Tampa General Hospital was stunningly derelict in its care of two patients admitted to the hospital's psychiatric unit who killed themselves only days apart. In a report released Thursday by federal regulators, the indifference of staff and administrators jumps off the page. TGH president and CEO Ron Hytoff said the findings left him "saddened, embarrassed and concerned" — and he should be. The picture painted by regulators looks more like a warehousing operation than a modern and responsive facility for treating suicidal patients.
Investigators found that staff did little to improve safety after a 44-year-old woman hanged herself with a bedsheet over a closet door July 21. After her death, staff was told to increase observation of patients in the unit, the inquiry said, but regulators found there was no change in policy and no plan for how any increased supervision would take place.
The day after the first suicide, a 28-year-old patient asked to change rooms. Staff moved him to the dead woman's room, where he hanged himself on the bathroom door July 23. Records show it took the staff 33 minutes from the time he was found for them to start trying to resuscitate him. But poor record-keeping kept regulators from determining whether the patient was seen on a regular basis and promptly given life-saving aid.
The most damning findings go beyond the two deaths, depicting the psychiatric unit as understaffed and lacking a sense of urgency. According to regulators, five patients requiring constant supervision were kept together in the hallway to sleep so a single staffer could monitor them. After the two suicides, the hospital held a training session, but only 17 of the unit's 137 staff members reportedly attended. TGH officials also stonewalled the regulators' request for investigative records about the incidents.
Hytoff set the right tone in his response, delivering an open letter to the community in which he offered no excuses and vowed to take "whatever steps" necessary to make the hospital's psychiatric unit safer and more responsive. He needs to retain that candor as Tampa General works to meet a Sept. 6 deadline to address the problem or face the loss of federal funding.