State mental hospital stops admitting patients

State mental health officials have stopped accepting new patients at Georgia's largest psychiatric hospital, following a federal inspection that found problems with patient violence, dangerous conditions and inadequate mental health treatment.

While Central State Hospital in Milledgeville will remain open, the problems are so grave that the facility will not accept patients for a period that could last several months while changes are made, said Thomas Wilson, spokesman for the state Department of Behavioral Health and Developmental Disabilities.

"There were some concerns of an urgent nature," Wilson said.

Wilson said new patients are being diverted to the state's other mental hospitals or community-based services when appropriate.  A part of the Central State facility, which accepts people the criminal courts have deemed insane or unable to stand trial, will continue to accept new patients, he said.

Federal inspectors from the U.S. Justice Department visited Nov. 2-6 and found three major areas of concern, he said. The hospital has problems with patient-on-patient violence. The facility has objects and fixtures that could assist patients in harming themselves or committing suicide. And the mental health treatment is inadequate, which Wilson said is leading to some patients being released only to return to Central State.

The state's move will thin a patient population that stands at about 450 and free up staff to undergo training, implement new policies and procedures, and change potentially dangerous conditions at the hospital, Wilson said. Overcrowding is not an issue driving this action, he added.

The federal complaints mark another problem as the state attempts to comply with a federal agreement to improve conditions at the state's seven mental hospitals. Georgia entered a settlement agreement with the Justice Department in January, but the federal agency has said it can no longer abide by the agreement since it believes the state is not doing enough.

The state had another setback recently when a federal judge rejected Georgia's plan to fix its mental hospitals.

On Wednesday, U.S. District Judge Charles Pannell directed state and federal officials to meet by Dec. 14, after which he will schedule a hearing on how to proceed in the case. The Justice Department said the state’s own reporting to the court shows that the January agreement has not resulted in significant improvements. Further, the department said, a “fundamental disagreement” exists over whether the agreement allows the federal government to force the state to expand community-based treatment as a part of remedying conditions in the  state hospitals.

The Justice Department has pointed an especially harsh spotlight on Central State this year, sending state officials a series of letters detailing conditions that continue to endanger patients’ safety.

In April, the department complained of “significant systemic failures” that contributed to a homicide last spring. Hospital staff members were not adequately supervising patients, nurses had falsified patient records and the patient who allegedly killed another had been improperly assessed, the department said. The hospital made matters worse, officials said, by returning the alleged killer to the same unit after he was booked at the county jail and sent back to Central State.

In June, the department notified the state it had learned of 11 patient deaths since January, which raised “significant questions regarding supervision, observation levels, and communication of relevant information to the appropriate clinicians.”

Federal authorities said their most recent visit to Central State confirmed that “grave harm continues to occur at the state psychiatric hospitals.”

Justice officials declined to comment on the matter Friday.

Georgia's mental health advocates praised the state for taking action, after what they say has been decades of neglect at the state mental hospitals. But they also said Georgia has a long way to go in providing the proper care for those with mental health problems.

"I think it's a good thing that they are not admitting patients to a hospital that is unsafe," said Cynthia Wainscott, a board member of Mental Health America of Georgia. "What we know now is what a mess it is."

She said the state is showing signs of addressing the problem. Gov. Sonny Perdue created a separate agency to handle mental health last year. When the governor ordered budget cuts across state government last summer, the new agency was the only one spared, said Wilson, the department spokesman. Hospital workers, unlike employees at other state agencies, were exempted from furloughs.

"There is a new agency and  new leadership. The governor is very focused on this," Wainscott said.

But it remains to be seen whether the state Legislature provides the additional funds needed to fix the system and provide more community based care, she said.

The federal involvement began in 2007 following articles in The Atlanta Journal-Constitution that reported that more than 100 patients from the state mental hospitals had died under suspicious circumstances since 2002. The newspaper found that abuse, neglect and substandard medical care had contributed to many of the deaths.

Wilson said the Justice Department is "concerned about progress, and we are concerned about progress" in improving the facilities.

But he said the state still expects to meet the benchmark that it will be in "substantial" compliance with the federal agreement in January.

The state recently hired several mental health experts to help with policies and procedures at Central State, which is located near Macon, he said.

He said the state will improve the screening and supervision of aggressive patients.

Workers will also change or remove fixtures or items that patients could use to hurt themselves. Wilson noted that a patient at a state mental health facility in Savannah upended a bed and used it in an attempt to hang himself. Since that time the beds in mental health facilities have been bolted down.

Staff writer Alan Judd contributed to this report.