Georgia mental health talks fail

By Alan Judd

The Atlanta Journal-Constitution

More than 15 negotiating sessions. Telephone conference calls at least once a week for four months. Five extensions of deadlines to file crucial court documents.

After all that, talks to settle a federal investigation of Georgia’s mental health system came down to a single meeting Wednesday. Yet again, the talks failed.

Federal authorities immediately went to court, asking a judge to force Georgia to make substantial and potentially expensive improvements in its state psychiatric hospitals and in its community-based treatment services — the same measures state officials rejected during the negotiations.

The U.S. Justice Department also wants the judge to take oversight of the state system from Georgia’s newly formed mental health agency and put it into the hands of an outside monitor.

“Regrettably, the parties’ negotiations have failed to resolve the United States’ concerns,” Justice Department lawyers wrote in a motion to U.S. District Judge Charles Pannell, who has supervised the negotiations, “and the grave harm alleged in the United States’ [earlier] motion must be addressed.”

The federal government sued the state in January 2009, claiming that its inadequate mental health system violated patients’ civil rights. Wednesday’s filing puts the state in the position of having to defend a system in which years of under-funding and overcrowding contributed to dozens of patients’ deaths.

But state officials, who met late Wednesday to plan a response to the filing, said they hope negotiations will resume, despite the Justice Department’s statements to the contrary.

“It’s not an end nor a beginning; we’re still in the middle of working through what’s going to be the best plan for us,” said Tom Wilson, a spokesman for the state Department of Behavioral Health and Developmental Disabilities. He described Wednesday’s meeting as “one event in a long series of events.”

To advocates for people with mental illness, the state’s reluctance to accept the Justice Department’s demands indicated that officials see no urgency to correct dangerous conditions.

“The state is unwilling to take the steps it needs to take to fix these problems,” said Alison Barkoff, a lawyer with the Bazelon Center for Mental Health Law, which intervened in the federal case. “It’s a real missed opportunity.”

Cynthia Wainscott, a former president of the advocacy group Mental Health America, said the failure of negotiations was especially disappointing in light of state officials’ promises to improve services. Still, she said: “I hope that we can quickly move forward, whether through an agreement or through an order from the judge.”

Senior officials with the Justice Department’s civil rights division came to Atlanta for Wednesday’s meeting with Frank Shelp, commissioner of the behavioral health agency, and the state’s lawyers. Both sides thought they could settle the case. But, participants said, state officials would not budge on two major obstacles: how much to expand community services and how to monitor the state’s performance under a new agreement.

The state had publicly complained about the demand for more community services, saying the Justice Department was trying to unfairly expand the scope of the original settlement, which covered only the state hospitals.

But “they’re interrelated,” Barkoff said. “You can’t fix one without fixing the other.”

Ultimately, participants in the negotiations said, the state failed to convince federal officials of its commitment to change.

“There comes a point where revisiting the same substantive issues doesn’t make sense,” said Ruby Moore, executive director of the Georgia Advocacy Office, which also intervened.

The Justice Department opened its investigation in 2007, following a series of articles in The Atlanta Journal-Constitution that revealed more than 100 suspicious deaths of state hospital patients during the previous five years. State and federal authorities reached an agreement in January 2009 that called for improvements in the hospitals.

But a year later, the Justice Department asked Judge Pannell to set aside the agreement, asserting in court papers that “preventable deaths, suicides and assaults continue to occur with alarming frequency in the hospitals.”

The department complained that the state had failed to address inadequate treatment, excessive use of restraint and sedatives to control patients and inadequate medical and nursing care. From May 2009 to January 2010, the department sent the state 11 “emergency letters” that detailed, among other events, a homicide at one hospital, rapes at two others, two suicides and two other deaths deemed to be “questionable.”

Pannell put the case on hold in March when both sides suggested they might reach an agreement. That led to the repeated meetings, in Atlanta and Washington, and telephone conferences. Several times, participants said, negotiators thought they could settle the case. “Despite these extensive efforts,” the Justice Department said in court papers, “the parties have failed to reach an agreement.”

Continuing coverage

In “A Hidden Shame,” a series of articles that began in 2007, the AJC revealed that dozens of patients at Georgia’s psychiatric hospitals had died from abuse, and that the state lagged in providing community-based mental health treatment. Georgia created a mental health agency, and the U.S. Justice Department opened an investigation. The AJC continues its coverage as developments unfold.