PEF/OMH STATEWIDE L/M MEETING
1168-70 TROY-SCHENECTADY ROAD, LATHAM, NY
JUNE 13, 2008
DRAFT MINUTES
Present:
|
PEF Patricia Baker, VP, LM Chair Lesley Williamson Bonnie Wood Carmela Triolo Kevin Conley Mike Solarchik John Lichak David R. Chudy Virginia Davey Ken Dischel Maureen Hogle Marianne Albamont Deborah J. Lee Barbara Rock Nancy Wolff Susan Mitnick Jane Schwarz Josephine Rice, Recorder |
MANAGMENT Scot Chamberlain, Chair Lisa Frazzetta Crystal Scalesci Sam Spearburg Michael r. Bigley David VanHeusen Doreen Patry Carol Owsiany Anita Daniels
|
ISSUE
1. Nursing Issues
DISCUSSION
A geographic differential was requested by Pilgrim PC last year but has not moved forward at all from the agency. A multi-agency taskforce group drafted the nurse class series. PEF asked what the status is. Management replied that Civil Service put together a group of six agencies with the goal to modernize the titles to be consistent with the field and update the job descriptions written in 1978. If you Google our system, the titles don’t necessarily represent their work. We asked for feedback from the Director of Nurses’s (DON). Comments/concerns are due to Civil Service by the end of June. PEF noticed the pre-mental health nurse titles, G19, were left out. There is no reallocation of grades. The RN supervisor, G20, is equal to NA1. Management: Civil Service wanted to do things in two steps. The second is to look at compensation. This is an extremely rough draft. Everything is up for discussion. They developed this on their own with their materials. We are all reacting at this point in time. What’s missing from the standards is they don’t address the thinking skills that nurses do. It’s very task oriented but nurses have to execute high level thinking, decisions. PEF didn’t feel the nurses possessed a lot of psychiatric experience. A Nurse Manager spends one year supervising a subordinate nurse. The Nurse 2 (N2) always supervised Nurse 1’s (N1) previously. Grade 23 qualifications include one year supervising a nurse. N2’s are filling in for NA’s. Many have experience but never officially served to meet the qualifications. Management: You don’t see psychiatric nurses because it needs to be global for other agencies. We are trying to create a structure more conducive with the outside and to create a career ladder. Civil Service is trying not to create more titles, but to compensate nurses. PEF: A Nurse 3 is very limited. Is there thinking in developing more nurse specialists beyond the Nurse 3? Management: The Nurse Supervisor level, G20, may be expanded because charge nurses aren’t compensated. Thirty hours will not be required for the supervisor. The standard sometimes does not reflect what the exam announcement will do. That’s what will allow us some flexibility. Civil Service is looking for agencies to provide feedback to fill gaps.
ACTION
PEF will submit comments by June 30.
The recently appointed DON will look at recruitment and retention. She toured 11 facilities and spoke to line nurses, N2s’, N3’s and NA’s. Some of the recommendations were providing more flexible schedules, mentoring and peer programs. We will look at why people are leaving, ie: money, overtime, education and support. Deputy Director of Operations at Rockland is also looking to improve and keep folks in the system. PEF: The Nurse Subcommittee is constantly in communication with OMH about nurse issues and welcomes opportunity to meet with you and present our issues and recommendations.
ACTION
PEF will provide information from past surveys to Management. PEF requested a meeting be scheduled with PEF representatives.
PEF felt the geographic differential should be a priority. Management has actively reviewed it since last fall. The State fiscal crisis has an impact on priorities. PEF asked what information was missing. What’s holding it up in house? We have a crisis in Pilgrim that isn’t going away. DOCS had a turnaround of three months. What can be done at the local level? Management: We appreciate your support. We will work with the facility, collecting additional data as requested by Civil Service.
ISSUE
2. Sex Offender Treatment Program (SOTP) Update
DISCUSSION
It’s the third year of the Governor’s directive for civil commitment. Manhattan has 14 of the 20 beds occupied as of June 5. St. Lawrence and Bridgeview have 80 bed capacity, 32 are between two wards. Central NY, Marcy has 150 beds in five open wards with 91 patients. Kirby unit closed their 137 beds and reverted them to CLP patients. The ultimate capacity is 250 in three locations. Recent stats show eight patients per month are entering. The Mid State annex building is to be completed by mid July and turned over to the state, when full. Staffing ratio is 2.2 to 1, with some additional staffing provided for perimeter security, transportation and food service. Mid State will add 370 patients over the next three years, once capacity is reached in the three existing facilities. National and international experts will be used to train staff. There will be strict, intensive supervision and treatment of individuals in the outpatient program statewide. The net gain has been eight per month. Very few are going out the back door. OMH is working with DOCS to develop other plans for housing. Manhattan has a viable program. Additional staff was provided with enhancements in NPS. Anything beyond the 250 beds must be requested from DOB. Plans were developed for beyond that point for increased staffing.
ISSUE
3. Standby/On-Call Pay
DISCUSSION
PEF had expressed their concerns 2-3 years ago about the delays in retroactive payments. There was an agreement that the monies will be available on a timely manner. Management said the delay was because of budget constraints placed on the agency. OMH believed it was resolved and submitted the information to DOB in March 2008. There are discussions with central office to prevent it from reoccurring next year. PEF asked what plans were put in place to correct this issue. Management said some facilities submitted late. It’s something we need to work with central office. CBO is part of the agency that sends information to facilities. We need to look at how we are notifying facilities and what kind of follow up is being done and communicated with DOB. The required reduction in spending plan was due to DOB by 5/16/08. We were charged with not affecting core programs. Areas to be cut were raised in operational groups. We tried to come up with consistent parameters but there are too many differences. The biggest areas were ACT, ICM, informational technical maintenance, and risk management. Each facility was asked to look at current practices and what they could do to more efficiently manage this. Folks had to be paid for shifts worked. They submitted plans with a start date of July 1 for reductions. We informed local unions and affected employees this was imminent. They needed to deliver the necessary coverage more efficiently by looking at the number of shifts. PEF stated that not all facilities followed directions by meeting with unions. Most were done unilaterally with no union involvement and no union representation on the local level.
People who did phone work were not given emergency pay. Management asked facilities to share the approved plan with affected employees and unions. They suggest the details be discussed at the local L/M meetings. PEF preferred to work as partners than being blindsided. It became a lot of money to these people. Management: Discussions can take place outside the meetings. Some had so many more shifts, more than one on call. Lots of calls come into the administrator on call. A lot of cut backs were made in maintenance.
PEF was concerned that people working by phone were not being told to record their time unless they physically show up. That time is supposed to get billed. Personnel did not clarify it properly. Management requested specifics. PEF suggested that rather than doing it piece meal, it would make more sense to have consistent information out there. PEF asked management to remind facilities to share the cost saving plan with local union representatives. Management just a sent memo last week saying what was previously stated.
PEF advised Management to submit their pay information to DOB in early February to avoid such delays in the future and provide a sufficient turnaround time.
ISSUE
4. Budget – Update on agency savings, targeted clinical salary enhancements
DISCUSSION
Handout
Salary enhancements were requested for Psychiatrist 2’s and 3’s. DOB recently approved $20,000 for Binghamton, Elmira, Hutchins and CDPC. The Pilgrim package is still active. CDPC nurses were denied. Management tries to anticipate questions in advance to facilitate their review process. It takes a little longer on the front end to incorporate that into the process. All requests are under review. CDPC’s request was resubmitted. Increased hiring was approved to step 4 but they denied our request for a geographic. We continue to work with each facility you listed to understand the retention and recruitment difficulties. If we knew the basis for the denial, we could address it. It would provide useful information for other facilities. DOB is not interested in geographics but working more with shift differentials. We were willing to ask for less. There is not enough money in the state to give every nurse a geographic. They couldn’t give a time frame. St. Lawrence discussed before submitting a request. They had all the data to back up their presentation. Sometimes they don’t want that.
PEF suggested inviting DOB or Civil Service to visit the facility. It was very effective with Children’s PC. They know these things are coming and need to be held accountable. Pilgrim is close to closing because they can’t retain. This needs to get out of Central Office first. Nurses were promised a year ago. They feel lied to when it’s not going anywhere. Management stated they do not use formal work plans for salary enhancements. Discussions happen from the feedback.
Management is not slowing down rehiring for vacancies. Commissioner sends in an attestation every two weeks that our hires are necessary and critical. Facilities above targets have been put in the SRTF pilot program to hire their own people. If under fill level, we can hire but have to provide paperwork. Were facilities told to reduce ceilings? Yes but it’s not slowing down. Most have gotten down. Buffalo hired 25 MHTA’s which put them up. PEF: That holds everything else hostage until we can get back into that balance. We have MHTA’s working in program wards, going in areas that should be PEF items. They have to plan for it over the next year. PEF questioned the 50% reduction in new initiatives and requested a list for implementation. Management replied that capital was not affected. Bronx Children PC is in design.
ISSUE
5. Workplace Violence Prevention (WPV)– status, ACT team issues – Handout
DISCUSSION
Final implementation has been delayed at DOL, possibly until November. NYC group raised some concerns. A memo provided guidance in the interim with recommendations as to how facilities may begin. We will work through the local LM process to prepare for implementation. Agency intent is to incorporate the WPV regulations with the STEP policies. Discussion took place with Maureen Cox at DOL and Jonathan Rosen at PEF. The multi-agency meetings will continue. NYSCOBA, CSEA and PEF raised issues.
The policy will be issued to all facilities with information. Some kind of guidance will be given if further delayed. PEF preferred the 12-hour training course over the four hour condensed course. It should be consistent rather than letting people decide what they want to teach. Management stated the guidelines allow some flexibility for implementation. We don’t control what each appointing authority does. We ask if issues were raised through local LM. We are more than willing to do conference calls to find any breakdowns. PEF: Downstate has no leverage over clients’ intent on hurting staff. Nothing happens to the patients. Prisons don’t want MH clients. Doctor orders a desk appearance, and they return within a couple hours. Policy and training should be covered more intensely.
The Creedmore incident was a result of insufficient training. Person’s life was saved by two other people. In patient is supposed to be a more controlled environment. Memos issued need to be more specific about directing people. The person could have done more to protect himself, but was concerned with OMH’s interpretation of harming the patient when his life was at risk. That thinking comes from training – protect yourself without fear that you will be punished if you live and survive the attack. With a hands-off policy, you need to give people the tools to protect themselves and the patient. Look at that message when integrating patients into the community. We haven’t transitioned the concepts into new settings.
ACTION
Management will look the issued raised for in patient in other settings, and training.
WPV prevention needs elements added to existing training. STEP training is safety for workers in the community and PMCS. You need input from staff and the union. Some have not been adhering to what they need to deliver. PMCS cannot be curtailed for the annual refresher. Safety training in the community is a half day delivery, annual refresher. Commissioner said we need to do trainings in the ways prescribed. We will go in and work with facilities if they deter. Most facilities do it correctly. They teach that everyone is responsible for developing a safety plan containing specific actions and elements. The curriculum can’t speak to every situation you may encounter. PEF: The 12 hour training needs to start as a new initiative for everyone. My facility just modified the previous course down to 5 hours.
ACTION
PEF will forward information to Lisa.
PEF: In one facility, a patient came in with a gun. That should have been a wakeup call to some things that need to take place to prevent violence. There are always problems with attendance and coverage. Make it so people can go. The Rockland trainer was unwilling to compromise the training content. Staff development in facilities disappeared. We have encouraged local reps not to wait until the LM meetings.
ACTION
PEF requested a copy of Commissioner’s memo to the facility directors. PEF suggested management attend the training unannounced.
ISSUE
6. Social Work – update on title change, responsibility for handling patient money
DISCUSSION
There are no changes yet. They continue to work on the standards and talk with Civil Service. The list has been exhausted in many locations. They are actively nominating candidates for 4.2b permanent appointments.
Bronx PC Incidence
PEF felt Social Workers should not be responsible for handling the patient’s money. There is a potential for patients to assault them if they become agitated. Management: Manhattan PC is piloting a program to go cashless. There are many hurdles, ie: privately run stores for patients with privileges. Clinically speaking, it encourages patients to become more independent, by handling cash. The Social Worker can write a cash list for the cashier’s office. PEF: It has nothing to do with treatment and places the Social Worker in a different relationship with the patient. There are weekly errors with credit cards and patients become excited and difficult.
ISSUE
7. Transformation Plan
DISCUSSION
Commissioner spoke about OMH becoming a bigger part of communities and providing care. It’s an initiative to reduce long term hospital care and return patients back into communities with support. There were talks about skills and experience that OMH employees have serving people in the hospitals and that work with them to have a life in the community. With lower stays, less than a year, people don’t wait as long to enter from Article 28 and we increase those admissions. In places with no waiting lists, we can support more out patients. Increasing the number of admissions will raise acuity level. Facilities were asked to think how each can help to further this agenda. Plans were to be submitted by the end of February for approval and monitoring. Al Holmes and Bob Myers met with field offices and members to generally talk about each region. Some have started implementing their plans. Some may be waiting for further clarification prior to being approved. PEF asked when the union would be involved because it was never raised in discussions. Management: You can ask at local LM meetings. County medical health directors are signing off on it. CDPC will be opening an acute unit because Albany Medical closed the unit. Locals are involved in discoveries but not to approve plans. In our plan for direct admissions, if someone is discharged within the last 12 months, they are linked to one of our clinics. Not every facility will be taking direct admissions. If locality doesn’t have a problem with Article 28 hospital and there’s no waiting list, it’s not necessary to be drawing from their business. It more hospitals close in the future, we will be doing more acutes. One county was told they did not need it. Creedmore has two admissions units, each having a transitional unit. It may change the type of staffing they want. Some may be cutting down on units and placing staff in outpatient. Field office had to dedicate 400 of 1000 beds to long term patients. Contracts were given based on that. If a patient leaves, they have to show the licensed beds remaining. It also includes supported housing.
ISSUE
8. MHARS update
DISCUSSION
OMH is deciding whether the system should be revised or scrapped.
ACTION
PEF will review the handout and contact Scott Derby with any questions. PEF requested he attend the next meeting.
ISSUE
9. Hiring of retirees – follow up on policies
DISCUSSION
Policy was given to PEF. It seemed to PEF that retirees kept getting extensions for temporary status. How are retirees tracked if given a part time job to transition in new people? Management: Facilities are responsible for tracking. Those under age 65 need to track so as not to impact their pension. It’s problematic for someone to train the first five months of the year and you have no one at end of year. It’s a workload issue. PEF is retirees at 20 hours a week, 12 months per year for 3 years. It gives no opportunities for someone else to move up the ladder, impacting on someone else’s retirement. N2’s were hired but placed not on wards. Central Office, DOB and Civil Service it’s of the opinion that if using permanent items for long term employees, it’s a problem. PEF: It’s not always based on need but relationships. Some have met their fill level by rehiring retirees. Management: We are setting up temp items to work on an interim process, and eliminate items when they leave. Each facility makes their own appointments. We cannot dictate to facilities what to do. PEF: You are only asking them to adhere to an existing policy. Every representative at this table can provide at least one case. You are creating a new workforce, not based on your policy. The retirees don’t work a ward and don’t have to do overtime. They go to committee meetings and review work. Facilities said they have nothing to do with us. They are not in our numbers because they are being paid from central office. It’s a matter of morale and respect. People are exhausted in critical care. Discussions fall on deaf ears. Local LM throws it back to central office. Management some retirees hired prior to the 2006 policy memo have permanent rights to that job. It’s appropriate for people to job share. We do not support or encourage facilities to hire retirees in permanent items. We cannot address individual things. It needs to be done case by case. PEF: If person has 30 years seniority, you have rights to a permanent position even though retired. Management: We need to know what’s happened locally. PEF: Those returning are not usually rank and file but deputy directors, supervisors, in positions that are not posted. Return items are secured before they even walk out the door.
OMH Licensing program
Commissioner is asking authority to approve regulations. PEF: There has always been an oversight committee for private mental health programs. Commissioner wants this authority and to wave regulations. How does this affect the patients and programs and services they receive? Non state operated private programs. PEF was concerned with whether OMH intends to maintain the same level of scrutiny or accountability for licensing them.
Dieticians were approved for an upgrade but it’s still in DOB. Can someone contact them and give us indication? Management: It’s not our initiative. It was submitted by employees as a multi agency effort.
ACTION
Management will follow up and provide an update to the PEF LM Co-Chair.