COUNTY DRUG FACILITY INVESTIGATED

State Cites Problems At Cedar Hills After Patient Mishandled,
Injured

During his more than three-month stay at a King County-run drug and
alcohol treatment facility, a patient with a known seizure disorder
was allowed to miss one-third of his doses of anti-seizure medication,
the state Department of Health reported Monday.

The sporadically medicated patient ultimately fell down a flight of
stairs, was hospitalized for head trauma and needed to be sent to a
nursing home for recovery, a state report said.

The patient's case prompted an investigation and charges that could
cost the county's Cedar Hills Addiction Treatment Facility its license.

The state filed the charges late last month and announced them Monday.
King County has until March 24 to request a hearing to present its
side of the case.

For now, county officials say they have launched a "full-court press"
to address problems at the 208-bed facility in Maple Valley.
Typically, the facility houses about 140 patients at a time. That
number has dropped to around 100 as top county officials reconsider
whether "medically fragile" patients belong at Cedar Hills at all.

The county's reassessment won't stop there because the state's charges
extended far beyond the case of the single seizure patient. The
Department of Health's other charges against Cedar Hills and the
county include:

* Keeping unneeded or expired medications in the facility.

* Failing to dispose properly of medical waste.

* Poor and unsafe equipment maintenance. This includes crossed
connections in the plumbing that risked contamination of the
facility's drinking water system.

King County Executive Ron Sims said the "depth and breadth" of the
problems found by the state came as a surprise.

Gary Bennett, director of facilities and services licensing for the
state health department, said only about a dozen health care
facilities in all of Washington face such serious charges in the
course of an average year.

But few end up losing their licenses.

"I'd say (with) the overwhelming majority of them, we're able to reach
a settlement with them prior to going to the hearing," Bennett said.

Citing a comprehensive, "Cabinet-level" response to the state charges,
Sims and other county officials predicted Cedar Hills would fix its
problems and keep its license.

Some of the same problems had come up in a routine state survey of
Cedar Hills last year, and the county already was in the process of
addressing them, officials said.

The charges involving the seizure patient are new. That patient's case
offers the most vivid example of how state investigators feel Cedar
Hills was failing in its duties.

The investigation report notes that Cedar Hills' own medication
records show the patient missed 15 out of 31 doses in October, 7 of 30
in November, 12 of 31 in December and 2 of 12 in January.

Despite the fact that Cedar Hills had formally concluded the patient
lacked basic skills to survive on the outside, the investigation found
no evidence that the facility did anything to help him take his
prescribed seizure medication.

Furthermore, the report states, "Not one of the six treatment plans
... had any signature. There was no way to identify who designed the
plan or the rationale behind it."

Nor is there any evidence that Cedar Hills tested the patient's blood
to assure that levels of the anti-seizure drug were neither too low
nor too high.

"It raises the question of what other medical issues are being missed
here," the report states.

Such questions are at the heart of the county's current reassessment
of whether Cedar Hills should be in the business of tackling the drug
and alcohol addiction of such a seriously ill patient. That, Sims
said, is part of the comprehensive effort to make sure Cedar Hills
becomes a facility the county can be proud of.

The state's Bennett said he has been encouraged by the informal
progress reports county officials have given him so far.

"The things that they're telling me are the things that we like to
hear," Bennett said.

But, he noted, the state will need clear documentation of improvements
before it agrees to any sort of settlement with Cedar Hills and the
county.

Monday, King County officials were not prepared to respond point by
point to the state's charges. That level of detail will be a part of
the county's request for a full hearing.

Meanwhile, the head of Cedar Hills, who county officials described as
overworked, has started a six-to eight-week break from her duties.

Two highly regarded county managers have been brought in to preside
over Cedar Hills' recovery. But the permanent head of the facility,
whom top officials said they do not blame, eventually will return to
her post.

Officials also noted that long-standing funding challenges eventually
could force the county to close Cedar Hills altogether. Most of the
facility's annual $3.2 million budget comes from the state. But the
state money is not enough to cover costs - especially in the case of
patients with serious underlying medical issues.