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Mayor Fenty Announces St. Elizabeths Hospital Reform Agreement with the Department of Justice

Wednesday, May 30, 2007

Mayor Fenty Announces St. Elizabeths Hospital Reform Agreement with the Department of Justice

Mayor Adrian M. Fenty announced an agreement between the District and the Department of Justice establishing ambitious targets for reforming St. Elizabeths Hospital.

Washington, DC—Today, Mayor Adrian M. Fenty announced an agreement between the District and the Department of Justice establishing ambitious targets for reforming St. Elizabeths Hospital to routinely meet patients’ needs and comply with national accreditation standards.
“This agreement avoids possible protracted litigation that would be costly to taxpayers and allows the Department of Mental Health leadership team to focus on quality patient care,” said Mayor Fenty. “The agreement illustrates the Department of Justice’s confidence in District’s commitment to making the necessary changes at the Hospital to improve patient care.” 
Though the hospital has a long and rich history of providing innovative and humane care for patients suffering from mental illness, in recent years it has not met the standards of care for national accreditation.  A Department of Justice report based on a 2005 investigation alleged widespread deficiencies in hospital practices.
“This resolution provides tremendous opportunity for St. Elizabeths to address critical care areas involving all aspects of  treatment including staffing, training, patient rights and the environment,” said Stephen T. Baron, Director of the Department of Mental Health.
The Hospital has set a goal to obtain full accreditation from the Joint Committee on the Accreditation of Healthcare Organizations by the time construction of the new facility is completed in summer of 2009.
“The settlement calls for changes to be made within three years and we have already started,” said Dr. Patrick Canavan, who was appointed COO by Mayor Fenty in January.  “We have made significant changes including the hiring of more psychiatrists, strengthening treatment plans and expanding visiting hours so families can be more involved in patient recovery.

In addition, Dr. Canavan has hired a compliance officer to monitor implementation of the settlement.

 Agreement Summary
Treatment will be individualized and supported by a multidisciplinary team working together to develop an integrated plan that is modified as needed based on each patient’s response. The goal of treatment is to obtain the ability to

 place patients in least restrictive environments.

  • Treatment at St. Elizabeths will strengthen and support an individual’s rehabilitation and recovery.
  • Patients will be encouraged to participate in treatment goals and treatment options.
  • Treatment will be individualized based on the patient’s presenting symptoms and history to meet the needs of each patient’s goals.
  • Treatment will be provided by interdisciplinary teams that work together to address the individual’s needs so that he or she can be placed back into the community.
  • Each patient will have a treatment plan that is updated as needed based on the patient’s response to treatment, at least every 60 days. The plan will specifically identify the therapeutic means by which the treatment goals are addressed, monitored, reported and documented.
  • Each patient will receive assessments by the clinical team, which includes psychiatrists, social workers, nurses, psychologists, pharmacists and rehabilitation specialists on a regular and as needed basis.

 Patients will be treated with respect and will be free from abuse and neglect.

  • Seclusion, restraint or involuntary psychotropic medications will be used only when the patient poses an imminent risk of injury to self or others and only after less intrusive alternatives have been considered and determined to be inappropriate.
  • Staff will be trained specifically in the use of seclusion, restraint and involuntary medication.
  • Patients will be informed every 30 minutes of the behavioral criteria for release from the intervention.
  • The use of special interventions will be of limited duration.

A sufficient number of highly qualified staff will implement this agreement.

  • Additional psychiatrists, nurses, psychologists, social workers, pharmacists and other staff will be hired to ensure an adequate work force and to provide proper supervision of patients.  Specifically, the Hospital will ensure that each psychiatrist on an acute care ward is not responsible for more than 12 patients and no more than 24 on a long term care ward.
  • There will be on going training for all staff in all areas of treatment including but not limited to best practices in diagnosing and development of individualized assessments, development of behavioral interventions, the use of interdisciplinary teams and development of integrated treatment plans.
  • Quality assurance measures will be in place for monitoring clinical practices including behavioral treatment interventions.
  • Staff will be trained on incident reporting.

 Patients will receive treatment in a safe and humane environment.

  • St. Elizabeths will improve its infection control program.
  • The Hospital will have the capacity to regularly review the units and areas of the Hospital to which patients have access for safety.
  • The Hospital will update its fire safety and evacuation plan.
  • The Hospital will identify and remove all hazardous and unsanitary conditions in living units and kitchen areas.

St. Elizabeths Hospital will have a quality improvement program that provides effective monitoring, reporting and corrective actions.

  • Within four months, the Hospital will submit corrective action plans concerning integrated treatment planning, mental health assessments, incident management, and restraints, seclusion and emergency involuntary medication.  The plans will have specific steps to be taken with certain timelines and will identify staff responsible for applying the action steps and the quality assurance mechanism to evaluate the status of implementation.
  • The Hospital will implement a comprehensive incident management program that identifies incidents to be reported. The program will be responsive to incidents or allegations of abuse or neglect so that individuals involved are protected. Incidents will be reviewed and appropriate corrective and preventative actions addressing the problems will be identified and developed.
  • The Hospital will put in place a system that tracks and trends incidents as well as the results of actions taken.