State regulatory officials, elected leaders learned of tragedy from InvestigateWest report

This story was originally published by InvestigateWest, a nonprofit newsroom dedicated to change-making investigative journalism. Sign up for their Watchdog Weekly newsletter to receive stories like this one in your inbox.

SPOKANE, WA – The Washington Department of Health is investigating a 12-year-old’s suicide at Providence Sacred Heart Medical Center last month that has prompted heartbreak and outrage from lawmakers, Spokane city councilmembers and behavioral health advocates statewide.

On April 13, Sarah Niyimbona slipped out of Providence Sacred Heart’s pediatrics floor, where she had been staying for three months related to self-harm attempts. She walked to a hospital parking garage and jumped, dying in the emergency room two hours later.

Health Systems Quality Assurance, the Department of Health’s regulatory division, opened its investigation sometime around April 28 after learning of the death from InvestigateWest’s reporting, spokesperson Frank Ameduri said in an email. The division issued a notice of “immediate jeopardy” to Providence Sacred Heart, alerting the hospital that it was “out of compliance in such a way that patients could be in danger of serious injury, harm, impairment or death,” Ameduri wrote. Immediate jeopardy notices put hospitals on track to lose their Medicare certification within 23 days. To prevent that, Providence Sacred Heart responded by submitting a safety plan to address the deficiencies noted. Ameduri declined to give additional details, citing the ongoing investigation.

Beth Hegde, Providence Sacred Heart spokesperson, said in a written statement that the hospital immediately launched a formal internal review “following a tragic event at Providence Sacred Heart Medical Center in April.” That included notifying local health authorities, she said. She declined to provide other details, citing patient privacy laws.

Asha Joseph, Sarah’s sister, said she was glad the health department is investigating and hopes it will force the hospital to improve safety for other children. She said that the hospital has not provided the family with any of Sarah’s medical records or additional information about what happened to her sister.

Lili Navarrete, a Spokane city council member whose district includes Sacred Heart, criticized the hospital’s silence.

“There’s HIPAA and then there are just plain questions,” she said. “I do believe they are hiding behind HIPAA.”

Elected officials are calling on the hospital to address community concerns about psychiatric care quality and safety protocols at Providence Sacred Heart, as it continues to receive young patients in mental health crises. Several said Sarah’s death has left them deeply worried about the fallout from the hospital closing its inpatient psychiatric center for youth, which provided such care for 40 years until last September.

“The frustrating piece is, we were told there’s a plan here, and, you know, it clearly failed,” said State Sen. Marcus Riccelli, D-Spokane, who met with hospital leaders last August to discuss how youth would still access critical care after the center closed. “I don’t know the ins and outs, but a tragic death like this can’t be called anything else but a failure of the system. And, yeah, I don’t think this would have happened if that unit was open.”

Five local elected officials said they learned about Sarah’s death from InvestigateWest’s reporting. Providence Sacred Heart has refused to answer the newsroom’s questions about safety and quality of care, or improvements following Sarah’s death. Hospital leaders declined an interview request for this story.

Under Washington law, the hospital is required to investigate any patient’s suicide and submit a “root cause analysis” to the Department of Health’s adverse events team, a separate, non-regulatory division. To avoid discouraging facilities from reporting, the adverse events division does not loop in the regulatory division, Ameduri said, and the root cause analysis is not public. Details from the health systems quality assurance team’s investigation, however, will be publicly accessible when it concludes.

While closing the Psychiatric Center for Children and Adolescents last year, Providence Sacred Heart’s CEO Susan Stacey said nearby facilities, including Inland Northwest Behavioral Health, a for-profit youth treatment center where Providence Sacred Heart is an investor, were ready to take over more inpatient services. But the private facility is less accessible, sometimes turning away teens with autism, chronic medical conditions, serious mental illness or violent tendencies, leaving many of them cycling in and out of local ERs.

State Rep. Timm Ormsby, D-Spokane, also called Sarah’s death a failure, and said he was “heartsick” over the news. He and other elected leaders urged the hospital to go beyond its legal duties and address the community as well.

“If you want to prevent it from happening again, you have to get to the bottom of it,” he said.

“It makes me super upset that if this were a white girl … would this be treated differently? Would people be demanding answers?” Navarrete said. “They need to answer for their wrongdoing.”

“What is going to be done differently after this? How did this happen and why?” said Paul Dillon, the other Spokane city council member for the district encompassing Providence Sacred Heart. “Those are questions that the community wants to know.”

Hospital staff have shared worries about specific practices and protocols within the pediatrics unit, where two rooms were converted to psychiatric beds after the youth psychiatric center was closed. Unlike the center that had at least two sets of locked doors, the doors to the general pediatric unit are not locked from the inside, making it easier for a child to leave undetected. And pediatrics staff who now care for psychiatric patients in the new rooms had received no additional training on how to treat and protect these patients, according to three people familiar. When asked if the hospital was implementing new training or changes to the pediatric unit, Hegde refused to answer.

Disability Rights Washington Attorney Chloe Merino recently learned of Sarah’s death from InvestigateWest. The nonprofit, which advocates for people with disabilities and mental illness, can also investigate her death under an agreement with the state. But those findings would not be public. The organization typically investigates when abuse or neglect is suspected and has yet to decide if it will look into Sarah’s death.

“When someone is admitted to a hospital for care, they should be able to receive adequate care that meets their needs in a safe environment,” Merino said in an emailed statement. “The circumstances of Sarah’s death raise questions such as whether she was in the most appropriate placement for her needs, what treatment and supervision she was receiving, and larger questions about how we are able to serve youth with mental health conditions.”

“This is what we were afraid of,” said Richelle Madigan, whose own child has lingered many times in emergency rooms waiting for treatment. “When you remove these critical services, kids fall through the cracks. And now, one of them is gone.”

Madigan, who lives in central Washington, is co-chair of the state’s Behavioral Health Advisory Council and runs a nonprofit that connects families with mental health resources across the state — resources that continue to dwindle.

“Before they closed, there weren’t enough resources,” Madigan said. “We were seeing families traveling to the west side of the state or even into Idaho to get services even before the closure. It was very impactful that the hospital closed, but the reality is, our behavioral health infrastructure has been inadequate for a very long time.”

State Rep. Joe Schmick, R-Colfax, called Providence Sacred Heart’s unit closure a “critical loss for eastern Washington” and criticized the hospital’s motives and transparency about its plan for closing the children’s unit.

Schmick also attended the August meeting with Dillon and Riccelli, where hospital officials blamed a shortage of mental health care providers for the closure. But after later learning from a January InvestigateWest report that the hospital had terminated all of its psychiatrists in 2022, Schmick said he felt duped.

“There was clearly nothing we could have done at that point,” Schmick said. “They should have come to us before it was too late. But by the time they brought us in, they had already decided to close and there was nothing we could do.”

Schmick said state lawmakers are also to blame for neglecting to prioritize the needs of children in crisis.

“This is an ongoing issue, and it’s something I’ve talked about for a long time, but it was not a priority this year​​,” Schmick said.

Hospitals rely on Medicaid reimbursement to cover many patient costs, including the exorbitant expense of providing inpatient psychiatric care for children. But that reimbursement is rarely enough to cover the cost of that care, leaving hospitals and treatment providers on the hook for the remaining expense. In 2023, state legislators increased Washington’s Medicaid rates. Behavioral health care providers of all kinds received an increase of 15%. But this year, legislators cut back 1% to accommodate a budget shortfall.

Seattle-based mental health advocate Laura Van Tosh said providers are bracing for those cuts. Van Tosh has struggled with mental illness since childhood and is now a member of the Joint Legislative Executive Committee on Behavioral Health.

“We need to protect these services and protect the people using behavioral health services,” Van Tosh said. “A young girl lost her life in the middle of us trying to figure out what our system is going to look like. That’s a blight on the system itself.”

InvestigateWest is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center and newsrooms in select states across the country.