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Work Starts on ASH's List of Repairs: Recent Analysis Showed Breakdowns in Patient Treatment

Posted on: Monday, 8 May 2006, 09:10 CDT

By Stephen Curran, The Tribune, San Luis Obispo, Calif.

May 8--Atascadero State Hospital administrators have started working to repair widespread breakdowns in patient treatment outlined in a recent Justice Department analysis.

In a list of criticisms leveled at ASH, Justice Department investigators found excessive use of restraints and medication, prescription drug misuse and inadequate medical care, among other problems.

Such problems increase the likelihood that dangerous patients will return to state custody once they're released, Justice investigators said in a May 2 report.

The report caps a lengthy review into alleged civil rights violations at the state's five mental hospitals that began last February. Investigators in November conducted an on-site inspection at ASH, reviewing internal incident reports and interviewing administrators, staff members and patients.

Too often, Assistant Attorney General Wan J. Kim wrote in the 12-page summary, the hospital's 1,200 or so patients are caught in a disjointed treatment system in which time-strapped doctors, psychologists and nurses provide only cursory examinations that fail to clearly map out an appropriate treatment plan.

"The harm to these patients caused by these deficiencies takes many forms," Kim wrote, "among them, inadequate, ineffective and counterproductive treatment."

At worst, he continued, patients are exposed to potentially damaging treatments for conditions from which they don't suffer.

Dr. John Cannell, an ASH psychiatrist and safety advocate, had yet to see the findings Friday afternoon. Still, he said the shallow examinations described are inexcusable under Justice Department ratios that limit the number of patients assigned to doctors at 25.

But with patient loads that often exceed 200, he said, doctors are rarely able to perform more exhaustive exams.

"The psychiatrists who have 20 or 25 patients like DOJ recommends will do very thorough evaluations," he said. "Last week I had 200 patients, and I can tell you what kind of evaluations I gave: They were short and cursory. That's a fact of life."

The federal scrutiny comes as employees, including Cannell, are mounting a union-backed effort to draw attention to staffing and recruitment shortfalls they say put patients and workers at risk.

The shortfalls have already prompted an institutional shift away from controlling patients' symptoms with powerful psychiatric drugs and toward a team-based counseling approach.

The new system was the backbone of a controversial state budget proposal that would add 57 senior psychologists and three new psychiatrists to the hospital for the criminally insane.

As of Feb. 1, according to the hospital, administrators were working to fill seven vacant psychiatrist positions and 217 nurse or psychiatric technician jobs.

In a statement, David Bourne, the hospital's acting executive director, said administrators have begun working to correct the problems in patient care.

"The pointing out of deficiencies," he said, "is painful when balanced against what we believe to be our good reputation for the humane care and treatment of California's forensically mentally ill and disordered individuals."

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Copyright (c) 2006, The Tribune, San Luis Obispo, Calif.

Distributed by Knight Ridder/Tribune Business News.

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Source: The Tribune (San Luis Obispo, Calif.)

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