, radiology, pharmacists and other clinical employees are quite capable of overseeing the quality, risk and compliance licensing of facilities—not just RNs. This same requirement should be changed in society because the clinical foundation, operations experience, and regulatory along with the degrees in business and public administration [usually at the graduate school level] are where the leaders are provided the education and experience to address safety concerns at the facility level.

For some reason, the system currently currently allows a 2 year RN to oversee Quality or a Manager/Director level role that normally a Masters prepared hospital administrator is responsible for. This is a true problem in society today, because the education and experience are critical in overseeing health facilities and services safely, and these nurses are nurses with little to no true education and experience in treatment, billing/payment/reimbursement, and operations/regulatory oversight. This also allows the quality, risk and compliance oversight role in a health facility to provide a place for clinical staff to retire to—that have the foundation and experience in a clinical discipline, and if they actually obtained the higher level operations experience and at minimum a bachelors degree in Business or Public Administration—these individuals would have a place to work until they retire.

There are numerous behavioral facilities that have all different types of education, and many employees truly never undergo CPI, CPR or even attend other formal training. Many residential or behavioral service licensed facilities do not have code competencies for critical incidents, someone evaluating admitting criteria and numerous patients get admitted that are truly a higher level of care. The general public thinks these facilities are hospitals with policies and procedures that address safety, and stay current on treatment--yet special hospitals and behavioral services tend to hire lesser qualified clinical staff and get away with issues that a hospital would never get away with operationally. There are so many critical incidents and issues in behavioral health that could result in a nightmare for the general public if the rules are minimalized. If these patient populations are not in a facility where they receive adequate treatment for their diagnosis--they will relapse. In turn, it will impact their family and the general public. Why do they relapse? Why is recidivism so high with the special hospital license class? It is because it is more minimally regulated with less qualified staff that do not have actual anger management and chemical dependency training. In order to address the problems in society, first we need to built systems that facilitate healing---with people that are educated and trained to work with these populations. How can a person with a drug problem or behavioral issues that has existed for years be treated and healed in just a few days? The answer is...they CAN'T.