The city’s new $161 million hospital has paved the way for several legal victories. (Department of Mental Health)

A nonprofit overseer brought the suit in 2005, claiming that the city had failed to fix longstanding issues at St. Elizabeths Hospital that endangered patient lives.

Under the settlement, the District will pay $175,000 over three years for a patient advocate who will report directly to the overseer, University Legal Services, on behalf of mental health patients. The group will also have greater freedom to enter and move about the hospital in order to monitor patient welfare.

“The hope is that we will be able to do more working with patients to address their specific issues before they blow up into something bigger,” said Mary Nell Clark, an attorney for University Legal Services.

The city has also agreed to provide “significant information about safety issues” and to notify overseers within three days of any patient death.

”We think this settlement benefits everybody and brings closure to this issue,” said Stephen Baron, director of the D.C. mental health department.

Clark said her group’s relationship with the hospital was “definitely, definitely improved” in recent years. “We’re not saying by any means that the hospital is perfect at this point,” she said. “But we have a better trust in the administration and feeling that they’ll work with us.”

In 2004, two St. Elizabeths residents died at the hands of fellow patients. The next year, three other patients died after receiving questionable medical care.

Around that time, University Legal Services filed its suit and the Justice Department started an investigation into the hospital, probing whether the chronic problems there violated the civil rights of its patients. After the federal investigation found numerous problem with patient care, the District government in 2007 agreed to make numerous improvements.

In February, a ULS report found an ongoing epidemic of assaults by patients, against staff and against other patients, resulting in almost 350 physical injuries in the yearlong period studied. “[T]roublesome cases of indifference and neglect” persist, the report found. A Justice Department report released around the same time cited improvements in hospital management, but noted that the hospital had failed to meet benchmarks established in the 2007 agreement.

But Clark said improved relations between her group, city administrators and federal lawyers paved the way for the settlement. “[W]e share the same goal: high-quality patient care,” Mayor Vincent C. Gray (D) said in a release.

The deal is the third major legal victory for the mental health department in two months. In September, the District and plaintiffs agreed to settle a class-action suit dating to 1974 that has resulted in longstanding court oversight of the city’s mental health system. The settlement is expected to be finalized in February. Earlier this month, the Justice Department agreed to ease the terms of the 2007 agreement, which could result in the end of federal monitoring by next fall.

At the time University Legal Services filed its suit, the hospital served 540 patients in a sprawling, dilapidated complex. Last year, the hospital moved into a new $161 million building on the historic Southeast campus. It is more compact and serves many fewer patients, currently about 280.