St. Elizabeths Hospital, the District's public psychiatric facility, stopped admitting new patients after a major electrical failure last month and is still not back to normal operations, officials said.
Admissions have resumed but remain well below average, according to court filings and mental health advocates. The trouble began May 24 when an explosion knocked out one of the aging hospital's three electrical feeders.
The hospital has been able to continue operating, but with another feeder only limping along and the weather turning hot and humid, officials tried to scale back energy use by limiting admissions.
Just 10 people have been admitted since May 28, when the 540-patient facility in Southeast Washington began cutting back.
At least 36 mentally ill people picked up in the city have been sent to other area hospitals, where advocates say they are less likely to receive appropriate care. Others have been kept for extended periods at an intake facility suited primarily for emergency care, not more lengthy treatment.
The disruption has lasted longer than anticipated, according to city officials, who said it could be weeks before the hospital is back to normal. The equipment's age has made it difficult to locate replacement parts, officials said. They also expressed reluctance to do any major work until the weather cools off to minimize the risk of new power complications.
Kelly Bagby, the legal director of University Legal Services, a city-appointed watchdog of St. Elizabeths, said she is not convinced that the city can keep tabs on how patients are being treated elsewhere. "They're not ensuring that they're getting treatment in these other places," Bagby said.
Martha B. Knisley, director of the D.C. Department of Mental Health, disputed that assertion, saying officials are closely monitoring the situation. Knisley defended the response to the power problems and said that in many cases, general-care hospitals are better able to treat acutely ill mental patients.
In many jurisdictions, general-care hospitals handle such cases, and hospitals such as St. Elizabeths are used only for long-term commitment. The District is moving toward a larger role for private hospitals, Knisley said.
But in many of those other jurisdictions, governments contract with private hospitals, which the District government does not. Without a contract, advocates say, private hospitals can be reluctant to do anything more than the meet their minimum legal obligations when it comes to mentally ill patients who are indigent or difficult.
Knisley said she has seen no indication that the other hospitals -- including George Washington, Washington Hospital Center and the Psychiatric Institute of Washington -- were providing inferior care.
The electrical explosion, which was the culmination of chronic power problems at St. Elizabeths, and the ensuing suspension in civil admissions are the latest troubles for the hospital and the D.C. Department of Mental Health.
In April, one patient allegedly beat another into a coma, and a patient died after an unrelated attack by a patient now accused of murder. The D.C. inspector general's office, which issued a report last year faulting the Department of Mental Health's handling of unusual incidents, is investigating the beatings to determine whether the staff was negligent in its supervision or response.
Lately, Bagby and other advocates have expressed concern about what is happening to patients who have not been admitted to the hospital.
The impact also has been evident in court filings. With so few patients coming in, the hospital has been filing few petitions in D.C. Superior Court for involuntary admissions. For two weeks, from May 25 to June 7, no petitions were filed, court records show. Such petitions are mandated if the hospital wants to go beyond the preliminary 48-hour hold that can be authorized by a doctor and keep a person against his or her will for up to seven days.
By law, the hospital is responsible for criminal defendants undergoing mental evaluations and for defendants found not guilty by reason of insanity, so such admissions have not been affected.
Some Superior Court judges have voiced concern about the increased reliance in recent weeks on the intake facility, seeing it as a worrisome sign.
The Comprehensive Psychiatric Emergency Program, located on the D.C. General Hospital campus, is where mentally ill people picked up by police or outreach workers are initially stabilized and assessed. Ordinarily, people are not kept there for more than 24 hours, but mental health officials have made provisions for stays of up to 72 hours.
Chief Judge Rufus G. King III, along with Judge Ann O'Regan Keary, head of the court's mental health rules committee, and Magistrate Judge Joan Goldfrank, chairman of the mental health commission, visited the intake facility last week.
In a statement yesterday, King said the court had "concerns about the health and safety of mentally ill individuals and the community, as well as related legal issues" and "will continue to monitor the situation."