Del. Franklin M. Slayton "was furious" after he inspected Eastern State Hospital in December 1983.
In one unit at the mental hospital, the legislator from South Boston, Va., found a staff of three serving 80 people.
"At that staffing level you warehouse patients, that's all," he said. He also found "awful, undercooked" food, "very very poor" maintenance and occasional linen shortages.
A few days later, two reports commissioned by the state Department of Mental Health and Mental Retardation said Eastern State was providing little more than "custodial care" to its patients.
A year later, criticism of Eastern State has largely been replaced by praise.
Legislators and mental health officials hail a variety of steps hospital administrators have taken to improve conditions at the often-troubled facility.
"Things are going forward. I can see physical evidence of it," said Hampton Del. Richard M. Bagley, chairman of the House Appropriations Committee.
Although hospital officials said many of the projects were planned before the critical reports came out, 1984 brought a burst of activity to Eastern State. Given an emergency $1.4 million appropriation from the General Assembly, the hospital has hired more than 80 nurses, psychologists and other employes.
The treatment program has been revamped, with a new emphasis on providing short-term care for acutely ill patients. New laundry facilities have been installed, the kitchen and heating system have been overhauled, and a project to replace some roofs is under way. Architects are planning an $800,000 modernization of the aging patient wards and a new fire safety system.
And the hospital administration is buying $500,000 worth of furniture and decorations to spruce up the patients' living quarters.
"We're not to the point where there's been a 100 percent improvement," said Thomas Coe, director of Eastern State's clinical programs. "But there's been a big improvement. We've improved the quantity and quality of our care."
"The criticism made us aware that we needed to move forward," said Chris Faia, director of the acute care unit. "The staff often felt overwhelmed."
Even Slayton has joined the ranks of those praising Eastern State. The criticism, he said, made a difference.
"I know a man down there who works in maintenance, and he told me he got more paint in the two months following my visit than he got in the 18 years previous to that," Slayton said.
The progress at Eastern State has led Slayton, Bagley and some other legislators to predict the facility may win approval from the Joint Commission on Accreditation of Hospitals, a national health-care standards group.
State mental health officials are less certain. "I'll be cautiously optimistic," said Joseph J. Bevilacqua, state commissioner of mental health and mental retardation. "Our target is to shoot for accreditation by the end of fiscal 1985-86. We're on track."
Officials acknowledge that some clouds still hang over the hospital. The special grant that allowed Eastern State to hire additional employes runs out next June and hospital officials hope to persuade the legislature to give them enough money to retain at least some of the workers.
"I'm hopeful consideration will be given to us," said hospital administrator David Pribble. "The big difference the new positions have made is that we have been able to increase the actual care we offer the patients."
Mental health officials said the staffing crunch resulted from two factors: state-imposed freezes on hiring and a larger-than-expected number of patients.
Although the hospital's census of patients has dropped rapidly in recent years (it now stands at about 900) state officials expected the decline to be even quicker, Pribble said. The reduction did not keep pace with cuts in the facility's budget.
This year's infusion of state money allowed Eastern State to hire additional psychologists and fill key nursing positions. It also paid for more social workers who expanded the patients' activity program. Recreational and therapeutic activities are now scheduled at night and on weekends.
Hospital authorities also reorganized their system for treating adult patients this year. They opened a new admissions unit that screens everyone admitted to the hospital. People who need short-term care remain at the unit for treatment; those who need further treatment are sent to other units based on the severity of their problems.
The system has dramatically shortened the hospital stay for many patients, said Faia, who administers the admissions unit. Three-fifths of the patients who enter the unit receive short-term care and are back home within four weeks, she said.
Dennis Wool, executive director of the Virginia Beach Community Services Board, agreed that the acute care program is working. "We are seeing people coming out of the facility more quickly. We don't see any inappropriate discharges," said Wool, whose board oversees Virginia Beach's mental health programs.
Hospital administrators, however, said more nurses, improved living quarters and new paint alone will not solve the facility's problems. They said the communities served by Eastern State must develop their own mental health care programs to relieve some of the burden on the hospital. "Some of the boards have done a better job than others," Pribble said.
Hospital administrators plan to hire six social workers to serve as liaisons with local mental health boards and departments. The workers also will monitor the progress of patients released into their communities from Eastern State.