D.C. Will Investigate Patient's Death

Man Restrained After Altercation

A senior adviser to the mayor said yesterday that the District is examining how a 39-year-old mental patient died after an altercation at the city-run St. Elizabeths Hospital.

Peter J. Nickles, the mayor's general counsel, said the psychiatric hospital's new chief, Patrick Canavan, is leading an investigation by hospital administrators into the events Tuesday afternoon.

The man became unresponsive after staff members tried to restrain him following a "dangerous altercation," according to a statement by the D.C. Department of Mental Health, which runs the Southeast Washington hospital. The statement said the man was pronounced dead at Greater Southeast Community Hospital after being brought by ambulance.

Mental health officials did not identify the man, citing privacy concerns.

The city will be open about the findings of its probe, Nickles said.

"There's going to be complete transparency about this," said Nickles, who before joining the administration of new Mayor Adrian M. Fenty (D) spent much of his career suing the D.C. government for the failings of many of its human services agencies, including the city's metal health agency.

The Department of Mental Health has begun an investigation as well, led by its Office of Accountability, said a spokeswoman, Linda Grant, in the statement released hours after the man died.

Grant said yesterday that the department had little additional information to provide about the circumstances of the altercation. Nickles said the District will provide facts as investigators learn them but will not engage in speculation about the death.

Whatever happened, Nickles said, he is troubled by another death at a hospital with a record of poor care, inadequate staffing and lax management.

"These things happen, but they've happened too often at St. Elizabeths," Nickles said.

A civil rights investigation by the Justice Department found the quality of care and supervision at the hospital lacking, and in a report released last year, the department demanded that the city take significant steps to improve operations at St. Elizabeths. The investigation was prompted, in part, by the deaths of two patients attacked by other patients in 2004 and three patients whose care was compromised in 2005.

Lawyers from the legal services organization responsible for advocating on behalf of patients at St. Elizabeths have sued the District, claiming that many patients do not receive proper treatment and live in abysmal conditions.

Yesterday, after learning of the latest incident, lawyers from the organization went to St. Elizabeths to begin an inquiry.

Mary Nell Clark, managing director of University Legal Services, said she learned that the trouble occurred in what is known as the treatment mall, a common area where patients are bought for classes and other therapeutic activities.

The man who died was restrained facedown, Clark said. She contended that should not have happened. "Prone restraint is very dangerous, for obvious reasons," Clark said.

The D.C. medical examiner's office has been asked to conduct an autopsy, but the chief of staff for the office did not return a call seeking information about the results of the examination.

Clark said she did not know what led the staff to restrain the man. And what preceded that is fuzzy as well, she said. Some patients were arguing in the treatment mall shortly before the incident, she was told. But by the time of the altercation, the room was cleared of patients except for the one who died, Clark said.