ACLU lawsuit update: The abuse continues

Update from Juli Lawrence
ACLU lawsuit update: The abuse continues

For those who need a refresher

The ACLU has brought a huge lawsuit against the state of Illinois (http://www.i1.net/aclu/aclu.html) and Gov. Jim Edgar for its horrible conditions in state psychiatric hospitals. If the suit is successful, Illinois will be required to make improvements. I am a primary witness in the case, having had the misfortune of spending a week (involuntarily) at Choate in Anna, Illinois in October 1995. Those who knew me then know it was pretty bad, and the abuse and neglect was horrific.
Originally, the judge in the case ordered a huge investigation, and the cost, shared by the state and ACLU, was $300,000. It was very damning of the entire system. Eventually, the state asked the courts to remove the judge, saying he was too close to the case. The appeals court said ok, and appointed a new judge. So the trial was delayed. And then the state wanted a *new* investigation. I figured the hospitals would have time to clean up their acts, but apparently they didn't. And the new investigation, paid entirely by taxpayers, is just as bad.
We go to trial in July.

Here is ACLU's latest release on the situation:

Experts Report Violence, Neglect, Improper Care At Illinois Psychiatric Hospitals

Study conducted in response to ACLU lawsuit

FOR IMMEDIATE RELEASE
Friday, April 11, 1997

CHICAGO -- The American Civil Liberties Union of Illinois today released an expert report that is sharply critical of care and treatment at several state psychiatric hospitals in Illinois. The report, prepared after an extensive investigation of nine Illinois state operated psychiatric hospitals by a team of psychiatrists and psychologists from Yale University, was the latest development in a class-action lawsuit filed in 1992 by the ACLU.
The suit, K.L. v. Edgar, challenges the conditions, management and care provided at nine state-operated mental health facilities. It charges the state of Illinois with violating patients' constitutional rights to safety, freedom of movement, and adequate medical and psychiatric services as protected by the Fourteenth Amendment to the United States Constitution.
According to the report, several of the state hospitals have serious deficiencies in the care and treatment they provide, including staff intimidation, abuse and neglect of patients, high rates of runaways by patients who are dangerous to themselves and others, injuries, and frequent imposition of restrictive procedures -- such as confining patients to isolation rooms for hours or even days on end without adequate medical supervision, or access to fluids or toilets.
The experts, who were retained by the ACLU after a court-appointed panel of experts was disqualified from testifying last year, conducted on-site inspections of each of the nine hospitals last November, interviewed staff and patients, and studied thousands of pages of documents, including patient medical records and numerous internal and external studies and surveys of the facilities. The experts returned to three of the hospitals in February -- Elgin Mental Health Center in Elgin, Choate Mental Health Center in Anna and Zeller Mental Health Center in Peoria -- to conduct follow-up inspections that focused on issues of particular concern.

Among their findings:

Choate Mental Health Center has "a culture of staff intimidation and abuse of patients on the treatment units...Patients and family members reported that patients routinely were afraid of and intimidated by staff, whether in anticipation of losing privileges or being physically injured. Intimidating and threatening staff behaviors were apparently unchecked either by administrative oversight or by the OIG [Office of Inspector General] process [for investigating allegations of abuse and neglect]."

Chicago-Read Mental Health Center on Chicago's northwest side has long been unable to prevent dangerous or suicidal patients from running away even when they are under the direct supervision of staff. The rate of elopements at this hospital "was four times greater than the average elopement rate for the other eight facilities...and departed significantly from a minimum acceptable professional standard." This problem "reflected a failure of the DMHDD system to ensure the safety of the patients treated in this facility."

A unit at Elgin Mental Health Center demonstrated a "long-standing pattern of abuse and neglect of patients" and " a "high incidence of injuries." Senior and middle management of the facility were "not adequately organized to detect the magnitude of the problems or to respond in a concerted manner to rectify these problems within a reasonable time frame."

Zeller Mental Health Center had a widespread practice of locking patients alone in seclusion rooms at the discretion of staff without adequate justification or monitoring, resulting in a "serious risk of injury and/or death." Choate Mental Health Center similarly isolated patients alone in rooms for extended periods of time without physicians' orders or appropriate monitoring.

Choate also demonstrated "serious deficiencies in all aspects of the assessment and treatment process," including misuse of psychiatric medications and punitive responses to patient needs and physical disabilities.

The Department's central office provided little structured oversight of the hospitals and often seemed "absent" as they confronted their most difficult problems.

The report acknowledges some improvement at several of the hospitals, and it specifically finds that three of the hospitals did not have any major deficiencies. The experts conclude, however, that they are "not persuaded that progress noted in the system had been sustained over an extensive period of time. Consequently, it was hard to be confident about the durability of the improvements already accomplished."

The report provides several specific examples of the poor care at several of the hospitals:

-- A blind patient at Choate Mental Health Center was isolated on a nearly continuous basis in a "special observation room" for 58 days without adequate justification or appropriate monitoring.

-- A patient at Chicago-Read Mental Health Center was permitted to run away three times over a single weekend.

-- A patient at Elgin Mental Health Center was forced to perform oral sex on a staff member. The same staff member had previously been accused of sexual abuse but had escaped discipline because of poor recordkeeping.

-- Two patients at Zeller Mental Health Center attempted to commit suicide while locked alone in isolation rooms without proper monitoring or physician oversight -- a consequence of a widespread and unlawful practice at Zeller referred to as "locked time out."

-- One patient who had a colostomy as the result of a multiple rape repeatedly was punished by staff at Choate Mental Health Center when she demonstrated urinary and fecal incontinence. Her treatment plan took no account of the fact that she had suffered serious emotional harm from a traumatic brain injury and a multiple rape, nor did her plan consider the physical causes of her incontinence.

-- A patient, discharged from Elgin Mental Health Center without seeing her psychiatrist, had no place to live and had received an inappropriate amount of medication. Shortly thereafter she checked into a motel, overdosed on these medications, and died. Her caseworker later falsified records in an effort to conceal what had happened.

"This report demonstrates that, in spite of several years of litigation, Illinois continues to subject many of the patients in state psychiatric hospitals to appalling care and treatment," said Benjamin Wolf, Director of the Institutionalized Persons Project of the ACLU of Illinois and the lead attorney in K.L. "Instead of continuing to spend millions of dollars in legal and expert fees defending its misconduct, we call upon the State to agree to a court-supervised process to protect the rights of our most
powerless citizens."

The expert panel consisted of several eminent mental health professionals with extensive experience working in state psychiatric hospitals and public mental health systems. The panel was supervised by Ezra Griffith, M.D., a psychiatrist, and Michael Hoge, Ph.D., a psychologist. The panel also included two additional psychiatrists, Michael Norko, M.D. and Richard Belitsky, M.D., and two psychologists, Jacob Tebes, Ph.D. and Larry Davidson, Ph.D. All six members of the panel are affiliated with the Yale University Medical School.

The experts will testify at the trial, now scheduled to begin on July 17, 1997.

The site that NAMI and the APA would like to see banned!
The Psychiatric Tattler
http://www.i1.net/~juli/mental/pnews.html

"Just as oncologists often become numb to death, so do psychiatrists tend to grow insensitive to the everyday exercise of what is, after all, an incredible degree of social power." ........Dr. Neil Scheurich
Psychiatric Times, January 1997.