A watchdog group has found that St. Elizabeths Hospital, the District's psychiatric facility, is seriously understaffed and that "patients' lives are in peril."
University Legal Services, a city-designated watchdog agency for people with disabilities, found that many hospital employees, particularly nurses, had to work excessive overtime to make up for the staffing shortage -- even as many wards in the Southeast Washington facility have been crowded.
Inadequate staffing, a shortage of resources and a deficient quality assurance program "have resulted in serious injury to patients and staff, as well as several recent patient deaths," the agency said in a newly released report.
"Patients' lives are in peril," the report concludes. " . . . The community and the consumers deserve a mental health hospital with a safe, sanitary and therapeutic environment that fosters healing."
Martha B. Knisley, director of the Department of Mental Health, which oversees St. Elizabeths, said the hospital has been moving aggressively to remedy the crowding and staffing problems. In a letter sent yesterday to University Legal Services, Anne M. Sturtz, the Mental Health Department's general counsel, said the agency had agreed to convene a panel of outside experts to develop a plan to improve St. Elizabeths.
University Legal Services began examining conditions in spring, when two patient-on-patient attacks brought to light bigger troubles at the aging hospital. Its report comes in the wake of other investigations into care by District and federal officials.
A 55-year-old patient was stomped into a coma by another patient, and a few weeks later, a 76-year-old patient was beaten by another patient and died.
The Department of Mental Health immediately began examining the violent events, as did the D.C. inspector general's office. In June, the federal Centers for Medicare and Medicaid Services began an audit of the hospital.
The inspector general's investigation is continuing but the other probes are done, and the results appear to reflect many concerns cited by University Legal Services.
Even with the routine overtime, the hospital has not provided minimal staffing in some wards, federal investigators found. A sampling of records by federal investigators found that almost none of the patients had appropriate treatment plans, and a spot-check of wards found that many patients are left to idle away their days, with little constructive activity or interaction.
Knisley said yesterday that the hospital is making progress. The number of patients, which reached 570 in April, is down to 455, and should be at 400 by July, she said. As part of her department's expanding community care program, many people who would have been admitted are now being cared for as outpatients in neighborhood facilities.
"We did have a serious problem in the spring," Knisley said. "Many things have changed since then."
It was only a couple of years ago that St. Elizabeths emerged from court supervision, and its record since then has drawn criticism from the inspector general and University Legal Services.
The death of the patient last spring dramatized the most glaring deficiencies, University Legal Services said in the report, written by staff attorney Robin Thorner and consultant Andrea Procaccino.
Willie Fraley, 76, was beaten April 21 by fellow patient Jessie Fields, 60, in a dispute over Fraley's habit of hoarding other patients' clothes, according to prosecutors and mental health department investigators. Fraley, whose son said she had been threatened repeatedly by Fields, died a short time later. Hospital staff members told investigators that the woman's son never complained about threats.
Fraley died of a heart attack, according to the D.C. medical examiner's office, but the beating was cited as a contributing factor and the death was classified a homicide. Fields is charged with murder, but her competency to stand trial is being evaluated.
The Department of Mental Health said that the death was a "tragic accident, not murder" and could not have been prevented, even if the employees on duty that day had been doing their jobs exactly as they were supposed to.
But what all of the reports make clear is that the employees did not perform as expected.
The Department of Mental Health's investigators found that the St. Elizabeths employees on duty in that ward were not monitoring the 21 patients in the day room and did not see the argument as it developed or grew physical.
It was not until Fraley had been knocked to the floor and was unconscious that some employees became aware of a problem. The ward's nurse had to be summoned three times and did not give investigators a reason for not responding sooner.
University Legal Services alleged that poor care contributed to other deaths at the hospital. In two other cases, patients died because the physical therapy they needed was discontinued or never even started, the watchdog group said.
Knisley said that she did not have any "final information," but that nothing she had learned so far indicated that the lack of physical therapy caused either death.