Audit finds ‘inadequate’ payroll, controlled substance records at Maryland psychiatric hospitals

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A legislative audit found that five state-run psychiatric facilities failed to provide adequate recordkeeping and financial documentation for payroll adjustments, as well as inadequate verification of the disposal of highly controlled drugs, among other issues.

The audit is the latest of several reports dinging the Department of Health for “unsatisfactory” or “pervasive lack of documentation,” that have led to financial woes for the agency.

The report from the Office of Legislative Audits is dated May 29, but was only released to the public on Monday. It covers a time period beginning in 2018 – start dates vary depending on the hospital – through June 2022.

Facilities covered included Spring Grove Hospital Center in Baltimore County, Clifton T. Perkins Hospital Center in Howard, Eastern Shore Hospital Center in Dorchester, Springfield Hospital Center in Carroll and Thomas B. Finan Hospital Center in Allegany. They are expected to “provide a wide range of comprehensive health and psychiatric services to patients throughout the State including inpatient treatment, competency and criminal responsibility evaluations, long-term inpatient services, and services to individuals in a maximum-security environment.”

“This report contains findings common to each of the five hospital centers, as well as those applicable to individual or specific centers,” the audit said.

It found that all hospitals failed to verify if highly controlled prescription drugs were properly disposed of when they were no longer needed, and that adjustments to payroll or time off were not properly authorized.

The audit also found that some of the facilities could not verify if amounts paid for drugs or housekeeping services were consistent with vendor contracts.

In her response to the audit, Health Secretary Laura Herrera Scott acknowledged that while concerns identified in the report were “factually accurate,” the department has taken corrective action or is planning to do so for each issue raised.One issue flagged at every facility was inadequate monitoring of the disposal of “controlled dangerous substances,” and a failure to ensure that such substances were properly locked away and out of reach of unauthorized personnel. The drugs include opioids, stimulants, depressants, hallucinogens and anabolic steroids.

The facilities are supposed to return unneeded controlled substances to the vendor for proper removal, and possible reimbursement. But hospital records were not sufficient to ensure that the drugs were returned or the hospital reimbursed, the audit found.

It also noted that employee access to those substances “was not being restricted” to appropriate staff.

In its point-by-point response, the department said all expired or unusable drugs “are stored in a locked area within the pharmacy in a separate location” from other drugs, until they can be collected by the vendor. The hospitals will ensure appropriate access control to all drugs and “will ensure only appropriate personnel have access to such areas,” it said.

The report also found that some adjustments to payroll and leave were not properly documented, in part because the hospitals did not have independent reviews of those adjustments.

“For example, one person was awarded 632 hours of sick leave without support to justify the adjustment,” the report said. “As a result of these conditions, there is a lack of assurance that the SPHCs’ (state psychiatric hospital centers) payroll and leave adjustments … were authorized adjustments.”

The audit found that the hospitals did not use appropriate channels to pay as much as $28.7 million in contractual services. About 47% of payments for contractual services were made directly, which the audit says “bypasses the critical automated document matching control found in other payment methods.”

“Specifically, the direct payment method does not include the control of matching an invoice to the corresponding contract/purchase order prior to payment, to ensure amounts paid are consistent with the related contract and do not exceed contract maximums,” it said.The health department’s response said corrective measures are either already underway or will be implemented within the year.

For the direct payment issue, the department said it has developed additional staff training to ensure state procedures are followed. The agency is also working closely with each hospital’s financial team to “ensure that financial tasks are completed appropriately each month.”

The department said its Office of Human Resources has already created standard operating procedures to better review payroll adjustments. The office will “ensure only authorized adjustments had been processed and investigate the propriety of discrepancies.”

And besides keeping controlled substances secured, it said, hospitals will be required to document when drugs have expired and will have to keep logs to record when they are removed from inventory and collected by vendors.

The health department’s communications director, Chase Cook, pointed out in an email the audit covered the period before Gov. Wes Moore (D) took office. But he said the audit “reveals many opportunities for improvement at the Department’s health care facilities,” which he said the administration is committed to.

“This administration is working diligently to correct the issues identified in these findings, as well as other issues we have identified, to ensure quality of care and financial accountability in our facilities,” Cook said.

– This story was updated on Friday, June 7, to include comments from the Maryland Department of Health.

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