New building could mark new era for St. Elizabeths Hospital

The District hopes a soon-to-be-opened building will restore a little of the prestige St. Elizabeths Hospital once knew and end years of court oversight brought on by chronic dysfunction.
By Henri E. Cauvin
Washington Post Staff Writer
Monday, April 19, 2010

From a single structure in 1855, it grew into a campus of more than 130 buildings in Southeast Washington. It was, by the early 20th century, known as St. Elizabeths, for the colonial land grant on which it was built, and it had become, in the words of an admirer, one of the "great, grand" dames of American psychiatric hospitals.

Today, at St. Elizabeths, that tradition is not what comes to mind. Not while wandering among the buildings, where it is difficult to tell which are abandoned and which only seem that way. Not while looking at press and government accounts of patients who endured neglect, abuse and too often a premature end to life.

And certainly not while standing in front of the sleek, angular facade of the hospital's newly constructed home. It is this new building, more than a decade in the works and set to open officially this week, that the District hopes will restore a little of the prestige the hospital knew and help end three decades of court oversight brought on by chronic dysfunction in the District's mental health system.

"The tradition of this place is not what we've heard about in the last 20 years," Patrick J. Canavan, the hospital's chief executive, said as he led a tour of the new building, which sits on the eastern edge of the campus, near the Congress Heights Metro station. "The tradition of this place is the forefront of psychiatry in the world."

Set up to serve residents of the District and members of the armed forces, St. Elizabeths had 7,450 patients in 1945, a year before the military stopped sending service members there. Today, it is home to 317 -- 172 of them committed through the criminal justice system and living in the John Howard Pavilion, and 145 committed through the civil system and living in the Rehabilitation Medical Building.

When the patients begin moving into the new building this month, many will, for the first time, have single rooms. Bathrooms in the 448,190-square-foot hospital will be for use by only one person at a time, affording a measure of privacy and safety unknown in the communal facilities of the old hospital. And the heating and cooling systems, officials promise, will work.

But the new building, constructed over three years at a cost of $161 million, isn't just about creating a more comfortable setting, officials say. They intend to create a more effective hospital, one focused on stabilizing people's conditions and, wherever possible, preparing them to return to their communities.

"It's a wonderful opportunity for healing," said Department of Mental Health Director Stephen T. Baron, who worked at St. Elizabeths in the 1970s while working on his master's degree in social work at Howard University.

A history of trouble

Since he was appointed in 2006, Baron has helped engineer improvements in the city's long-troubled mental health system, which has been the subject of a federal class-action suit since 1974. For the first time in many years, an end to the case appears within reach, but with the District proposing to cut nearly 10 percent of the Department of Mental Health's budget, a court monitor has worried publicly that the agency's efforts could be set back.

Fixing St. Elizabeths, which the city inherited from the federal government in 1987, is a crucial piece of that change. It has not been accredited by the Joint Commission, a national body, since 1988. Even though it became clear in the 1990s that a new hospital was needed, ground wasn't broken until Dec. 19, 2006. In the meantime, problems in patient care deepened.

In the most damning inquiry of recent years, the Justice Department documented what it said were widespread civil rights violations stemming from an excessive number of assaults, a lack of adequate psychological and psychiatric services, and failure to ensure adequate discharge planning and placement.

Canavan, a psychologist who had worked at St. Elizabeths in the 1990s, was installed as the hospital's chief with a mandate to turn it around. In 2007, the city reached a settlement agreement with the Justice Department.

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