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Report Faults St. E's for 'Needless' Suffering

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By Paul Duggan
Washington Post Staff Writer
Wednesday, January 9, 2008

In a scathing report on 11 deaths last year at the District's St. Elizabeths Hospital for the mentally ill, an advocacy group for the disabled told city officials yesterday that medical neglect resulted in "needless pain and suffering" for most of the patients "and may well have contributed to deaths from treatable conditions."

The study, to be made public today by the nonprofit group University Legal Services, is the latest of several reports in recent years, including one by the Justice Department, that have criticized the 418-patient psychiatric hospital in Southeast Washington for providing chronically shoddy care.

"The medical records and the District's own investigations of the patients' deaths in 2007 reveal a number of disturbing patterns," according to the report, which University Legal Services gave to the city yesterday. The group, designated by the city to serve as an advocate for the disabled, including the mentally ill, has been involved in a lawsuit against the District since 2005, seeking improvements at St. Elizabeths.

In reviewing medical records of the deceased patients -- nine men and two women, most of them middle-aged, who suffered from debilitating physical ailments as well as mental disorders -- the group said it found "significant gaps in both nursing and physician leadership; deficiencies in the delivery of medical care; dysfunction in nurses' authority and decision-making; and nurses' failure to perform basic and fundamental nursing functions."

Of the 11 patients, 10 died of medical ailments and one from injuries he suffered while being restrained by a mental health counselor, according to the report.

Because of the 2005 lawsuit, which is pending, the D.C. Department of Mental Health, which runs the hospital, declined to comment on the report, referring questions to the city's acting attorney general, Peter J. Nickles.

In an interview, Nickles called the report unfair, saying the department has made "steady progress" in improving care at St. Elizabeths, and he accused University Legal Services of seeking publicity in advance of a scheduled court hearing in the lawsuit next week.

Among the cases cited in the report is that of a 56-year-old man identified as Mr. B, who complained of stomach pains April 21. "The next morning, the nurse on the ward found Mr. B dead in his bed, 'stiff with rigor mortis,' with signs of gastric bleeding on his bed sheets," the report says.

The lack of medical attention in his case was typical in nearly all the deaths, according to the report.

"The nurse on duty the evening before Mr. B. died did not write an entry in Mr. B's progress notes about his complaint of abdominal pain or any nursing response, in violation of hospital policy and general nursing practice," the report says. "In fact, there is not a single progress note written by any staff member on April 21, the night of Mr. B's death when he probably experienced excruciating pain."

It turned out that he was suffering from a twisted bowel and gangrene of the bowels, according to the report. In a separate report on the death, the Department of Mental Health cited "a chaotic nursing staff," which resulted in "a clear lack of clinical response to Mr. B's complaint of abdominal pain; and a system of superficial bed checks that indicated Mr. B present in bed at a time that he was already dead."

Acknowledging that some of the cases involved substandard care, Nickles said the department "investigated every death," and "where there were problems, we have terminated and/or suspended the nurses involved for failing to provide the kind of care we expect. And in another case, a doctor received a written reprimand."


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