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The Shame of St. Elizabeths

The headlines today show D.C. Mayor Tony Williams finally taking action on the horrific treatment of the mentally retarded in this city, as the mayor, facing the prospect of losing control to a court-appointed receiver, sacks the head of the District's mental retardation agency.

But the shameful way in which Washington takes care of its most vulnerable citizens extends beyond the mentally retarded right into the District's primary facility for the mentally ill, St. Elizabeths Hospital, the faded jewel of an institution overlooking the city in Southeast.

A new investigation by the U.S. Justice Department blasts the city for its treatment of patients at St. Es, concluding that patients there live in great danger, are subjected to inhumane treatment and are sent out from the hospital without the tools to survive or thrive in their new settings. Justice is threatening to sue the city over its mistreatment of the mentally ill unless the District agrees to a whole mess of changes, pronto.

The investigation found abuse of patients, patients walking out of supposedly secure facilities, and a frightening pattern of assaults--138 patient on patient assaults and 34 patient on staff assaults in the first four months of last year alone. "There appears to have been little or no supervision" in many of those assaults, the report says.

Apparently, patients who are supposed to be under watch walk off campus pretty much at will, and the investigation found that in at least some of those escape cases, St. Es staff didn't bother to look into the disappearance at all.

When a patient found another patient sitting on a toilet with a plastic bag around her head and a string around her neck, the suicidal patient was supposed to be put on observation. Instead, St. Es personnel restrained her on a bed for 24 hours and made no effort to find out where she had gotten the bag or string--or a piece of glass that she used in a second suicide attempt four days later.

The investigation offers a long catalogue of incidents in which St. Es overmedicates and undersupervises, tosses them into seclusion for little or no reason, fails to look into allegations of abuse or neglect, and fails to address problems with a physical plant that is in "severe deterioration and serious dilapidation." We're talking rats, mice, bugs, an "overwhelming" stench, soiled diapers left in the open, and "deplorable and unsanitary conditions in the food preparation area." The list goes on: Egregious staffing shortages. Exposed electrical systems and several feet of standing water, resulting in a palpable "risk of execution." Inoperable smoke dampers, no fire alarm inspection since 2003.

Things don't get better when the feds look at the medical care provided to patients. The investigation found misdiagnoses, doctors who never finished diagnoses, cases that lingered for months or even years without any attention to identifying the patient's malady and setting a treatment plan. "In the vast majority of the cases that we reviewed, St. E's psychiatric assessments were inaccurate, incomplete and uninformative," the report says.

The investigation chronicles a number of deaths that may have happened because of lousy medical care and a gross failure to follow basic professional standards. Yet the report, by Assistant Attorney General Wan Kim, fails to name names, placing blame generally on the institution rather than holding anyone accountable. If the federal investigators are unwilling to say who is at fault here, how can the city be expected to take the report seriously?

By Marc Fisher |  June 7, 2006; 7:50 AM ET
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You laid this out well and I was with you right up to the last sentence: "If the federal investigators are unwilling to say who is at fault here, how can the city be expected to take the report seriously?"

I would think they'd take the report seriously because they want to do the right thing. Is it necessary first to blame someone before correcting a wrong? Doesn't assigning blame divert attention from the problem in endless, political rounds of "the blame game"?

Anyway, in this specific instance it would seem blame starts with the Mayor and Council and goes down to the maintenance crews. Once you start blaming, when would you stop? And once you've blamed everyone would you be any closer to a solution?

Posted by: Kalorama Kat | June 7, 2006 8:49 AM

This is just an example of how the mentally ill are treated in this country. Unfortunately we end up with the "you can take care of this now or you can take care of this later." In this country we would rather "take care of this later". Mental illness does not cure itself, rather it spirals into issues of assault, the ruin of families and sometimes death. Surely, there are responsible alternatives for our mentally ill citizens, not only at St. Elizabeth's but everywhere in this country.

Posted by: concerned | June 7, 2006 9:31 AM

Wow, a DC government agency abysmaly failing in it's mission...I'm shocked!

Posted by: RL | June 7, 2006 9:58 AM

I worked at St. Elizabeths from 1978 to 1988. During that time patient's rights and the related notion of "least restrictive environment" came into being. The Federal bureucracts overseeing St. Elizabeths (it was once Federally owned, funded and run) at first resisted and then embraced the idea. They realized that "least restrictive" meant they could dump patients into the community with only a modicum of ongoing support. Hence the sudden rise of homelessness. Many patients I saw on the grounds as inpatients I started seeing in DC panhandling.

The coup-de-grace came when the Feds pawned St. E's off on the District in 1987. Marion Barry resisted the offer when it first came up in the mid-80s. He knew the city could not afford to run the hospital. The annual per inpatient cost then was about $50,000. But the Feds pushed and eventually prevailed, all a part of the Reagan budget cutting. They gave the District some short-term help, but all of us knew the hospital and its patients were doomed over the long run. I left in 1988 after a year with the District running things. It was clear they were trying to figure out how to manage the hospital with ever decreasing funds. While patient care in a big, publically funded hospital is always second or third best treatment, I can't imagine what it is like now. The article was depressing to read.

Posted by: Don | June 7, 2006 12:25 PM

The famous Ronald Reagan, the results are starting to come to surface.

The other sad thing is how Barry or our local government will take the fall, when factually it's the federal governments fault for taking away the money and allowing such a thing to knowingly happen.

These people just don't care.

And people wonder why DC is a strong Democratic state (oops i meant city).

I am sure there are many stories like this one that has been affected by those cuts made in pass and present.

I predict it ain't over yet, we have plenty more of this kind of thing to see.

Before you bash me, think about it and study the history.


Posted by: Frankey | June 7, 2006 12:35 PM

The lack of comments on this strand sadly says a lot about the other "problem" in the District, a really pathetic lack of engagement by the public in significant city issues. If this were a discussion of some frivolous lifestyle issue or the need for additional places to buy a $4 cup of coffee it would take ten minutes to scroll through the comments.

It's a sad commentary on the folks who read this blog and an even sadder commentary on those who are increasingly taking up residence in the District.

Posted by: CW | June 7, 2006 1:41 PM

Is St. E's supposed to be closing soon?

Posted by: John | June 7, 2006 1:50 PM

Best comments: CW's (most incisive); Don's (most informative). Marc, I'd recommend following up with Don.

CW has it E X A C T L Y R I G H T.

And as I have complained ad infinitum to Marc, I think the residents of Washington are oftentimes aggressively underinformed on local issues. The only good part is there are still people willing to get involved. But I am glad that Marc wrote about this, b/c it gave us a chance to see Don's comments. Good job.

Posted by: The usual critic | June 7, 2006 2:09 PM

I think St E's is to be divided in half (St Eliz's east and St E's west) with half going to federal, the other half remaining for the District with probably some partial development for housing and comm'l. Not sure what percentage is slated for development. Might not be set yet. Federal uses include Homeland Security offices and Coast Guard, if I am not mistaken.

Posted by: The usual critic | June 7, 2006 2:12 PM

I have monitored this strand today and I like CW am disapointed in the lack of interest and concern. This not only says a lot about the District but also of the metropolitan area.

Posted by: concerned | June 7, 2006 2:18 PM

Hey, I'm interested, but I have to work. Will post later.

You're partly right about what attracts attention and participation on the Post blogs. Lifestyle issues can be huge. The best example is the recently initiated blog called "On Balance", which deals with various issues related to balancing work and family life. And, there too, the serious issues--such as employment discrimination--get less attention than lighter, less technical topics.

The other blog traffic blog--to the extent that I have a view of all of them--is Chris Cilizza's "The Fix", which, as he says, deals with "raw politics". It's popularity is not surprising in a town of political junkies, and Chris's expertise is indeed impressive.

Not back to work. This already took too much time!

Posted by: THS | June 7, 2006 2:35 PM

I think people post to those other blogs because they feel more personally invested. Very few people feel personally invested in the plight of mentally ill people. And we should be. It could be anyone, and there's just no money out there to help. It's not just DC - mentally ill people get screwed everywhere.

Posted by: h3 | June 7, 2006 2:59 PM

This issue touches people more than they know. Let me try to make a principled concervative case for fixing these the issue:

People don't connect DC's inadequate (or absent) mental health, homeless, and drug and alcohol treatment with homelessness and crime. As an ANC Commissioner, I am regularly asked to close public parks at dark or seek increased enforcement against these at-risk people. And I can understand why- they are often a nuisance and can be dangerous. None the less, the knee-jerk reaction to move people to "somewhere else" is deeply dysfuntional. There is no "somewhere else"- everywhere is "here" for someone. So, through myopic competition between neighborhoods, these folks are just pushed back and forth and moved from place to place. We waste time and resources relocating and locking up and releasing these people, only to do the same thing the next day.

No one in government has ownership for the underlying problems. Try lobbying your elected (and paid) officials and see what happens. Really, you should. In the long run, it will save us all city money mis-spent on remediating (and re-remediating) an issue. And it's the right moral thing to do, besides.

Posted by: Mark | June 7, 2006 3:35 PM

It is truly a sad state of affairs when a new stadium is more important than providing adequate facilities/care for our mentally challenged and fixing up the public schools in the District. St E's is a forgotten institution. When I first came to DC in 1965 (I lived on Mississippi Ave) St E's was in pretty good shape. We seem to forget that one of us might have to be admitted to St E's one day. Who knows!!! The so called mayor is only concerned about himself. For St E's to be in the condition that you describe is truly unexcusable!! NO ONE, should have to endure such living conditions. When a new stadium is more important than proving for our mentally challenged and our youth, that tells you what sort of DC officials that we are dealing with!! MENTALLY CHALLENGED!! Let's admit them into St E's for one week and see what happens!!

Posted by: Becki | June 8, 2006 10:42 AM

Thank you very much for writing this article. I applaud you for bringing the plight of these vulnerable people out into the light. We, and our elected officials, cannot pretend we don't know what is going on anymore. People with illnesses and/or disabilites are not "less than", or "throw-aways". These people at St. E's are, were, someone's child. Anyone who thinks they will not be touched by an illness or disability in their life is sadly, sadly mistaken. Again, I thank you for speaking out on their behalf, Mr. Fisher.

Posted by: TL | June 8, 2006 12:29 PM

To be fair, the number of posts on Mark Fisher's blog is not much of an indicator of civic interest.

That said, I think you're right, folks don't seem to get it.

"The lack of comments on this strand sadly says a lot about the other "problem" in the District, a really pathetic lack of engagement by the public in significant city issues. If this were a discussion of some frivolous lifestyle issue or the need for additional places to buy a $4 cup of coffee it would take ten minutes to scroll through the comments.

It's a sad commentary on the folks who read this blog and an even sadder commentary on those who are increasingly taking up residence in the District."

Posted by: Tahrlis | June 15, 2006 5:30 PM

Good blog post, and the Post's coverage of the report was also good.
I challenge the Post to direct its Sunday Source writers to work on one Metro front page story every two months to find a really creative vivid way of presenting a story like this, or a similarly civic-minded story.
If only the Post's Metro section had used as much creativity in presenting the story on the mentally ill as they did on the poor intern who squanders $1200-odd dollars on a 70-square foot apartment. The assumption that readers won't engage with a topic is self-perpetuating. The admittedly clever title of a "In Harms Way At Hospital" is a good title because it invites readers to read by provoking curiosity, but the photo and the dull narrative presented the story in a dull way that made the issue sound routine-D.C. gov't incompetence as usual. The story endorses complacency.
--Sean O'Neill, in Dupont Circle

Posted by: Sean | June 17, 2006 5:11 PM

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