St. Elizabeths Hospital, unwanted and neglected by both federal and District governments, is so riddled with administrative gaps that the care of its 2,200 patients has become severely deficient, the General Accounting Office reported yesterday.
St. Elizabeths, which has been without accreditation since 1975 and under court order to remove more than half of its patients who no longer need mental care, has shortcomings in "virtually every aspect" of its management, GAO officials told the House District Appropriations Subcommittee.
In a six-month review of the hospital that began last October, GAO found deficiencies including:
Failure to pay interest on money held for patients, depriving the patients of an estimated $200,000 sinceSeptember 1975.
An estimated $13,600 loss to the hospital on rents charged employees who live in seven "cottages" on the hospital grounds. Monthly rents as low as $223 for the housing totaled about $40,850 over a two-year period, but more than $53,000 was spent on upkeep of the dwellings during that time.
No system to determine if ordered materials are needed. As a result, for example, 13 color televisions were stored unused since 1973, and 138 small trucks costing $3,100 each, were driven a naverage of 1,300 miles a year, and some only 132 miles.
Staff assignments unmatched to patient needs. Medical care is often given at the expense of psychiatric care, and some wards have no regular psychological services.
The number of administrative jobs has risen 79 per cent in the last 10 years, while the number of patient car workers increased by only 11 percent. The number of patients declined from 5,929 in 1966 to the current 2,200.
The GAO officals testified in opposition to a bill that would place St. Elizabeths under an independent nine-member board appointed jointly by District and federal health officials. The measure, introduced last month by House District Committee Chairman Charles Diggs (D-Mich.), would confuse the already chaotic District mental health system, GAO officials said.
St. Elizabeths problems are both a cause and a partial result of the District's lack of any overall mental health program, the officials said. The D.C. Department of Human Resources uses it as a "catch-all" institution often dropping responsibility for patients it refers there, they said.
The hearings were the third congressional attempt in two years to determine who should control the 120-year old facility. Federal authorities, who now control the hospital, have sought unsuccessfully since 1969 to give it directly to the District.
However, the District's financial troubles, and the funds needed to bring St. Elizabeths up to accreditation standards call for an alternative governing body, Diggs said in his opening statement yesterday.
"The Congress and the Executive branch have neglected St. Elizabeths. Both have a responsibility to correct the situation," said Rep. Ronald V. Dellums, (D-Calif.), chairman of the subcommittee.
Representatives of citizen advisory groups to three community mental health centres run by DHR testified in support of the Diggs bill, as did a fourth center which is under St. Elizabeths' jurisdiction.
"DHR has dramatically shown its inability to administer programs and should not be given another one," said Deborah Shore, speaker for the advisory groups.
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Dellums emphasized that his subcommittee is open to solutions other than control by an independent board for St. Elizabeth's.
"Ultimately this facility ought to be run by the District . . . Whatever the committee does, we have to do it in the spirit of self determination," Dellums said.
Dr. Beryce McClennan, mental health advisor of GAO, said she found St. Elizabeths problems typical of those of many large state hospitals throughout the country. A problem peculiar to the District, however, is the difficulty in communication between the hospital, local officials and the federal government, she said.
The "lines of communication are cumbersome and adversely affect the decision-making process" for St. Elizabeths, said Gregory Ahart, director of the GAO human resources division.