Federal judge rejects plan for Georgia's mental hospitals

Justice Department, advocacy groups say 'harmful and unsafe conditions' continue

The ruling by U.S. District Judge Charles A. Pannell represented a setback for the state, which had vowed in January to significantly improve care in the seven hospitals. The state’s promise had forestalled the possibility that the U.S. Justice Department would ask the judge to take over Georgia’s mental health care system.

Now the state must devise another way to live up to a settlement agreement with the federal government. State and federal officials had asked Pannell to approve the agreement in January, but he allowed several mental health advocacy groups to present their objections.

In Wednesday’s ruling, Pannell said he could not approve the long-standing motion to validate the January agreement because the Justice Department “has indicated it no longer agrees with the motion.”

Pannell is likely to soon conduct a hearing on how to proceed, lawyers involved in the case said. But if a suitable plan for improvement isn’t proposed, the judge could order sweeping, expensive changes. He also could take away the state’s control of its own institutions.

The settlement agreement had been intended to resolve a federal investigation opened in 2007, after articles in The Atlanta Journal-Constitution reported that more than 100 patients from the state 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.

In court papers filed Wednesday, by coincidence just minutes after Pannell released his ruling, the Justice Department and several mental health advocacy groups alleged that “harmful and unsafe conditions” continue unabated in the hospitals. Federal investigators, according to the court papers, have found “little substantive, sustained improvement” in the past nine months.

Investigators documented sexual assaults, suicides and attempted suicides, and other suspicious deaths in at least three of the seven hospitals this year, according to court papers. Those episodes, the government contended, “demonstrate that patients continue to suffer preventable harm due to deficient practices.”

“You’ve got deaths and rapes still happening in the state hospitals,” said Josh Norris, a lawyer for the Georgia Advocacy Office, which, along with the nonprofit Bazelon Center for Mental Health Law in Washington, represents organizations opposed to the settlement agreement. “The state’s really made no progress in addressing these things.”

A spokesman for the state Department of Behavioral Health and Developmental Disabilities, a newly created agency that took over the state hospitals in July, did not respond to requests for comment late Wednesday. Two weeks ago, the agency submitted documents to the court asserting it was trying to comply with the terms of the settlement agreement.

But seven times this year, according to court documents, the Justice Department wrote to state officials, complaining of new failures to protect patients.

The episodes included:

In April, the department said, one patient beat another to death at Central State Hospital in Milledgeville. In May and again in August, two patients were raped at East Central Regional Hospital in Augusta. Another rape occurred in July at Southwestern State Hospital in Thomasville.

A patient committed suicide at Georgia Regional Hospital/Savannah in August. And on Sept. 22, another patient at East Central attempted suicide when he was left alone, according to court papers, after telling staff members he had nothing to live for.

The episodes at East Central and Savannah were “particularly troubling,” the Justice Department said, because they occurred soon after federal investigators visited those facilities and pointed out “serious concerns” about whether the hospitals were capable of preventing suicides and protecting patients from harm.

“The continuation of these grave incidents demonstrates the state’s failure to implement the [settlement] agreement in a timely manner,” the Justice Department told the judge.

The department found especially troubling conditions at Central State.

So far this year, 11 of its patients have died, most under circumstances that caused federal officials to question the quality of medical and nursing care. One patient who was supposed to be under constant supervision was instead left alone for an hour, during which she died; staffing was insufficient, an investigation found, and the nurse on her unit didn’t know how to summon emergency help and didn’t attempt to resuscitate the woman. Another patient, for whom cardiac tests had been ordered but not performed, died of a heart attack.

The Justice Department questioned how thoroughly Georgia officials investigated the deaths at Central State.

In some cases, the department said, relevant witnesses were not interviewed, and important medical documents were not reviewed. Investigators, the department said, made no effort to resolve conflicts in the accounts given by different witnesses.

The Justice Department also said the state has failed to make needed improvements in community-based mental health services. Without adequate treatment, advocates say, many patients wind up continually returning to the state hospitals. At East Central, investigators found that as many patients are discharged to jails as to treatment programs. In a recent 12-month period, about 40 were sent either to shelters for homeless people, motels, boarding houses or, in one case, the streets.

Support real journalism. Support local journalism. Subscribe to The Atlanta Journal-Constitution today. See offers.

Your subscription to the Atlanta Journal-Constitution funds in-depth reporting and investigations that keep you informed. Thank you for supporting real journalism.