Patient sex, safety lapses prompted DOH action against now-closed Fairfax hospital youth unit

Patient sex, safety lapses prompted DOH action against now-closed Fairfax hospital youth unit
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The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

Editor’s note: This story includes references to self-harm.

On the evening of Feb. 11, three teenage patients at BHC Fairfax Hospital in Kirkland found their way to a secluded area of ​​the psychiatric facility’s courtyard.

Among them was a 15-year-old girl and a 13-year-old nonbinary patient, who both had histories of sexual abuse and were deemed at risk of being victimized. With them was a 16-year-old boy, who had been displaying sexual behavior and wasn’t supposed to be allowed outside.

Each patient was documented to be inside the hospital during this time on Fairfax’s observation charts, but they were actually behind the bushes in the darkened courtyard. As a hospital staffer sat on a bench with his back to them and eyes on an electronic device, the three patients engaged in a sex act.

The incident was among the reasons why the Washington Department of Health declared an “immediate risk to patient safety” and briefly stopped Fairfax from admitting adolescent patients to its Kirkland campus in April. It was also part of a pattern of violations that DOH has documented at the state’s largest private psychiatric hospital since the spring of 2021, according to records reviewed by The Seattle Times.

Fairfax closed its teen inpatient unit the month after DOH’s enforcement action, citing “current patient demand and demographics.”

Christopher West, chief executive of Fairfax Behavioral Health, said by email that the hospital conducted an internal investigation into the incident on Feb. 11, and that “retraining was conducted with identified staff to reinforce vigilance.” He didn’t respond to a question about whether regulatory violations played a role in the hospital’s decision to close the adolescent unit.

A DOH investigator last year questioned how Fairfax determines if patients can consent to sexual encounters, given that they’ve been admitted for not being able to make safe decisions. A staffer responded that this was for law enforcement to determine, not the hospital, according to DOH’s report.

One way to stop patients from sexually acting out is to check on them more frequently, but that often means a need for more staff on hand. A Fairfax nurse told investigators in the spring of 2021 that increasing a patient’s observation “alters the budget” and had become increasingly difficult, DOH records show.

DOH began its latest investigation after receiving three complaints in February and March that alleged different cases of sexual abuse of adolescents.

Department investigators arrived at Fairfax on April 6 and found a series of violations, from failing to reassess patients for suicidal risk to not implementing plans to prevent sexual abuse.

Each of the patients involved in the sexual encounter was noted by staff to have engaged in “inappropriate sexual behavior” in the days leading up to the incident, according to the DOH report, but no plan of care was put in place to address the risks until afterward.

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Fairfax’s policy is to conduct rounds on patients at least every 15 minutes, verifying where they are and what they are doing, as is common for psychiatric hospitals. The observation record shows that, at 7 pm on Feb. 11, the 13-year-old nonbinary patient was in a hallwaythe 15-year-old female was in a common roomand the 16-year-old boy’s whereabouts were, to DOH’s review, illegible.

But according to an incident report and video footage cited in the DOH report, they were all in the same place at that time — the darkened corner of the courtyard.

A Fairfax staffer told DOH that the patients were coming in and out of the unit, which explained the “discrepancies.” The investigator’s review of the video, however, showed that each entered the courtyard at 6:52 pm and returned inside at 7:30 pm

Much of the 68-page report focuses on risks to patients in Fairfax’s now-closed adolescent unit. An investigator found that one patient who was on “sexual aggression precautions” had been assigned a roommate who was on “sexual victimization precautions.” A staff member acknowledged “They should not be in the same room.”

The report also cited six patients for whom Fairfax didn’t follow its policy on screening for suicide risk. One, a 13-year-old patient, told nursing staff she had thoughts of suicide and scratched her arm with broken glass. Fairfax staff apparently didn’t notify a psychiatrist or search for contraband until the next day, when they found the patient “cutting her wrist and neck with a piece of broken glass from a nail polish bottle,” according to DOH’s report.

DOH’s findings echoed serious violations that investigators had documented in the spring of 2021, when the regulator cited Fairfax for not taking steps to address or prevent teenage patients from engaging in sexual encounters and repeatedly harming themselves.

How to find help

If you are experiencing suicidal thoughts or have concerns about someone else who may be, call the National Suicide Prevention Lifeline at 800-273-TALK (8255); you will be routed to a local crisis center where professionals can talk you through a risk assessment and provide resources in your community. More info: suicidepreventionlifeline.org. Or reach out to Crisis Text Line by texting HOME to 741741 for free, 24/7 crisis counselling. More info: crisistextline.org.

Faulting Fairfax for lapses that “resulted in a serious adverse outcome” and noting the pattern of violations, DOH investigators delivered a notice of “immediate risk to patient safety” to Fairfax’s director of risk management on April 21. Two days later, DOH briefly halted admissions to the adolescent unit, using for the first time expanded enforcement powers granted to it by a 2020 law after a Seattle Times investigation into private psychiatric hospitals.

Fairfax response to DOH’s findingssaid it initiated new training and procedures, cut back the bushes in the courtyard and would no longer allow patients to be outside after dark.

DOH lifted the order stopping admissions to the adolescent unit after a few days, but warned Fairfax that “significant deficiencies remained incorrect.” Three weeks later, Fairfax said it would close the unit.

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