Report blisters state mental hospital in Atlanta

A team assembled by the Medical College of Georgia conducted the review last month. The Department of Human Resources, which operates Georgia's seven state hospitals, commissioned the study during a recent AJC investigation of patient deaths in the psychiatric facilities.

The newspaper reported in January that at least 115 state hospital patients had died under suspicious circumstances from 2002 through 2006. That number included 19 from the Atlanta facility. The newspaper also found 194 confirmed cases of physical or sexual abuse.

The study shows problems remain rampant at the Atlanta hospital despite increased scrutiny prompted by the newspaper articles.

The hospital's staffing "has reached desperate levels and hiring standards are compromised in order to just fill a position,'' the surveyors reported. They quoted employees as saying that, with a lack of accountability for substandard care, the hospital focused "more on looking good than actually being good."

Moreover, the hospital has failed to correct practices known to put patients at risk, the surveyors found. The study did not address previously reported patient deaths. But it specifically cited continued problems with monitoring constipated patients which contributed to the deaths of at least two patients featured in Journal-Constitution articles and conditions that might enable suicide attempts by adolescent patients.

Officials at Georgia Regional and in the governor's office did not respond Tuesday to requests for interviews.

Despite the severity of problems outlined in the report, the inspection team, which includes an internist, a psychiatrist and a nurse, has no authority to force change at any of the state hospitals. But a Human Resources spokesman, Thomas Wilson, said the report "outlines several different areas of things that can be improved. We're glad we have that so we can go forward. ... The positive side of it is it's pretty clear what needs to be done."

The consultants labeled their study as "interim," designed to give immediate feedback and point out priorities for the hospital to address.

The team already had issued an interim report on Georgia Regional Hospital/Savannah. Dr. Peter Buckley, chairman of the college's Department of Psychiatry and Health Behavior, said the surveyors would examine the other five facilities by the end of the summer before writing a final report.

The surveyors found fewer problems in the Savannah hospital than in Atlanta. Nevertheless, they criticized the facility for failing to follow up on patients' medical conditions, for not documenting the reason patients were secluded or restrained, and for allowing patients to be sedated without a physician's assessment. They also noted that the facility counted such activities as movie screenings and bingo as patient therapy sessions. But in contrast to Georgia Regional in Atlanta, the Savannah hospital had "good staff attitude and morale," despite overcrowding on the patient wards.

The Atlanta report contains unusually strong language, expressing "surprise" over several conditions and describing other situations as "disturbing."

The surveyors described broad problems in documentation of patients' medical conditions and treatment, noting that some medical charts were inexplicably "purged." They said some patient information recorded as recently as March had already been discarded.

The hospital failed to document whether it followed numerous guidelines for restraining patients, including whether workers checked the patients' vital signs or even whether physicians assessed the patients, the surveyors found. The Joint Commission, a national accrediting agency for medical facilities, requires that hospitals promptly notify patients' families of restraints or seclusions. It also requires that physicians order or approve restraints in writing and that hospital staffs check patients' conditions every 15 minutes during restraint.

Record-keeping of patient medications was inconsistent, and possible drug allergies or interactions with other medications were not immediately flagged in some cases, the surveyors reported. In one instance, a physician did not notice a drug-interaction report from the hospital's pharmacy for four days.

The report cited a lack of follow-through when problems arise. For instance, when 78 medication errors by physicians occurred in a single month, the hospital didn't follow up on possible patterns of errors. Nor were patients' medical problems fully assessed. In half the charts reviewed, the report said, physical examinations were "late, scanty or blank."

One adolescent patient did not immediately receive a physical exam, despite reporting that she was hit by a truck before her admission. The patient had reported that her ''whole body hurt,'' but nurses failed to record that she was in pain.

Despite consistently overcrowded conditions, a psychiatrist on the inspection team found that many patients could be discharged. The report said, however, that records of many discharged patients reflected vague diagnoses, indicating a lack of thorough evaluation.

The surveyors cited safety problems in the adolescent unit, where patients had access to long shoelaces and other conditions that create ''a scenario where suicide by hanging could occur with reasonable ease.'' The report also described a "lack of supervision" in an outside area where patients had unraveled portions of the hospital fence.

Other problems cited in the report include patients sleeping in chairs and on the floor during a group therapy session, as well as poor employee morale.

Many workers were "reluctant, even fearful, to talk," the report said. "Some employees stated that they had experienced retaliation when they had spoken out, or were 'reported' even when just talking among themselves.''

The surveyors recommended the hospital keep better records, examine patients more promptly, try to keep good employees and communicate more with patients' families.

The report comes amid increased scrutiny that could lead to changes in the state hospitals. The Justice Department is opening an investigation into whether patients' civil rights have been violated by conditions in the hospitals. And state lawmakers recently created a commission to study a possible overhaul of the mental health system.

Already, the Atlanta hospital's administrator, Ronald Hogan, has announced he is retiring later this year. Officials have said his retirement is unrelated to disclosures of problems at the hospital. Regardless, Medical College of Georgia's Buckley said the change comes at an opportune moment.

"If you get the right people," he said, "you can turn things around."

Additional information :

Report blisters state mental hospital in Atlanta: from www.ajc.com