Iowa State student health making changes after scathing report

Iowa State University's student health center is looking to improve almost every aspect of its operations after a recent assessment found widespread deficiencies that could have 'significant and even catastrophic consequences.”

'One staff member likened it to a balloon ‘that could very well pop over the health center' in the form of a serious incident such as a severe student illness that went unseen, unrecognized, or inadequately assessed and treated,” according to a report produced by Keeling and Associates earlier this year. 'This may be a question of not ‘if' but ‘when.'”

The consulting firm's assessment of Iowa State's Thielen Student Health Center found shortcomings in an array of areas, citing poor leadership, dismal student access, inadequate medical training and licensing, understaffing, poor record-keeping, and low morale. Those factors have put the center's accreditation in danger, created significant risks for the university, 'and made student health care at Iowa State a source of increasing concern and serious complaints,” according to the report.

'Many students simply no longer regard the health center as an option when seeking medical care,” according to the report.

The report provided two examples of misdiagnoses at the health center, including one that could have ended in catastrophe. In that case, a student went to student health with a potentially life-threatening appendicitis and was misdiagnosed, reportedly being 'rushed in and rushed out.” Another student said his stress fracture went unnoticed at student health and was only diagnosed after he went off-campus for care - adding six weeks to his recovery and hurting his academic pursuits.

The university requested a review of its health center's operations after its former director Michelle Hendricks retired in September, according to Martino Harmon, ISU associate vice president for student affairs.

Harmon agreed to serve as the health center's interim director on a temporary basis - until the university could find an interim leader trained in the field. But that temporary fix lasted longer than expected, and Monday - after more than 10 months - an interim director with health care experience finally took over.

Mary Hensley, a retired administrator with the University of Minnesota Medical Center, has agreed to fill the void until a permanent director takes over. Harmon said the search for a permanent director still is in its early stages, with university officials this month reviewing information from and meeting with about 15 applicants.

The search could continue for another six months, Harmon said.

‘This is a serious problem'

Iowa State's health center is fully accredited after completing its last reaccreditation in 2013. The next review for accreditation comes in 2016, meaning a self-study should begin no later than the start of the upcoming school year.

But, according to the Keeling report, the center is in danger of losing its standing.

'Absent attention to quality management in the current academic semester, Thielen Student Health Center will not be fully accreditable in 2016/2017,” according to the report.

Areas of concern cited in the report include student access to the health center's services and the quality of care provided. Students cannot easily be seen; front desk personnel who are not medically trained make 'critical intake assessment decisions;” and unlicensed personnel sometimes provide medical advice, the report states.

One permanent staff physician never has been board certified. And during the consultant's review, physicians complained that newly hired nurse practitioners had little experience, while nurse practitioners complained that physicians didn't take them seriously.

Many physicians complained about students, the consultant reported.

'One described students as ‘know-it-alls' and others said working with students was often frustrating and difficult,” according to the report. 'Another complained about having to ‘spend so much time communicating with international students.'”

The consultants heard reports that front desk staff, at times, would refer students directly to the pharmacy when appointments weren't available, producing an 'unacceptable liability risk.” And, according to the report, consultants found 'significant issues concerning protection of patient confidentiality.”

'These issues exceeded the scale of small anecdotal incidents and threaten the credibility and trustworthiness of the entire center,” according to the report.

For example, some students - while sitting in the waiting room - reported overhearing comments made to or about other students by front desk staff. One manager said she was 'mortified” to hear a receptionist discussing private student health details within earshot of other students.

The consultant also reported significant errors in the center's business operations, endangering its fiscal sustainability.

'Both student affairs administrators and (health center) staff members reported that documents are often misplaced, mislabeled, and/or forgotten, and that financial and other data are frequently miscalculated and sometimes misrepresented,” according to the report.

Those errors, at times, resulted in information being filed in the wrong students' records.

'This is a serious problem, even if it only happens infrequently,” the consultant reported.

The report notes that one of the health center's insurance providers requires it to use three local in-network laboratories for tests done on students - a common request, according to the consultant. But, 'in what is a worrisome and potentially very costly trend for the health center, students, and parents,” some clinicians have ignored this requirement and sent laboratory tests to an out-of-network provider, according to the report.

'The result of this practice is that either the health center, or students and their families, must pay for out-of-network laboratory tests when they would not have been charged for in-network tests.”

Staff told the consultant the health center absorbs those costs to avoid passing them on to students and parents, adding to the center's mounting fiscal woes.

‘Severely understaffed'

The report characterizes the center as 'severely understaffed at all levels” - especially among providers. And Iowa State enrollment has increased nearly 38 percent since 2007, placing a 'great deal of stress and strain on the entire university,” according to the consultant.

During that period, the health center lost providers without replacing them.

'Too many students are not being served in a prompt and professional manner by appropriately trained and prepared personnel,” according to the report. 'The pressure this creates within Thielen, and the discomfort and loss of confidence it causes among students, are both growing as enrollment rises and demand increases.”

The clinic is staffed by six medical doctors, one trained in osteopathic medicine, four registered nurse practitioners, three license practical nurses, six full-time staff nurses, 10 medical assistants, and one nursing assistant.

Considering normative rates and the institution's 34,000-plus students, the health center should provide 60,000 to 70,000 annual visits.

'Levels of utilization of Thielen Student Health Center are far below usual and customary norms,” according to the report. 'Were students to use the health center at normative levels, Thielen would be completely overwhelmed.”

The Keeling report includes 10 pages of recommendations, including hiring 'experienced and rigorous leadership,” reviewing the financial management structure, improving data collection, and increasing training and standards.

'They gave us great feedback on opportunities for improvement and realigning our organizational structure,” Harmon said. 'We are making sure we are making better assessments of when students need to see someone and how urgent their needs are.”

Harmon said the health center already is implementing some of the suggestions, reorganizing its staff, requiring more training, and hiring new people. The changes so far have resulted in six layoffs - three administrators and three clerks, according to Harmon.

Some of those employees could apply for other positions within the university, he said.

'The biggest change, from the student perspective, was the intake,” Harmon said. 'That was really critical and important. If we can improve that … and our financial management and data collection, we will be well positioned for the future.”