Death at St. Elizabeths

A dozen cases last year underline the urgency of reforms.

A51-YEAR-OLD man who was a patient at St. Elizabeths Hospital died when he wandered from the grounds. Attempting to crawl under a fence, he became wedged in a gully and drowned when it filled with water during a heavy rainstorm. This death, never disclosed, is one of 12 deaths last year focusing new attention on the ongoing problems of this troubled hospital and the efforts of D.C. Mayor Adrian M. Fenty's administration to correct them.

Advocates for the disabled highlighted some of the deaths in a scathing report last month, chronicling a pattern of neglectful and substandard care in the facility serving about 420 mentally ill patients. There is no way of knowing what deaths could have been prevented -- many of the people suffered from serious health conditions. No doubt, though, inattentive treatment, medical mistakes and other issues related to the quality of care and practice added to the burden of patients' illnesses -- not to mention their pain and suffering.

The city's response to the report was to first suggest that University Legal Services was looking for some publicity to buttress its lawsuit against the District seeking improvements at the hospital. That might be true, but the group should be applauded, not chided, for shining a light on the District's dreadful care of these vulnerable men and women. It was the work of University Services that brought the problems at St. Elizabeths to the surface and caused the city to see the need for reforms. That said, we are uncertain what would be gained by greater court involvement.

The District is already party to a binding settlement agreement with the Justice Department. It calls for a comprehensive multiyear set of strategies to reform the hospital and for regular inspections and reports. As part of the agreement entered into last May, the District is building a new facility, hiring more people and revamping procedures.

There's no question that St. Elizabeths is in terrible shape, but for the first time there's a good leadership team in place, armed with the right plan and appropriate resources. Indeed, the latest report to the Justice Department notes "progress in areas that should serve as a foundation for further reform." A case in point is the response to last year's deaths. Officials investigated each death, made changes in procedures and in three cases took action against staff members who provided improper care. For instance, in the case of a patient found with rigor mortis after dying because a twisted bowel went undetected and untreated, one nurse was fired, another was allowed to resign and a technician was suspended. Then too, the recent hiring of Albert Fernandez-Milo, former director of the Comprehensive Psychiatric Emergency Program at Bellevue Hospital Center in New York, as director of medical affairs could be a key step in improving patient care.

Much more, of course, needs to be done. It's appalling that hospital workers are not subject to criminal background checks, and it's wrong that information such as that concerning the deaths of patients is not easily available to the public. The next eight to 10 months are critical and will say much about whether the city will be able to live up to its commitments.