St. Elizabeths Emerges From Federal Oversight

St. Elizabeths Hospital in Washington, D.C., is finally free of the federal monitoring put in place seven years ago to ensure that the rights of patients were enforced.

“This is the last of several cases and gets the Department of Behavioral Health completely out from under any federal oversight,” Stephen Baron, L.C.S.W., director of the District of Columbia Department of Behavioral Health (DBH), told Psychiatric News.

On August 28, the Department of Justice (DoJ) asked the U.S. District Court in Washington, D.C., to dismiss the injunction against the city, which owns the psychiatric hospital. The department said that the District of Columbia had sufficiently improved the care and treatment of patients at St. Elizabeths Hospital, which has served as a training ground for generations of psychiatrists.

Reforms undertaken by the city agency “have resulted in important improvements in integrated treatment planning, psychological and psychiatric services, nursing care, and protection from assault,” said the DoJ in a statement. The reforms also improved discharge planning and the community placement process.

The case began in 2005 when the DoJ investigated 400 hospitals nationwide under the Civil Rights of Institutionalized Persons Act and the Americans With Disabilities Act and concluded that 75—including St. Elizabeths—needed closer monitoring.

Based on its review, the DoJ cited St. Elizabeths for a lack of individualized treatment and quality treatment, poor treatment planning, too few discharges, and excessive use of seclusion and restraint. It issued its report in May 2006, a month after Baron arrived to lead the DBH.

“We then sat down and negotiated a five-year settlement agreement containing 224 performance benchmarks, which was finalized in June 2007,” said Baron.

Among other provisions, the hospital moved to increase to 50 percent the proportion of direct-care staff who are R.N.s. An electronic medical records system and other changes were put in place to support discharge planning. And the opening of a new hospital building in 2010 addressed environmental issues (Psychiatric News, May 21, 2010).

Involuntary civil admissions were reduced from about 150 a month 10 years ago to between 15 and 20 a month today, largely by increasing the number of inpatient beds in four community hospitals devoted to involuntary acute care.

“If individuals need an inpatient stay longer than 14 days, then they are transported to St. Elizabeths,” he said. “It functions now as a way station.”

The connections with other area hospitals mean that St. Elizabeths is now part of an integrated community mental health system, said Baron. “We’re not just a hospital; we’re a whole system of care.”

“The leadership of the Department of Behavioral Health and of St. Elizabeths Hospital has made significant and often difficult decisions to change the clinical culture at St. Elizabeths Hospital and ensure that persons confined to hospital were appropriately discharged and integrated into the community with adequate supports,” said Acting Assistant Attorney General for Civil Rights Molly Moran, J.D., in a statement. “They strongly supported the required changes and provided the time, energy, and resources necessary to achieve reform.”

A second lawsuit, filed by the advocacy group University Legal Services (ULS), was settled in 2011. That litigation also covered “blatant violations of the individuals’ rights and a disturbing lack of respect for the individuals served, . . . practices resulting in abuse and neglect.”

ULS will continue to play a monitoring role under federal law, said managing attorney Mary Nell McGarity Clark, J.D.

“We have had an open cooperative relationship with the management since our settlement, and we are at the hospital at least once a week visiting clients and making presentations,” Clark told Psychiatric News. “Because of the settlement agreement in our case, reinforced by the agreed dismissal of the Department of Justice litigation, we are able to advocate more effectively for the patients.” ■

The Department of Justice’s statement on the St. Elizabeths case can be accessed here. More on St. Elizabeths is available on the DBH website here.