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?
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