DATE: Saturday, November 1, 1997            TAG: 9711010032

SECTION: LOCAL                   PAGE: B6   EDITION: FINAL 

TYPE: Editorial 

                                            LENGTH:  127 lines

TOO SICK TO STAY OPEN ? CONTINUING PROBLEMS JUSTIFY LOSS OF ACCREDITATION FOR MENTAL HOSPITAL

Max Schneier, a nationally known advocate for the mentally ill, has read dozens of government reports evaluating mental hospitals in various states.

His assessment of the report summing up the U.S. Justice Department's evaluation last summer of Central State Hospital south of Petersburg is blunt: ``It's by far the worst I've ever read in my life.''

The retired attorney helped draft the standards by which the nation's top accrediting group measures mental hospitals. He's outraged that the findings did not prompt that organization to strip Central State of its accreditation.

Earlier this week, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced that Central's standing was being downgraded to ``conditional accreditation.''

A plan of action must be submitted within a month, and JCAHO will make another review in six months.

But for Schneier and other leading advocates for the mentally ill, putting Central State on probation is like trying to breathe life into a patient who has already expired.

``It appears to me that there are no grounds under which they would take away accreditation,'' said Schneier in disgust. ``Must everybody die in a hospital before they take accreditation away?''

State officials and JCAHO staff argue that everyone is working mightily to improve conditions. Earlier this month, the Allen administration announced plans to spend millions of dollars to hire new staff, upgrade training and reduce the population at Central State. A new, take-charge administrator is on board.

A JCAHO spokesman says withdrawal of accreditation could have led to the loss of federal funding, which might close down the hospital. The better alternative is to push and prod for improvements, she says.

The temptation is to concur that this is the rational approach.

But that's before listening to the story that John Doe (he didn't want his real name used) is writing down this week to send to Justice Department lawyers and any public official who will listen.

* * *

On Sept. 26, Doe's wife was voluntarily admitted to Central State Hospital. She was suicidal and suffering from severe depression. Insurance, which paid for 30 days' care at a private hospital in Richmond, had expired. Her physical condition was excellent.

But shortly after being admitted to Central State's psychological unit, she became catatonic, essentially entering a coma-like state in which she was unable to eat or drink.

As far as Doe has been able to determine, his wife was given no nutrients or fluids for three or four days. On Oct. 3, dehydrated and incontinent, she was transferred to Hiram Walker Medical Center, a state hospital located on the grounds of Central State.

The next day, Doe's sister-in-law, who is a nurse, visited his wife, who was by then semiconscious. According to Doe, ``she was covered in excrement and bleeding in her private area.''

When Doe's sister-in-law asked for assistance to get his wife to the bathroom, an aide seemed not to know how to help a patient who was unable to move.

His sister-in-law massaged his wife's arms and legs until movement returned. Later, the sister-in-law asked for a urine test. She was told that one would be done Monday, two days later. Only after she demanded immediate attention was a test done.

Angry meetings with Central State and Hiram Walker administrators followed, and according to Doe, his wife began to receive excellent care. But, in his view, the dehydration that his wife experienced while at Central State caused medical problems that delayed for several weeks the treatment of her mental condition.

Doe is a school counselor. His wife is a medical transcriptionist, trained in foreign languages. His sister-in-law is a professional in the medical field.

Doe's question and ours is this: How many families have the knowledge and resources to raise the fuss that this one did? How many patients have no one to advocate for them when their treatment is inadequate or inappropriate or all wrong?

Our answer to the first question is, ``not many.'' The answer to the second, we fear, is ``most.''

Remember, the hospital that Doe and his family encountered is the one where Gloria Huntley died 15 months ago after being strapped to her bed for 300 hours in the last month of her life.

In the months since then, officials have drafted plans, shuffled personnel, and issued statements promising to upgrade conditions at Central State. All that talk and attention apparently had no impact on the services received by John Doe's wife.

Even the advocacy system that was supposed to protect her failed. In the middle of the week of Oct. 19, Doe's wife - who is much improved - left a note in the mailbox of the patient advocate for her unit, asking to speak with him.

By Monday, Oct. 27, she had still had no response. On either Monday or Tuesday morning (he cannot remember which), Doe called the office of the patient advocate and left a message, again relaying his wife's request.

As of Thursday, she had still not heard from a patient advocate.

We need no additional proof that this system, as well, is broken.

* * *

The state's solution is the announcement that it will spend $8.7 million by June improving the hospital, and more over time. But many mental health advocates think that's the wrong answer. ``It breaks my heart to see them pouring that money into an institution,'' said Powell, the executive director of the Virginia Mental Health Consumers' Association.

Like many mental health advocates, she believes community-based care is far preferable - so long as it is adequately funded. Virginia has one of the highest rates of mental institutionalization in the nation.

Val Marsh, who heads the Virginia Alliance for the Mentally Ill, was also disappointed. She believes a culture of neglect has become so institutionalized at Central State that it probably is beyond repair.

``Here we are at the end of October,'' four months after the Justice Department issued its report, Marsh said. ``They are making all kinds of promises. They have a plan all laid out. And we continue to get calls from consumers saying, `This place is terrible.'''

Everyone from the federal government to the Allen administration to the state legislature to JCAHO has now offered their recommendation for Central State. Here is ours.

We have made tremendous progress in recent years in the treatment of mental illness. Through medication and appropriate services, individuals who once would have been sentenced to a lifetime of hopelessness now can live useful lives.

But Virginia has been unwilling to invest adequately in community-based resources for the mentally ill. That's shameful. The end result is overspending on hospitals that, at least in the case of Central State, ill-serve the population they are intended to save.

The day-to-day performance of Central State must be improved immediately to the point that lives are not being jeopardized. And there must be aggressive, independent oversight to make sure that it's happening. Appoint an on-site inspector general to make sure that patient complaints are being heard. Otherwise, we join Max Schneier in saying: Shut it down. KEYWORDS: CENTRAL STATE HOSPITAL

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