DHR to monitor itself in mental hospital settlement

Federal authorities will rely on a self-interested source to oversee Georgia’s progress in fixing its state psychiatric hospitals.

The Department of Human Resources —- the agency that operates the seven state hospitals —- will monitor its own compliance with a settlement agreement reached last week with the U.S. Justice Department. The agreement calls for the state to correct deficiencies that caused hundreds of injuries and illnesses and dozens of deaths among psychiatric patients, spending as much money as is necessary.

Within six months, a state employee will prepare Georgia’s initial compliance report, the agreement says. This “point of contact” for federal authorities then will report annually during the five-year term of the agreement.

But in settling other recent cases where it found dangerous conditions in mental facilities, the Justice Department insisted that states hire independent monitors to oversee promised improvements. The department required the District of Columbia to appoint a “compliance officer” for its psychiatric hospital who was acceptable to federal authorities. Its agreement with Nebraska specified the “independent expert” to design an overhaul of the state’s facilities for people with developmental disabilities.

In Georgia, federal authorities retained the right to intervene, threatening to take state officials to court if they don’t comply. For the first time, they will also review every patient death.

Still, the lack of routine outside supervision worries advocates for people with mental illnesses, many of whom wanted the Justice Department to continue investigating the state hospitals.

The investigation followed articles in The Atlanta Journal-Constitution, which reported that at least 136 patients died under suspicious circumstances from 2002 through 2007.

“We have an agreement that basically says, ‘Do the right thing,’ without anything put in place to make sure the state does the right thing,” said Ira Burnim, legal director for the Bazelon Center for Mental Health Law in Washington. “There is no assurance of sufficient oversight.”

The settlement agreement leaves the state with “wiggle room” as it addresses the most critical problems, said Thom Bornemann, director of the Carter Center Mental Health Program in Atlanta.

“I’m very concerned about early compliance over the next year,” said Bornemann, who contended the agreement could have established tighter time frames for improvements. “People dying in state custody is extraordinarily serious. The lives of people are involved.”

The agreement gives Georgia one year to improve efforts to prevent patient suicides, choking deaths and patient-on-patient assaults. Within four years, the state must demonstrate improvements in medical and nursing care and discharge planning, and it must show that hospitals restrain or seclude patients as little as possible. The state also must show that it conducts thorough, impartial investigations into patient deaths and other serious lapses.

State officials will “aggressively” monitor overall compliance with the settlement agreement as well as plans for corrections at each hospital, said Dena Smith, a DHR spokeswoman.

Although it gives the state primary oversight responsibility, the agreement allows the Justice Department to take strong action if additional deficiencies become apparent.

And if state officials don’t live up to their promise to appropriate enough money to make substantial improvements, the department may ask a federal judge to force additional spending.

Gov. Sonny Perdue has neither proposed budget increases for the state hospitals nor briefed key lawmakers on how much money might be needed. Rep. Mark Butler (R-Carrollton), chairman of a House subcommittee that oversees spending on social services, said the money in the existing DHR budget might be diverted to the state hospitals.

“Any time you have an agency that large, there’s a possibility of finding a place to squeeze out more money,” Butler said. “If not, we’re just going to have to figure it out.”

State officials, he said, should have been prepared to pay for hospital improvements.

State officials said they haven’t determined how much new spending will be required. But they said several provisions of the settlement agreement —- dealing with staffing levels, employee training and consultants to develop better hospital procedures —- could be costly.

The agreement apparently won’t derail an effort the state already had begun to address hospital deficiencies: hiring private companies to run the facilities.

Privatization and meeting the Justice Department’s requirements “are different animals with the same goal,” said Smith, the DHR spokeswoman.