U.S., D.C. Reach Deal on St. E's

Mayor Adrian M. Fenty, left, with council member David A. Catania and Peter Nickles, general counsel to the mayor, at a news conference to discuss the settlement with the Justice Department over the city's psychiatric hospital.
Mayor Adrian M. Fenty, left, with council member David A. Catania and Peter Nickles, general counsel to the mayor, at a news conference to discuss the settlement with the Justice Department over the city's psychiatric hospital. (By James M. Thresher -- The Washington Post)
By Henri E. Cauvin
Washington Post Staff Writer
Tuesday, May 15, 2007

The District has agreed to a long list of improvements at St. Elizabeths, the city's public psychiatric hospital, as part of a settlement with the U.S. Justice Department, which had threatened to sue over widespread deficiencies at the hospital.

Announced by Mayor Adrian M. Fenty (D) yesterday morning at St. Elizabeths, the agreement calls for treatment to be tailored to individual patients, for abuse and neglect of patients to be halted and for the hospital's many health and safety hazards to be corrected.

The commitments, outlined in 41 pages, are strikingly basic, a reflection of the fundamental problems that authorities found at the hospital. But if the objectives seem simple, reaching them will not be, officials said yesterday.

"This is not an going to be easy," said Stephen T. Baron, head of the Department of Mental Health, expressing a sentiment repeated more than once during the announcement.

The settlement establishes deadlines for improvements: a year for some of the safety problems, three years for some of the treatment needs.

Although applauding the city's intentions, advocates who sued the city two years ago to force improvement at St. Elizabeths said the agreement allows the city too much time and provides too little oversight.

"If there's not independent oversight, then we can't be assured that the change will take place," said Mary Nell Clark, an attorney for University Legal Services, which filed the 2005 suit.

St. Elizabeths, long a troubled place, is the core of a troubled mental health system in the District. It has been the subject of periodic reform efforts. But in the District, as elsewhere, the needs of the mentally ill are often eclipsed by other demands, such as better schools or more police officers.

A spate of deadly violence three years ago, and the outside scrutiny that ensued, helped bring the hospital's chronic problems out of the deepest shadows and placed St. Elizabeths on the agenda of some of the city's key policymakers, advocates for the mentally ill say.

In one incident, a 55-year-old died after another patient stomped him into a coma. A few weeks later, a 76-year-old died after being beaten by another patient. A wave of investigations followed -- by D.C. police, the D.C. inspector general, the federal Centers for Medicare and Medicaid and the civil rights division of the Justice Department.

In a letter to the city last year, the Justice Department said it had found that the hospital "fails to provide its patients with a reasonably safe living environment" and often subjects them "to harm or risk of harm."

The District's settlement with the Justice Department avoids a long legal battle over St. Elizabeths. Fenty said the agreement allows his administration to focus on fixing the problems at the hospital.

"This is an acknowledgment that improvements needs to be made at St. Elizabeths, which we've already started," Fenty said, speaking in the hospital chapel.

After taking office in January, Fenty named Patrick J. Canavan to run St. Elizabeths. Canavan, a psychologist, had headed the Department of Consumer and Regulatory Affairs under Mayor Anthony A. Williams (D). Fenty kept Baron as head of the Mental Health Department. Baron had come to work for the District only a few months before the mayoral election.

Canavan and Baron have been praised for moving aggressively to shake up St. Elizabeths and for recognizing that providers of essential outpatient care must not be made to wait months for payment, which had been a common practice.

D.C. Council member David A. Catania (I-At Large), who heads the Health Committee, said that after years of operating "out of sight and out of mind," St. Elizabeths had the political attention and the fiscal support that it needs.

"Sadly, it's late in coming," said Catania, who praised Fenty's involvement in the effort.

Fenty has said he wants to turn around troubled human services agencies, which in many cases remain the subject of litigation.

The city has not reached agreement with University Legal Services, which filed a report in court last month documenting continuing problems at St. Elizabeths. A spokeswoman for the mayor said yesterday that the city plans to file a motion today asking the judge to rule in its favor without a trial, based on filings already made in the case.

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