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Public Roundtable on The Department of Justice Investigation of St. Elizabeths Hospital

Monday, June 26, 2006

Public Roundtable on The Department of Justice Investigation of St. Elizabeths Hospital

Stephen T. Baron

INTRODUCTION

Councilman Catania, I appreciate your calling this hearing, and I want to assure you that the District of Columbia, the Department of Mental Health, and St. Elizabeths Hospital take the allegations in the Department Of Justice (DOJ) letter very seriously, and we are committed to working collaboratively with DOJ to address areas of concern.

We’re here today because of an investigation of St. Elizabeths Hospital by the U.S. Department of Justice (DOJ). Congress gave DOJ the authority to investigate the care and services provided by public institutions, including state psychiatric hospitals like St. Elizabeths, which treat people who are severely mentally ill, typically indigent, present a danger to self or others, and cannot or do not have access to care at community-based psychiatric hospitals. DOJ serves an invaluable role in ensuring that these institutions, which care for the most difficult and dangerous to treat, protect the patients’ civil rights.

However, because DOJ has the authority to bring suit against the District, there is an existing lawsuit by University Legal Services against the District with regard to services provided by St. Elizabeths, and certain incidents and events identified in the DOJ findings are the subject of other pending and threatened litigation, on advice of counsel, I will not be able to discuss the details of particular facts and circumstances described in the DOJ investigation report in the course of my testimony today.

Significantly, Chairperson Catania, we are at the beginning of our work with the DOJ, and thus conclusions, predictions, and bold statements about the Hospital from me are premature. We do not expect this to be a short or easy process. We anticipate getting additional information from DOJ in the coming weeks and will start discussing issues with them.

We have already begun, and will continue, to look at the specific incidents discussed in the DOJ letter and will develop the best structure to closely monitor the Hospital. We will take whatever steps are necessary to address areas of concern. No person or process that is relevant to patient safety and quality of care will be excluded from our review, including overall staffing. If personnel actions are called for, personnel actions will be taken. If processes are flawed or broken, those processes will be changed and improved.

Much work already has been done by new clinical leadership at the Hospital, but even that work will get a second look as part of our review. In short, while I cannot tell you exactly how this process will unfold, I can tell you that it will be thorough, fair, and move with all deliberate speed.

Despite its many challenges, we believe, the Hospital has made improvements since the DOJ investigation in June 2005. I would like to highlight that progress in the major areas addressed in the DOJ report. First and foremost is the establishment of new medical leadership which is committed to implementing high quality treatment, holding clinicians and other direct care staff accountable for performance and ensuring that staff are well trained in these best practices as they integrate them into the care provided to the patients.

PATIENT SAFETY

It is important to note that there have no patient suicides in the past seven years due to the use of appropriate observation procedures. Unfortunately, the use of these procedures is not always documented adequately in individual patient charts.

The new medical and psychiatric leadership has revised the Seclusion and Restraint Policy, which was implemented in early 2006. Today there are approximately 200 hours per month as compared to 15,000 month five years ago.

Another issue addressed by DOJ is the use of medications. When people with severe mental illness display behavior harmful to themselves or others, sound clinical practice dictates using certain medications to prevent injury. St. Elizabeths’ leaders are making sure these medications are being used properly and in appropriate circumstances.

St. Elizabeths uses strict standards for regulating the movement of patients both on the grounds and off. As a result, if a patient does not return at the exact time required, that tardiness is recorded as an “elopement”. However, as a result of our policies the number of elopements is declining. A comparison of the period reviewed by DOJ in 2005 with the same period in 2006, shows that elopements are down 30 percent. I want to assure the public that there have been no elopements from St. Elizabeths’ maximum security units because these strict standards are applied throughout the Hospital.

QUALITY IMPROVEMENT

Quality improvement is the continuous process of analyzing high-risk and high-volume operations to identify means for improvement.

We developed and implemented new performance improvement measures for forensic services that captured participation of treatment team members in Interdisciplinary Recovery Planning Conferences and provided quarterly feedback on each discipline’s performance to Performance Improvement Committee and Discipline Directors.

According to an independent expert, there has been strong progress with regard to performance improvement training, awareness and use of performance improvement teams.