Progress at D.C. Hospital Is Limited, Report Says

In her first report on the District's plan to improve conditions at St. Elizabeths Hospital under an agreement with the Justice Department, a lawyer hired to monitor the effort said the city has "made progress in areas that should serve as a foundation for further reform." But she also cited "major areas in which little or no progress has been made, and where significant improvement is needed."

The 85-page status report, submitted to the Justice Department in December and recently obtained by a watchdog group under the Freedom of Information Act, said that as of Oct. 31, patient care at the city-run psychiatric hospital had not been upgraded "in any significant way" since the summer, when the District settled a federal investigation by agreeing to make improvements at St. Elizabeths over a three-year period. The next status report, from chief compliance officer Janet Maher, is due in the spring.

"I would say that they've made some progress," said Maher, who was hired by the D.C. Department of Mental Health to monitor the District's adherence to the agreement. In an interview, she said: "I don't think at this point that they're in danger of missing any of their [periodic] deadlines. That's why it's a three-year agreement, because everyone knew that there are big fixes needed, not little ones.

"There's lots of work still to be done," she said.

The hospital, with about 420 patients, is at the core of a long-troubled mental-health system in the city. In a scathing report issued Jan. 9, for example, an advocacy group for the disabled in the District described the circumstances of 11 patient deaths at St. Elizabeths in 2006, saying medical neglect resulted in "needless pain and suffering" for most of those who died. An investigation by the Justice Department also found substandard conditions at the hospital, resulting in the agreement signed by the city in the summer.

The advocacy group University Legal Services, which obtained Maher's status report, has been involved in a lawsuit against the District since 2005, seeking improvements at the sprawling, 156-year-old hospital in Southeast.

In her report, Maher listed several improvements: The hospital's psychology training program was awarded full accreditation by the American Psychological Association; patient screening has been upgraded and some key leadership positions have been filled; the hospital obtained several grants for treatment and training programs; and construction of a new hospital building is on schedule.

However, "staffing shortages in psychiatry, psychology and nursing are at significant levels," she wrote. "There is no automated information system that serves the hospital and provides regular data reports. Despite 200 new computers, there are at least 100 staff who do not have a computer or rely on old, outdated equipment." Although the hospital has added 72 positions "to increase direct care and other critical staffing," Maher wrote, "there is no identified funding for computers for the additional 72 staff."

Officials at St. Elizabeths are introducing, on a small scale, several new ways of assessing and treating patients, and they plan to expand these "best practices" to more wards over the next 18 months. "But, after years of inattention, it is not surprising that the initiatives have not yet yielded the desired results," Maher wrote. "Patients are not yet experiencing the kinds of changes" required by the agreement.

"The hospital leadership is realistic in preparing for mid-course corrections as the best practices initiatives take hold, but staff at all levels have not yet embraced the new models and the new expectations they will need to meet," Maher reported.

"The accomplishments to date are important first steps, but they are just that, first steps," she concluded. "The next eight to 10 months will be critical, and substantial improvement in patient care must occur if the time frames set out in the agreement are to be met."

After Justice Department officials finish reviewing the status report, they are scheduled to conduct an on-site review of the hospital this month, Maher said in an interview. She said they will make other visits after each six-month status report until the final deadline in 2010.