A collision of pandemic related depression and an exhaustion-fueled shortage of mental health workers proved to be the catalyst for a determination of failure to adequately supervise suicidal patients at a Pottsville hospital.

The state Department of Health, in an unannounced onsite complaint investigation on Feb. 2 and 3, 2022, found that Lehigh Valley Hospital–Schuylkill’s behavioral health unit did not comply with federal rules or established procedures.

They included a suicidal patient who attempted self-harm while in the emergency department, and another who was allowed to go into the bathroom alone, despite policies that required they not be left alone.

A staff member assigned to them had to watch two suicidal patients at the same time.

The hospital “failed to ensure suicide precautions were ordered and initiated and (one on one) visual observation was provided for (patient 1) foIlowing an attempt at self-harm while in the emergency department, a DOH report said.

“The facility further failed to ensure observation of seven of 19 patients with a mental health diagnosis was per facility policy and failed to ensure suicide precautions were ordered and initiated per facility policy for two of the 19 patients reviewed.”

The issues were immediately corrected, according to the DOH.

“Hospitals and health care systems around the state have seen a significant increase in behavioral health patients at a time when there’s a national staffing shortage,” said hospital spokesman Michael Peckman said in an emailed response.

“At Lehigh Valley Hospital–Schuylkill, and throughout our health network, we take these matters very seriously and our commitment to patient safety is demonstrated by our self-reporting and immediate response to remedy this situation and prevent future occurrences, which included re-education of our staff, as outlined in the Department of Health report. Our plan of correction was accepted by the DOH and we are in full compliance,” he said.

The hospital’s correction included immediate assignment of an observation attendant to each patient identified at risk for self-harm, and requiring visual observation and record reviews of all behavioral health patients currently in the emergency department to ensure suicide precautions were ordered and initiated, the DOH report said.

“Staff and providers who were currently working in the emergency department would receive immediate education regarding the requirements for the initiation of suicide precautions and one-on-one monitoring of patients requiring visual observation,” it said.

The corrections also including sharing of that information with all staff and providers before the start of their next shift, and a review by the department director or designee prior to each shift to make sure orders for suicide precautions and visual monitoring are being followed and that someone watches to make sure one-on-one monitoring is being done.

Among the rules established since the violations:

• Observation attendant always maintains direct visual observation of the patient.

• Observation attendant assigned to monitor only one patient.

• The patient requiring arm’s length observation will never be left alone and will always maintain an arm’s length distance to the patient, including bathing and toileting.

• Patients at risk for suicide have documentation of a provider order in the record for suicide precautions.

• Audits will continue three times daily for four weeks and then randomly each week for three months.

According to the Centers for Disease Control and Prevention, anxiety and depression in U.S. adults rose about four times higher between April 2020 and August 2021 than in 2019.

At the same time, employment in health care is down by 250,000, or 1.5 percent, since February 2020, according to the Bureau of Labor Statistics.