Behavioral Health Services and Arizona State Hospital annual report

              HES 9.1: 1988/89 ./
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ARIZONA STATE HOSPITAL
ANNUALREPORT
FISCAL YEAR 1988 - 1989
ROSE MOFFORD, GOVERNOR
STATE OF ARIZONA
TED WILLIAMS, DIRECTOR
ARIZONA DEPARTMENT OF HEALTII SERVICES
BOYD DOVER, ASSISTANT DIRECTOR
DMSION OF BEHAVIORAL HEALTII SERVICES
GLENN LIPPMAN, M.D., SUPERINTENDENT/CHIEF MEDICAL OFFICER
ARIZONA STATE HOSPITAL
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Pursuant to Title VI of the Civil Rights Act of
1964, Section 504 of the Rehabilitation Act of
1973 and the Age Discrimination Act of 1975,
Arizona Department of Health Services does not
discriminate on the basis of race, color, national
origin, handicap or age. For further information
or to file a complaint contact:
The Department of Health Services
Office of Affirmative Action
1740 West Adams
Phoenix, AZ 85007
(602) 542-1030
T.T.D. (602) 256-7577
An Equal Employment Opportunity Agency
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ARIZONA STATE HOSPITAL
ANNUAL REPORT
FISCAL YEAR 1988 - 1989
TABLE OFCONTENTS
IN1R.ODUCI10N ........................................................................................................................................ 1
Organiza.tional Structure ............................................................................................................................... 2
Cli.nical Services .... · .......................................................................................................................... 2
The General Adult Program (GAP) .............................................................................. 2
The Psychosocial Rehabilitation Program (PSR) ........................................................ 3
The Extended Care Program (ECP) .............................................................................. 3
The Geropsychiatry Program (GPP) ............................................................................. 3
The Behavior Management Program (BMP) ............................................................... 4
The Youth Services Program (YSP) .............................................................................. 4
Hospital Administration ................................................................................................................ 5
Hospital Information, Planning, Evaluation and Research ...................................................... 5
MAJOR CUNICAL ACCOMPUSHMENl'S .......................................................................................... 6
MAJOR ADMINIS1RATIVE ACCOMPUSHMENl'S ......................................................................... 6
MAJOR PERSONNEL ACCOMPUSHMENl'S ..................................................................................... 7
PATIENT DEMOGRAPHICS AND STATISTICAL SUMMATION ................................................. 9
Admission Statistics...................................................................................................................... 9
Discharge Statistics ....................................................................................................................... 10
CONCLUSION ..................................................................................... !' ••••••••••••••••••••••••••••••••••••••••••••••••••••••• 11
EXHIBITS, GRAPHS, AND TABLES
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Exhibit 1 ASH Financial Summary FY 1988-89 ........................................................... 12
Exhibit 2 ASH Total Full Time Equivalents (FfE) .................................................... 14
Graph 1 Inpatient Monthly Census July 1985 - June 1989 ........................................ 15
Graph 2 A Comparison of Admission and Discharge Rates FY 1988-89 ............... 16
Graph 3 ASH Legal Status at Admission FY 1988-89 ............................................... 17
( Table 1 ASH Admissions by Ethnicity ........................................................................ 17
Table 2 ASH Admissions by Age ................................................................................. 18
Table 3 ASH Admissions by Gender .......................................................................... 18
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Table 4 ASH Total Number and Percentage of Admission by County .................. 19
Table 5 ASH Admission Rates per 100,000 Population by County ........................ 20
Table 6 ASH Admission Type by County ................................................................... 21
Table 7 ASH Number and Percent of Admissions by Diagnostic Grouping ......... 22
Table 8 ASH Length of Stay for Discharges .............................................................. 23
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Table 9 ASH Discharge Type by County .................................................................... 24
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ARIZONA STATE HOSPITAL
ANNUAL REPORT
FISCAL YEAR 1988-1989
INTRODUCTION
The Arizona State Hospital is a publicly funded facility dedicated to the restoration and preser­vation
of emotional health for the residents of the State of Arizona. The Hospital strives to provide
contemporary and quality inpatient mental and physical health care. Further, the Hospital's ad­ministration
is committed to the concept that all patients and staff members must be treated with
the dignity and respect required to maximize personal and professional growth.
The Arizona State Hospital provides psychiatric inpatient hospitalization and treatment for any
person who meets the admission criteria and is presently living in the State of Arizona. The Hospi­tal
completes an individualized evaluation and develops a treatment plan designed to meet the
patient's personal needs. While providing evaluation and treatment, the Hospital is continually
cognizant of the rights and privileges of each patient, particularly the patient's right to confiden­tiality
and privacy.
A patient's treatment is directed by a multi-disciplinary team which includes Hospital staff, the
patient, the patient's family, and the appropriate community mental health system representatives.
This team is responsible for the development of a comprehensive, individualized treatment plan
that addresses the biological, psychological, spiritual and socioeconomic needs of the patient. A
psychiatrist, who provides clinical leadership for the team, has the ultimate authority for the
patient's care and is also responsible for the development and strengthening of the interdiscipli­nary
relationships within the team itself.
Throughout a patient's treatment, the Hospital advocates placing the patient in the least restric­tive
therapeutic treatment environment. In advocating this goal, patient placement within the
Hospital is made after assessment and consideration of all treatment factors to assure the
chosen placement will provide maximum therapeutic benefit. Additionally, the Hospital recog­nizes
its responsibility to provide patients required sanctuary and to safeguard the community.
In order to provide quality care for the patients, the Hospital's staff actively participates in the
statewide continuum of mental health care and assists the community treatment agencies when
developing treatment and discharge plans with the patients.
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Organizational Structure
The Arizona State Hospital is structurally organized into three major components:
Clinical Services
Hospital Administration
Hospital Information, Planning, Evaluation and Research
Clinical Services:
Clinical Services, under the direction of the Chief Medical Officer, includes the following:
Department of Psychiatry
Department of Medicine
Nursing Services
( Psychology Services
Social Work Services
Rehabilitative Therapy Services
( Patients are placed on a treatment unit based on their treatment needs, level of functioning,
chronicity of illness and age. Each clinical service is provided to the patients through treatment
units which are grouped into treatment programs as follows:
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The General Adult Pro~am (GAP)
Units: Kachina 1, Kachina 2, Juniper 5
The General Adult Program serves as the primary reception and admission area for adult
patients and is designed to provide diagnostic and assessment services as well as short­term
treatment services (90 days or less). Patients are anticipated to have a shorter
hospitalization and may have less institutional experience, more characterologic distur­bances
and higher incidents of drug abuse or legal involvement.
Major treatment modalities include psychotropic medication, group or individual
psychotherapy focusing on acceptance of treatment and specific discharge plans and
goals, vocational rehabilitation, chemical dependency intervention, intensive prepara­tion
for community reintegration and aftercare, leisure and recreational activities, physi­cal
care, and reality focusing.
While Kachina 1 is primarily a secure treatment unit with limited off-unit privileges
granted, Kachina 2 is a "semi-open" unit with many patients having full grounds privileges
and Juniper 5 is an open unit utilizing an active therapeutic community approach to care.
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The Psychosocial Rehabilitation Program (PSR)
Units: Juniper 6, Juniper 10, Transitional Living Unit
The Psychosocial Rehabilitation Program serves as the primary treatment program for
patients with chronic, less refractory mental disorders. Most patients in this program
will require a moderate period of hospitalization ( 90 to 365 days). Patients tend to have
more hospitalizations and require more structured aftercare.
Major treatment modalities include psychotropic medications, psychotherapy to
. develop insight into reasons for admission, occupational therapy, recreational therapy
and chemical dependency interventions.
Juniper 10 serves as the secure treatment unit for the PSR Program, Juniper 6 as a "semi­open"
unit, and the Transitional Living Unit as the open unit. The Transitional Living
Unit, funded by special appropriations, is specifically designed to assist patients in
making the transition from the Hospital to the community environment.
The Extended Care Program (ECP)
Units: Juniper 2, Juniper 4, Juniper 8
The Extended Care Program serves as the primary treatment program for patients who
require an extended period of hospitalization (over 365 days). The Developmentally
Disabled/Mentally Ill Day Treatment Program, developed jointly between ADHS and
ADES, is an extension of this program. Treatment emphasis is placed on the activities
of daily life skills ( e.g. hygiene, dressing, eating) since many patients suffer from coexis­tent
organic mental disturbances.
Treatment modalities include medications, reality orientation group, current events
group, structured unit activities leisure planning and recreational therapy.
Each of these treatment units is designed to provide a safe and secure environment for
the patients; therefore, access to off-unit activities is limited, based on the individual
patient's functioning level.
The Geropsychiatcy Program (GPP)
Units: Juniper 3, Juniper 7, Juniper 9, Granada
The Geropsychiatry Program serves as the primary treatment program for older adult
patients ( over 55 years of age) with special needs due to severely disabling mental and
physical disorders. Many of these patients require an indefinite period of hospitaliza­tion.
Families are involved in placement planning and receive assistance with bereave­ment,
loss acceptance· and coping skills.
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Primary treatment modalities include supportive care, psychotropic medication, self­care
skills, reminiscence groups, community orientation, current events and unit com­munity
meetings. Specialized groups in music and art therapy, gardening, cooking and
nutrition, and reality orientation are also provided. Medical care is also a vital treat­ment
modality for this population.
Juniper 3 is an open unit designed to meet the needs of higher functioning, older adults.
The remaining treatment units provide a safe, secure environment for the patients with
limited off-unit access due to the severely disabling mental disorders of the patients.
The Behavior Management ProiJ'am (BMP)
Units: Cholla, Juniper 1
The Behavior Management Program serves as the primary treatment .program for
patients with recent histories of dangerous behavior, patients believed to be dangerous,
patients with a high escape risk, and patients with legal requirements on placement
( determination of competency to stand trial or commitment for treatment after being
found not guilty by reason of insanity). Most patients require a moderate to extended
period of hospitalization (over 90 days).
Treatment modalities include psychotropic medications, psychotherapy focusing on par­ticipation
with treatment, specific discharge planning, interpersonal skills training, per­sonal
care and rehabilitation. Intensive liaison for community reintegration and after­care
treatment, leisure and recreational activities, reality focusing and modification of
pathologic behaviors are also important components of care.
Both Cholla and Juniper 1 provide a secure environment for the patient and limited off­unit
privileges are granted on an individual basis.
The Youth Services Proil'am (YSP)
Units: Adolescent Treatment Unit (ATU), Child Treatment Unit (CTU)
The Youth Services Program serves as the admission, assessment and treatment program
for children and adolescents ( ages 6 through 17 years of age) requiring intermediate
term care (90- 180 days) as a result of a substantial mental disorder.
Major treatment modalities include individual, group and family therapy, academic
rehabilitation, occupational, recreational, and speech/hearing therapy, and psychotropic
medication, as appropriate. Aftercare planning for the patient and family is an essen­tial
component of treatment. Active liaison between staff and community also exists to
assist families and outpatient caregivers in placement of treatment referrals.
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Both treatment units provide a safe, secure environment for the patients. Patients are
given off-unit privileges based on their behavioral functioning level and ability to accept
personal responsibility.
Hospital Administration:
Hospital Administration, under the direction of the Administrator, includes the following:
Fiscal Services
Religious Services
Medical Records
Laboratory Services
Pharmacy Services
Radiology Services
Dental Services
Hospital Personnel Services
Engineering Services
Dietetic Services
Housekeeping Services
Laundry Services
Security Services
Hospital Administration is responsible for the operation of the Hospital through distribution and
monitoring the allocated budget, ensuring adequate numbers of staff, ensuring a safe and
therapeutic environment, maintaining the patients' medical records, providing administrative/su­pervisory
functions for selected clinical services, and providing "day-to-day" needs of the patients,
e.g. dietary, laundry and housekeeping needs.
Hospital Information, Planning, Evaluation and Research:
Hospital Information, Planning, Evaluation and Research includes the following:
Clinical Quality Assurance
Staff Training and Education
Public Information Office
Hospital Information System
Program Evaluation
Patient Education Services
Volunteer Services
Hospital Policies and Procedures
Hospital Information, Planning, Evaluation and Research is responsible for evaluating the quality
of clinical care provided by the Medical Staff, evaluating the quality of services provided by the
various program areas, training and education provided Hospital staff, providing educational ser­vices
for patients (primarily children and adolescents), computerizing Hospital data, developing
Hospital policies and procedures, providing general Hospital information and coordinating the
services of volunteers at the Hospital.
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MAJOR CLINICAL ACCOMPLISHMENTS
Throughout FY 88-89 clinical services for the patients were expanded and improved. New ser­vices
for the patients included:
An Occupational Therapy Independent Living Skills Program for Spanish speaking
patients;
An Occupational Therapy Work Program;
A Human Sexuality Program;
Psychiatric evaluations for bilingual/bicultural Hispanic patients; and
Psychological services for Spanish speaking patients, including a Spanish version of the
Concise N europsychological Scale.
Through the joint efforts of the Hospital, the Office of Community Behavioral Health, and the
Division of Behavioral Health Services; ADHS, re-entry facilities were established making it pos­sible
for the Hospital to transition many of the longer-term, chronic patients to community living.
By the end of FY 88-89 there were 47 re-entry facility beds available and utilized for placement
of Hospital patients.
Surveying regulatory agencies also noted an improvement in the quality of care provided the
patients. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) com­pleted
a focused-survey in September 1988 which resulted in each of the remaining deficiencies
being removed. After re-application for participation in the Medicare Program in February 1989,
the Health Care Financing Administration (HCF A) completed the initial survey and found the
Hospital to be in compliance with the two required conditions - staffing patterns and medical
records. A follow-up survey conducted by HCF A in March 1989 found that the Hospital had con­tinued
to remain in compliance with the two conditions of participation. The Hospital was able
to submit billings to the Medicare provider as of March 26, 1989. This will result in reimburse­ment
of approximately $2 million to the State's general fund.
MAJOR ADMINISTRATIVE ACCOMPLISHMENTS
Fiscal Year 1988-89 proved to be an exciting year for administrative accomplishments, highlighted
by the initiation of a Master Plan for Hospital re-construction. Although not totally completed in
this fiscal year, the majority of the research and planning meetings were completed with Ander­son
DeBartello Pan, Inc., a major architecture and engineering firm. Fina1ization of the Master
Plan for Hospital re-construction will occur early in FY 1989-90.
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Another major accomplishment was the initiation and completion of major roadway re-surfacing
scheduled during this fiscal year. The completion of this project was a significant enhancement
to the safety and welfare for the Hospital patients and staff.
Throughout FY 88-89 administrative services were continually challenged to repair the continu­ing
deterioration of patient housing units, treatment areas, laundry facilities, cooling and heating
systems, and the main dietary preparation facilities. The Hospital was required to implement the
Internal Disaster Plan on two occasions - one related to a major water line break and one related
to a natural gas line leak. Each occurrence was handled without major incident or treatment dis­ruption
for the patients.
Additionally, Medical Records Services increased automation of transcription services to meet
increased requests for such services. Dietetic Services completed some necessary service equip­ment
replacement projects and underwent an organizational modification of c1.dministrative per­sonnel.
Engineering Services renovated the Hospital Chapel, implemented asbestos control
projects, and began a Hospital-wide building painting program.
The Hospital's Financial Summary (Exhibit 1) reveals a total funding of $31,352,690 and a total
cost of operations of $30,862,218. The Hospital's collections, which are deposited to the State's
General Fund, amounted to $2,362,316. The daily cost per patient by treatment program ranged
from $121/day (Geropsychiatry Program) to $403/day (Childrens' Treatment Unit, Youth Ser­vices
Program). The average cost per patient per day was $157.
MAJOR PERSONNEL ACCOMPLISHMENTS
Personnel accomplishments were highlighted by the Hospital's ability to successfully recruit and
maintain sufficient clinical staff to meet the psychiatric and therapeutic requirements of the
patients. These efforts were recognized by the Medicare program, Health Care Financing Ad­ministration
(HCFA), which re-certified the Hospital indicating that although the Hospital was
minimally staffed, the patients were receiving adequate mental health and medical care. To more
adequately meet the nursing needs of the patients, the Hospital developed an in-house nursing
pool composed of twenty-five Registered Nurses, ten Licensed Practical Nurses, and twenty-five
Psychiatric Technicians.
Many of the psychiatric physician staff members began the process of becoming Board Certified
which is an indication of the Medical Staff's dedication to providing quality psychiatric services to
the patients at the Hospital. Hospital Training and Education Services provided staff training re­lated
to non-aggressive management of the violent patient, self-defense, and asbestos training.
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In an effort to improve internal communications and more quickly answer questions staff might
· have, Hospital Administration implemented the "Superintendent's Notes" and the "Lippline
Response" which are extensively distributed twice monthly. The Superintendent's weekly "Open-
< Door" hour has continued throughout this fiscal year and has provided employees the opportunity
to discuss issues of concern directly with the Superintendent.
The Hospital was staffed by a total of 932.25 full time equivalent (FTE) positions. Direct patient
care staff accounted for 691. 75 or 74.2% of the allocated positions and support staff accounted for
( 24050 or 25.8% of the allocated positions (see Exhibit 2). Additionally, the Hospital individual­ly
contracts with psychiatric physicians, medical physicians, and consultants. These contracted
positions are not included in the total allocated positions.
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PATIENT DEMOGRAPHICS
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STATISTICAL SUMMATION
< FISCAL YEAR 1988-89
The Arizona State Hospital began this fiscal year on July 1, 1988 with a patient census of 501.
( · Throughout the fiscal year, the Hospital admitted 760 patients, discharged 753 patients, and ended
the fiscal year June 30, 1989 with a census of 508, a net increase of 7 patients. The average daily
census for the fiscal year was 502. A total of 1,121 individual patients (unduplicated count) ac­counted
for a total of 183,473 patient days. The inpatient end of month census is depicted in Graph
1, covering July 1985 through June 1989. A comparison of admissions and discharges by month
< for FY 88-89 is provided in Graph 2.
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Admission Statistics:
Of the 760 patients admitted this fiscal year, 81 % were admitted by court order; the remaining
19% were admitted on a voluntary status (Graph 3). The ethnicity distribution of the admissions
were 75% Caucasians, 13% Hispanic, 9% Black, 2% American Indian, and 1% Other (fable 1).
Individuals admitted to the Hospital were primarily between the ages of 19 - 64 (83% ). Children
under the age of 19 accounted for 11 % and adults over 65 years of age accounted for 6% (fable
2). Analysis of admissions by gender indicated 449 (59%) were male and 311 ( 41 % ) were female
(fable 3). Each of these percentages remained virtually unchanged when compared to the pre­vious
fiscal year (1987-88).
It is particularly important to note the Hospital's recidivism rate which is the readmission of a
patient who was discharged from the Hospital within 180 days prior to readmission. The
recidivism rate for FY 88-89 was 21.2% compared to 19.3% in FY 87-88*. The recidivism rate
for FY 88-89 (21.2%) includes the readmission of approximately sixteen (16) longer term, chronic
patients discharged to re-entry facilities. Longer term, chronic patients discharged to re-entry
facilities are more likely to have a higher re-hospitalization rate due to their lengthly dependency
on the Hospital; therefore, there has been a slight increase in the annual recidivism rate. The
recidivism rate of approximately 20% continues to be favorable when compared to reports from
other state mental health facilities.
• The recidivism rates presented are determined by dividing all of the fiscal year readmiwons with lengths of stay
out of the Hospital less than 180 days by the total admissions for the fiscal year. This new formula provides more
accurate and useful data. The previously reported recidivism rate for FY 87-88 (11.1 % ) was determined by divid­ing
the latest six ( 6) months readmissions with lengths of stay out of the Hospital less than 180 days by the total ad­missions
for the latest twelve (12) months.
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Maricopa County continued the historic trend of the highest number of admissions - 523 ( 68.8% ).
Pima County accounted for 98 (12.9%) of the admissions. It is also important to note that not all
patient admissions through a county are actually a resident of the admitting county but may be, in
fact, a resident of a neighboring county (Table 4). When comparing admission rates per 100,000
population, it was noted Graham County had an admission rate of 60.5, Yavapai County had 27.6,
Yuma County had 27.4, and Maricopa County had 25.3 (Table 5). The State's average was 21.1
admissions/100,000. ·
Individuals admitted to the Hospital for the first time accounted for 45.8% of all admissions.
Readmissions accounted for 43.01 %, readmissions from conditional discharge for 2.77%, and
readmission from combined inpatient/outpatient treatment for 8.42% (Table 6).
The diagnostic groupings (reason for admission) were essentially unchanged when compared to
the previous fiscal year. Schizophrenic disorders accounted for 39.61 % of all admissions while af­fective
disorders accounted for 37.10% The reason for the increase in disturbance of conduct
diagnosis, from 9 (1.29%) in FY 87-88 to 21 (2.76%) in FY 88-89, is a consequence of additional
children being treated at the Hospital (Table 7).
Discharge Statistics:
The Hospital discharged 753 patients during FY 88-89. The median length of stay (WS) was 99
days (unchanged from FY 87-88), while the mean was 307 days (up 84 days from FY 87-88). The
incre~e in the mean is attributed to the Hospital's ability to discharge an increased number of
patients who had been hospitalized for more than five (5) years (22 discharges in FY 88-89 com­pared
to 12 discharges in FY 87-88). The increase of discharges for patients with lengths of stay
greater than five (5) years is attributed to the availability of 47 re-entry facility beds. Approximate­ly
one-third of the patients discharged who had lengths of stay greater than five (5) years were dis­charged
to re-entry facilities.
Additional highlights in Table 8 include patients discharged after a hospitalization of 31-60 days
accounted for 113 discharges (15%), those hospitalized 61-90 days accounted for 147 discharges
(19%), and those hospitalized 91-180 days accounted for 242 discharges (32%). These percent­ages
have remained fairly stable when compared to previous fiscal years.
Patients discharged from voluntary status accounted for 29.7% of the total discharges. Patients
discharged to outpatient treatment accounted for 20.9% and those discharged under conditional
status accounted for 12.6% (Table 9).
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CONCLUSION
The Hospital, in its continuing efforts to serve the mentally ill residents of the State of Arizona,
has established various milestones during Fiscal Year 1989-1990. These include, but are not
limited to:
1. Providing contemporary psychiatric inpatient hospitalization and treatment for any
person who meets the Hospital's admission criteria and is presently living in the State
of Arizona;
2. Establishing a methodology for providing adequate staff-to-patient ratios to meet the
changing needs of the Hospital's inpatients;
3. Maintaining participation in the Medicare Program, Health Care Financing
Administration (HCF A);
4. Maintaining accreditation by the Joint Commission on Accreditation of Healthcare
Organizations;
5. Participating in the development of an enhanced statewide mental health program;
6. Finalizing the Hospital's Master Plan for reconstruction and presenting the plan to the
Division of Behavioral Health Services, the Arizona Department of Health Services,
and the State Legislature;
· 7. Planning, developing, and implementing community relations projects that will enhance
the image of the Hospital;
8. Encouraging and supporting a high degree of competency, professionalism and continuing
education for the Hospital's staff;
9. Addressing staff issues related to recruitment, morale, absenteeism and turnover; and
10. Re-establishing associations with the University of Arizona, College of Medicine,
enhancing the Hospital's research activities, and increasing the public sector resident
physician's exposure.
Attaining each of these major milestones will measure the Hospital's commitment and successful
completion of FY 1989-1990. The Hospital's administration is dedicated to attaining these mile­stones,
but it is only through the support of the Hospital's staff, the Division of Behavioral Health
Services, the Arizona Department of Health Services, the mental health advocacy groups, the
State Legislature, and the citizens of the State of Arizona that these milestones will be reached
and the mentally ill residents of the State of Arizona served.
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EXHIBIT 1
ARIZONA STATE HOSPITAL
FINANCIAL SUMMARY
FISCAL YEAR 1988 - 1989
Funding Sources (General Operations):
State General Fund Allocations (net)
including the Transitional Living Unit
Personnel Services and Related Benefits
Operating Expenses
Rental Income
Endowment Earnings
Patient Benefit Fund
Donations
Total Funding
Expenditures:
*
Personnel Services and Related Benefits
Professional and Outside Services
Travel (In-State)
Travel (Out~of-State)
Food
Other Operating
Capital Equipment
Assistance to Others
Total Cost of Operations
Collections (Deposited to the General Fund):
Medicare
Family, Guardian, or Patient
Insurance
Counties - Rule 11
Social Security, VA, or Railroad Retirement
Military Service Connected Neuropsychiatric
Total Collections
$23,671,678
6,505,333
602,396
433,483
135,700
4,100
$31,352,690
$23,634,729
2,961,473
40,189
4,759
709,670
3,163,524
328,795
19,079
$30,862,218
$ 674,624
869,486
209,262
296,904
293,424
18,616
$2,362,316
* Contract Physicians, Nursing Registries, and Outside Hospitalization Costs
( continued)
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EXHIBIT 1 (cont.)
ARIZONA STATE HOSPITAL
FINANCIAL SUMMARY
FISCAL YEAR 1988-1989
Daily Costs by Treatment Program:
General Adult Program
Behavior Management Program
Psychosocial Rehabilitation Program
Transitional Living Program
Extended Care Program
Geropsychiatry Program
Youth Services Program
Adolescent Treatment
Childrens' Treatment
Average
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$179
203
134
212
131
121
291
403
$157
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EXHIBIT 2
ARIZONA STATE HOSPITAL
TOTAL FULL TIME EQUIVALENTS (Fl'E)*
JUNE 30, 1989
DIRECT SERVICES STAFF SUPPORT STAFF
Psych Nurse Trtmt. Mgr. 15.0 Superintendent 1.0
Psych Nurse 80.0 Adm. Svs. Off. ill 1.0
Psych Nurse Director 1.0 Physical Plant Dir. 1.0
Psych Nurse Asst. Director 2.0 Finance 4.0
Psych Treatment Unit Coord. 9.0 Clerical 24.0
PsychLPNil 26.0 Adm.in. Assistant 14.0
Therapist 27.0 Clerk (Diet) 3.0
Teacher 7.0 Hskpg. Attendant 43.0
Psychologist 12.0 Bldg. Maint. Supv. 4.0
Psychology Intern 2.0 Maintenance 26.0
Social Worker 30.5 Groundskeeper 6.0
Psychiatric Technician 353.5 laundry Worker 10.0
Medical Records 35.0 Training Officer 4.0
Psych Nurse Instructor 2.0 laborer 1.0
Librarian 2.0 Custodial Supv. 5.0
Dentist 2.0 Food Service Dir. 1.0
Pharmacy 8.0 Dietitian 2.0
laboratory 6.5 Food Supervisor 6.0
Radiology 1.0 Cook 8.0
Behav. Health Tront Unit Mgr. 1.0 Food Svs. Worker 27.5
Beautician 1.0 Driver 8.0
Lifeguard .25 Security Officer 20.0
Chaplain 2.5 Sewing Supervisor 2.0
Barber 1.0 Quality Assur. Mgr. 1.0
Psych Nurse Shift Supervisor 33.0 Pts' Rights Rep. 1.0
Therapy Technician 23.0 Res/Stat. Analyst 2.0
Psych Nurse Coordinator 4.5 Vol.Svs.Coord. 1.0
Public Health Nurse 1.0 Adm.in. Svc. Off.IT 2.0
Audiometrist 1.0 Qual. Assur. Analyst 2.0
· Psych Nurse Clinical Mgr. 1.0 Prog/Proj. Spec. Il 3.0
Dental Assistant 1.0 Exec. Staff Asst. 1.0
Clinical Director 1.0
Switchboard Oper. 4.0
Investigator 1.0
SUBTOTALS 691.75 240.50
TOTAL 932.25
•To ere were approximately 15 psychiatric physicians and 6 medical physicians on staff with the
Arizona State Hospital during this period. These positions are not included in the FfE total.
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GRAPH 1
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INPATIENT CENSUS
( JULY 1985 THROUGH JUNE 1989
560
( 540 CENSUS
520
500
( 480
460
(
440
420
400
* * * * ( FY 1985-86 FY 1986-87 FY 1987-88 FY 1988-89
MONTHS
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END OF MONTH CENSUS
MONTH FY 1985-86 FY 1986-87 FY 1987-88 FY 1988-89
July 471 496 551 524
( August 462 528 544 502
September 466 537 542 494
October 475 547 520 505
November 488 536 510 . 491
December 505 538 520 487
January 502 545 526 494
February 514 544 525 515
March 515 542 508 511
{ ~rll 519 546 510 500
ay 499 550 511 507
June 492 544 501 508
15
(.
(
(
(
(
(
(
(
(
(_
GRAPH 2
A COMPARISON OF ADMISSION
AND
DISCHARGE RATES
FY 1988-89
100,---------------------,
801---
40
20
0
JUL SEP N
AUG OCT
MONTH
MONTH ADMISSIONS DISCHARGES
July 70 47
August 62 84
September 60 68
October 70 58
November 53 68
December 56 60
January 60 53
February 68 47
March 58 62
April 63 74
May 72 65
June 68 67
TOTAL 760 753
16
~
ADMISSIONS - DISCHARGES
(
(
(
(
(
(
(
(
(
(
l
GRAPH 3
ARIZONA STATE HOSPITAL
LEGAL STATUS AT ADMISSION
FY 1988-89
VOWNTARY (19%)
INVOLUNTARY (81%)
TABLE 1
ARIZONA STATE HOSPITAL
ADMISSION BY ETHNICITY
EY 1988-89 EY 1987-88 FY 198§-S7
ENTHNICITY NUMBER ~ NUMBER '2 NUMBER ~
White 566 75 505 72 528 73
Hispanic 102 13 102 15 118 16
American Indian 12 2 14 2 14 2
Black 69 9 66 9 57 8
Other 11 1 11 2 3 1
TOTALS 760 698 720
17
(
TABLE 2
( ARIZONA STATE HOSPITAL
ADMISSIONS BY AGE
( FY 1988-89 FY1987-88 FY1986-87
AGE NUMBER ~ NUMBER ~ NUMBER ~
Under 12 years 23 3 29 4 0 0
(
13- 18 years 64 8 70 10 81 11
19-29 years 228 30 196 28 209 29 .
30-39 years 208 27 180 26 200 28
40-64 years 194 26 185 27 194 27
(
65 + years 43 6 38 5 36 5
TOTALS 760 698 720
(
TABLE3
(
ARIZONA STATE HOSPITAL
ADMISSION BY GENDER
( FY 1988-89 FY 1987-88 FY1986-87
GENDER NUMBER ~ NUMBER ~ NUMBER ~
Male 449 59 399 57 428 59
( Female 311 41 299 43 292 41
TOTALS 760 698 720
(
18
TABLE 4
(
ARIZONA STATE HOSPITAL
TOTAL NUMBER AND PERCENTAGE OF ADMISSION BY COUNTY*
(
~OUNTYOF FY 1988-89 Eil98Z-88 EY 198§-87
ADMISSIO~
Number ~ Number ~ Number ~
Apache 5 .66 4 .57 4 .56
(
Cochise 9 1.19 12 1.72 4 .56
Coconino 18 2.37 19 2.72 18 2.50
Gila 7 .92 12 1.72 11 1.53
Graham 15 1.97 8 1.15 7 .97
Greenlee 0 .00 0 .00 0 .00
la Paz 0 .00 0 .00 1 .13
Maricopa 523 68.80 447 64.04 475 65.97
Mohave 9 1.19 14 2.01 6 .83
Navajo 5 .66 13 1.86 13 1.81
( Pima 98 12.90 69 9.89 71 9.86
Pinal 16 2.11 39 5.59 40 5.56
Santa Cruz 1 .13 1 .14 0 .00
( Yavapai 27 3.55 26 3.72 37 5.14
Yuma 25 3.29 34 4.87 31 4.31
Out-of-State/ 2 .26 0 .00 2 .28
( Unknown
TOTALS 760 698 720
• Admissions through a county in which the individual was not a resident occurred as follows:
( Maricopa 15 Gila 5 Mohave 1
Pima 10 Coconino 3 Navajo 1
Pinal 7 Graham 3 Santa Cruz 0
Yavapai 7 Apache 1 Greenlee 0
Yuma 6 Cochise 1 LaPaz 0
19
(
(
(
(
(
(
(
(
TABLES
ARIZONA STATE HOSPITAL
ADMISSION RATES PER 100,000 POPULATION BY COUNTY*
COUNTVOF FY ]988-89 FY 1987-88 FY 1986-87
ADMISSION
Apache 7.8 6.4 6.7
Cochise 8.8 12.0 4.1
Coconino 19.0 20.7 20.2
Gila 17.3 29.9 27.5
Graham 60.5 32.4 28.0
Greenlee 0.0 0.0 0.0
La Paz 0.0 0.0 7.1
Maricopa 25.3 22.5 24.8
Mohave 11.1 17.7 7.8
Navajo 5.6 14.9 17.6
Pima 14.3 10.5 11.0
Pinal 14.5 36.4 38.5
Santa Cruz 3.3 3.4 0.0
Yavapai 27.6 27.4 40.2
Yuma 27.4 38.0 35.2
STATEWIDE RATES 21.1 20.1 21.4
• FY 1988-89 Admission Rates per 100,000 Population by County based on "Arizona
Population Projections - Counties and Places, 1986-2035" prepared by the Arizona
Department of Economic Security, Population Statistics Unit, April 1988 and approved by
the Population Technical Advisory Committee on March 11, 1988.
20
(
( TABLE 6
ARIZONA STATE HOSPITAL
ADMISSION TYPE BY COUNTY
(
FY 1988-89
COUNTY EIRST BEADMISSIOf:j CONDITIONAL BETURN FROM TOTALS
(
ADMISSION DISCl:(ARGE INPATIENTL SUM %
OUTPATIENT
Apache 1 4 0 0 5 .66
Cochise 4 5 0 0 9 1.19
( Coconino 8 9 1 0 18 2.37
Gila 4 2 0 1 7 .92
Graham 6 9 0 0 15 1.97
( Greenlee 0 0 0 0 0 .00
La Paz 0 0 0 0 0 .00
Maricopa 224 229 12 58 523 68.80
( Mohave 7 2 0 0 9 1.19
Navajo 3 2 0 0 5 .66
Pima 55 37 4 2 98 12.90
( Pinal 9 7 0 0 16 2.11
Santa Cruz 1 0 0 0 1 .13
Yavapai · 11 13 0 3 27 3.55
Yuma 14 8 3 0 25 3.29
Out of State 1 0 1 0 2 .26
TOTAL: SUM 348 327 21 64 760 100.00
( % 45.80 43.01 2.77 8.42
21
(
TABLE 7
( ARIZONA STATE HOSPITAL
NUMBER AND PERCENT OF ADMISSIONS
BY DIAGNOSTIC GROUPING
(
FY 1988-89 FY 1987-88 FY 1986-87
DIAGNOSTIC
(
GROUPING Number Number Number ~
Schizophrenic
Disorders 301 39.61 253 36.25 273 37.92
Affective Disorders 282 37.10 269 38.54 249 34.58
( Paranoid States 5 .66 6 .86 2 .28
Other Psychoses 12 1.58 4 .57 8 1.11
Neurotic Disorders 11 1.45 11 1.57 14 1.94
Senile & Presenile
Organic Psychotic
Conditions 11 1.45 19 2.72 12 1.67
Alcoholic Psychoses . 3 .39 1 .14 2 .28
Other Organic Mental
Disorders 25 3.29 25 3.58 23 3.19
Drug Related
Disorders 7 .92 5 .72 5 .69
( Personality Disorders 5 .66 0 .00 4 .56
Adjustment Disorders 1 .13 5 .72 8 1.11
Disturbance of
Conduct 21 2.76 9 1.29 6 .83
(_
Mental Illness/
Mental Retardation 0 .00 0 .00 4 .56
Substance Abuse 2 .26 2 .29 2 .28
( Other 74 9.74 89 12.75 108 15.00
TOTALS 760 698 720
22
(
(
TABLE 8
( ARIZONA STATE HOSPITAL
LENGTH OF STAY FOR DISCHARGES
( FY 1988-89 FY 1987-88 FY 1986-87
DAVS IN HOSPITAL Number ~ Number ~ Number ~
Under7 days 6 1 10 1 32 5
( · 7 :.13 days 12 2 14 2 23 3
14-20 days 22 3 9 1 23 3
21 -30 days 31 4 39 5 35 5
( 31 -60 days 113 15 130 18 82 12
61 -90 days 147 19 141 19 105 16
91 -180 days 242 32 218 29 191 29
( 181 - 365 days 91 12 90 12 100 15
1 - 5 years 67 9 78 11 69 10
5+ years 22 3 12 2 8 1
TOTAL 753 741 668
MEAN 307 days 223 days 198 days
MEDIAN 99 days 99 days 104 days
(
(
{
23
- - ,... ,-. -- ..... .-.
TABLE 9
ARIZONA STATE HOSPITAL
DISCHARGE TYPE 8Y COUNTY
FISCAL YEAR 1988-89
fnJI To
o.ttlalt To To Other TOTAL
Fna Prior ID r.a.ttlalt ~leased"' "11e Title QnH- Olt- Other Heilltlare Title Fna
Yoltatt."Y !!e!_ration ~ "" rart~ 11 13 11' Death ttonal 111tfent tbspital ~ 36 .lM!nfle fal>lete SM ..!
~£ 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 3 0.4
CWUSE 2 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 5 0.7
IDIJilt() 1 0 0 0 0 1 0 1 0 12 1 0 3 0 0 0 19 2.5
GILA 3 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 6 0.8
SWffl 1 3 0 0 0 0 0 0 0 5 0 0 5 0 0 0 14 1.8
IHEK.EE 0 0 0 0 0 0 0 0 0 . 0 0 0 0 0 0 0 0 .o
LA PA! 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .o
NIRICXl'A lfiO 29 18 15 8 13 2 3 13 49 132 15 29 8 2 0 496 65.9
KIM 0 2 0 0 0 1 0 0 0 2 1 0 0 0 0 0 6 0.8
M\'i\l) 1 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 3 0.4
Pllt\ 37 g 2 4 0 10 0 0 1 10 12 0 7 0 1 0 93 12.4
PltW.. 4 1 2 0 0 1 0 0 0 4 2 0 0 0 0 0 14 1.8
SNfm OlJZ 0 0 0 0 0 0 0 0 0 3 2 0 1 0 0 0 6 0.8
YAVN>AI 4 1 0 2 1 0 0 0 0 0 7 0 2 0 0 0 17 2.3
ll.M 3 1 1 0 0 0 0 0 1 6 0 0 2 0 0 0 14 1.8
WT CF STA'II 7 14 1 2 1 0 2 0 0 1 0 1 0 0 2 1 32 4.3
lNWAIIA!l.E 1 0 0 4 0 0 1 19 0 0 0 0 0 0 0 0 25 3.3
lUL'l.: SUI m 61 25 28 10 26 5 23 15 !I; 157 16 54 8 5 1 753 liD.O
I 'l'J.7 8.1 3.3 3.7 1.3 3.5 0.7 3.0 z.o lZ.6 20.9 Z.1 7.2 1.1 0.7 0.1 100 100.0
24
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