Parkland psych ER is again scene of patient abuse

The psychiatric patient spat at Parkland Memorial Hospital staff as they strapped her into a chair. Then a nurse shoved a toilet paper roll into her mouth, while a co-worker put a sheet over her head.

“Blood stains can be seen on the toilet tissue” after its removal, says a police report that describes security camera footage. A follow-up report says a third employee warned the caregivers that their actions were “illegal.”

Texas health authorities are investigating the March incident — the first abuse in Parkland’s psychiatric emergency room to become public since the hospital hired a new chief executive. One nurse involved in the gagging was also involved in the 2011 restraint of a psych ER patient whose death triggered a federal investigation and virtual takeover of Parkland.

State health regulations prohibit restraint that obstructs a psychiatric patient’s airway or ability to communicate. A prior state enforcement action against Parkland requires hospital managers to report patient abuse within two days of becoming aware of it.

Parkland reported the gagging incident more than three weeks after it occurred. The hospital said managers didn’t know about it initially but acted promptly once they did.

“Employees on site did not elevate this incident appropriately,” Parkland spokeswoman April Foran said. The hospital fired two of five employees who were present during the restraint, she said. Two others resigned, and a fifth “received corrective action.”

Parkland, which collects hundreds of millions of dollars a year from Dallas County taxpayers, would not name the employees. But The Dallas Morning News confirmed the identities of two: Charles Enyinna-Okeigbo, the nurse who forced the toilet paper roll into the patient’s mouth, and Sherwin De Guzman, a supervising nurse.

Authorities have previously investigated both nurses: Enyinna-Okeigbo for domestic violence, and De Guzman in connection with the 2011 death of psych ER patient George Cornell. State and federal regulators found that Cornell was illegally restrained shortly before dying. They cited De Guzman for failing to supervise the technicians who subdued Cornell.

Parkland’s in-house police department investigated the March incident and asked the Dallas County district attorney’s office whether assault charges should be filed. A prosecutor said that the use of force was “unfortunate” but not criminal.

Both nurses declined to comment to The News. Enyinna-Okeigbo told police that he was merely trying to stop the spitting and was not angry with the patient, according to Parkland records.

UT Southwestern Medical Center, whose physicians supervise care at the public hospital, identified the psychiatrist in charge as Dr. Uros Zrnic. He “was not informed or aware of the incident until the videotape was reviewed” in April, UTSW said.

Terrified patient

Experts criticized Parkland after reading police reports on the latest incident at The News’ request.

“When a patient spits, it’s the last resort of a terrified human being, and being restrained like this is terrifying,” said Dr. Peter Breggin, a New York psychiatrist and former consultant for the National Institute of Mental Health.

“Trained mental health workers in this day and age know that spitting is a cause for staff to back off,” he said, adding that forcing objects into patients’ mouths can escalate violence. “There’s no excuse for this abuse.”

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said some Parkland psych workers “still don’t get it.”

“This is pretty outrageous when it was just a few years ago that these kinds of actions were supposed to trigger training and other safe approaches at Parkland,” Borel said. “Everything in the patient’s behavior indicates she was desperately trying to protect herself, and they were making it worse. They failed the patient miserably.”

The state health department hit Parkland in 2012 with a $1 million fine because of Cornell’s death and several other “egregious deficiencies.” It was by far the largest hospital fine in Texas history.

Under a settlement, the hospital paid $750,000. It can avoid paying the rest if, by later this summer, it demonstrates compliance with safety requirements.

Because of the gagging incident, regulators are investigating whether there have been more “significant, egregious deficiencies and a failure to correct them or an attempt to hide them,” said health department spokeswoman Carrie Williams. “It’s an open investigation, and there have been no findings in this case so far.”

Parkland also remains under a 2013 corporate integrity agreement with the U.S. Department of Health & Human Services. It requires periodic reports on patient safety, among other steps.

Compliance with that agreement is a top stated priority of Dr. Fred Cerise, Parkland’s new chief executive. He started work about a week after the March gagging incident.

Cerise and other hospital officials declined to be interviewed for this report. In written responses to questions, Parkland said “the event was discovered” on April 8 during a routine review of security video from March 16. Parkland notified the Texas health department within a day, they said, in compliance with state regulations.

Parkland also said that in addition to taking personnel actions, it now requires video reviews of restraints within 24 hours. But it would not say whether it previously had a schedule for reviewing the security videos, or why it took more than three weeks to detect the gagging incident.

Quick investigation

The criminal investigation lasted less than 48 hours before the case was closed as “unfounded,” police reports show. A News investigation last year found that Parkland police have a history of quickly closing cases in which hospital employees are accused of abuse.

The hospital released nine pages of reports on the investigation, blacking out the names of employees and the patient. It released no information about why the patient was in the psych ER or whether she was injured in the restraint incident. There is no indication in the records that police tried to interview the woman.

When asked, the hospital spokeswoman told The News that “Parkland made multiple attempts to locate the patient” but failed.

The reports contain conflicting versions of what led to strapping the patient to the chair.

Enyinna-Okeigbo told police the woman became “extremely agitated” while in a common area of the psych ER. He said he gave her medication to calm down, but it didn’t work. When staff then directed her toward seclusion rooms, she began to “spit, swing, and kick at the staff,” police wrote, summarizing Enyinna-Okeigbo’s account.

A fellow caregiver who was interviewed “does not recall seeing the patient strike or attempt to strike any staff members,” a police report says. This caregiver also said he didn’t recall seeing the toilet paper roll put into the patient’s mouth or any bleeding. He denied covering the patient’s face with the sheet. The police report noted that “video of the incident contradicts this.”

The reports quote another staffer as saying he saw the bleeding and thought the patient had been “struck by a nurse.” He described the scene as “very chaotic” and said employees lacked training for such situations.

The police description of video footage begins as the patient resists efforts to strap her into a restraint chair: “She appeared to be acting aggressively toward to the medical staff, including spitting on multiple occasions in the direction of the staff.”

Five staffers approached the woman, including one who “immediately placed the roll of toilet tissue over the patient’s mouth,” a report says. “The patient began to resist,” leading Enyinna-Okeigbo to “shove the end of the roll into the patient’s mouth, at one point even appearing to force the patient’s jaw open to completely insert the roll.”

Then another employee secured the sheet around the patient’s head, and the bloody toilet paper was removed from her mouth. Next, a surgical mask was put on the patient. It, too, later showed blood stains.

A Parkland officer met with Assistant District Attorney Craig McNeil on April 10 to discuss potential criminal charges against Enyinna-Okeigbo. “McNeil stated that he felt the culpable mental state exhibited was negligence, and the mental state that has to be met for assault is reckless,” a police report says. “Therefore, McNeil stated that he did not feel that [Enyinna-Okeigbo] met the culpable state to be charged with a crime.”

McNeil told The News he did not know why the hospital didn’t consider charges against the staff member who put the sheet around the patient’s head. Foran, the Parkland spokeswoman, said hospital police gave the DA’s office “complete details” of the incident and noted that prosecutors have “full discretion” about how to proceed.

No assault

The News became aware of the incident on May 28 and asked Parkland for all related police reports. That same day, a Parkland detective asked McNeil for a written explanation of his reasoning, which the hospital gave The News.

“The use of force against a patient in an altered mental state is always unfortunate and should be avoided,” McNeil wrote. But it “does not appear to have been done with the intent to harm the patient.”

In an interview with The News, McNeil identified Enyinna-Okeigbo as the nurse who stuffed the toilet paper roll into the patient’s mouth.

The prosecutor said that spitting could be considered assault because of the potential for disease transmission. In using that term, he said, he did not mean to suggest that the patient should be charged with assault but added: “You have the right to defend yourself.”

McNeil said he could not tell from the video why the patient had blood in her mouth. He said he saw no footage of the patient being struck.

McNeil handled a 2011 case in which security video showed Parkland psychiatric technician Johnny Roberts choking a patient into unconsciousness. The hospital fired Roberts, but grand jurors declined to indict him.

“I was not happy about that,” McNeil said. “I still don’t know why they did that.”

Troubled pasts

The News’ reporting of George Cornell’s death ultimately led to a regulatory crackdown and two years of round-the-clock federal monitoring of Parkland.

The hospital installed security cameras — the same ones that captured the recent gagging incident. It also promised to fire problem employees and retrain others, especially on patient restraints.

Parkland would not say whether Enyinna-Okeigbo or De Guzman received this training.

De Guzman left his job at Parkland at some point after Cornell’s death in February 2011. He returned to work later the same year, according to hospital employment data. Parkland would not explain his departure or return.

Cornell’s death also led to a federal civil rights lawsuit that’s still pending against the hospital, UTSW, De Guzman and other caregivers. In court records, Cornell’s family has noted ways that regulators found fault with De Guzman.

Enyinna-Okeigbo, who was hired at Parkland in 2005, was charged with misdemeanor assault of his wife in 2008.

Dallas County prosecutors initially proposed a deal under which he could plead guilty and serve probation, court records show. Instead, for reasons the records don’t explain, they dismissed the charge in exchange for his completion of an anger management class. He never entered a plea and has no conviction record.

Parkland would not say whether it was aware of the allegations against Enyinna-Okeigbo. The hospital said that before 2011 it conducted criminal background checks only on prospective employees. It said it now checks existing employees, too.

In 2013, Parkland hired privately owned Green Oaks Hospital to manage its psychiatric services. Green Oaks, which receives $1.1 million a year under the deal, declined to comment for this report. Parkland would not discuss the company’s performance.

Source: Miles Moffeit and Brooks Egerton, “Parkland psych ER is again scene of patient abuse,” Dallas Morning News, June 14, 2014.

Czech psychiatric hospitals violate human rights laws

During a panel discussion held in Prague on June 30, psychiatric experts, lawyers and human rights activists all agreed that psychiatry in the Czech Republic is in an appalling state and violates international human rights laws. It is necessary to invest more money in psychiatric facilities and make them compliant with human rights standards. We appeal to the Ministry of Health and the government, headed by Prime Minister Bohuslav Sobotka, to enforce systemic changes to psychiatric hospitals and prevent the cruel treatment of patients.

Extreme understaffing, lack of control and lack of care within large institutions lead to massive violations of the dignity and rights of psychiatric patients. “Hospitals are like factories for patients,” said Lenka Ritter, a member of the Kolumbus Association and a former psychiatric patient.

In their critical report on the situation, the Mental Disability Advocacy Center and the League of Human Rights appealed to the Czech government to immediately prohibit the current inhumane practices rife within the country’s psychiatric facilities. The document shows that locking people in cages, tying them to their beds, closing them in solitary confinement and excessively medicating them with sedatives are still common practices. By ignoring this situation, the state is committing serious violations of international law.

“The whole Czech psychiatry is in a net bed,” commented Dr. Ján Praško, psychiatrist at the University Hospital Olomouc, speaking figuratively about the inability to improve the lives of patients without systemic solutions.

“In a cage you feel like a monkey, but worst of all is being chained to the bed. Your muscles stiffen, you can’t move and the staff will not give you a drink even for 12 hours. You have your tongue cracked and in your diapers are accumulating excrements and nobody is changing them. Even these days, I sometimes wake up with nightmares about being chained to the bed,” says Lenka Ritter, describing her experience in one of the country’s psychiatric hospital.

According to Zuzana Durajová of the League of Human Rights, “The state must undertake immediate actions to stop the inhumane treatment of patients to prevent further tragedies. Prohibition of the use of degrading restraints is just one of them. It must be accompanied by a revision of the entire mental health care system.”

Monday’s panel discussion introduced the petition End Cage Beds, which is addressed to Czech Prime Minister Bohuslav Sobotka. The petition can be found here.

Source: The League of Human Rights, “Czech Psychiatric Hospitals Violate Human Rights Laws,” European Liberties Platform, July 3, 2014.

Psych hospital spied on patients via closed-circuit TV without consent

Psychiatric patients in a major Dublin hospital were being spied on in their bedrooms without their consent, according to the inspector of Mental Health Services.

The Irish Patients’ Association has demanded an immediate investigation after it emerged that CCTV was placed in bedrooms without the patients’ knowledge.

Patients in a high-dependency unit (HDU) in Connolly Hospital, Blanchardstown, were being watched through CCTV cameras, although they had not been told about it.

The inspector described the practice as “unacceptable” and an “infringement of their right to privacy and dignity”.
He said the CCTV cameras had been installed “without adequate risk assessment and care planning for the residents”.

After the inspection by Mental Health Services, it was reported that “the CCTV in bedrooms had been disconnected”.

In a statement the HSE said CCTV was installed when the hospital was built.

“The CCTV was installed in the HDU to assist in ensuring the safety of patients,” said a spokesperson.

It noted that all CCTV is now disconnected except in seclusion rooms. “CCTV is only ever used in the seclusion room of the HDU and never in the bedrooms. Whenever a patient is in seclusion, the patient is told the CCTV is in use.

“The nursing staff in the HDU have access to the CCTV cameras and the information is not stored.

“The decision to install CCTV was made by the Mental Health Service Management at that time and the management team also made the decision only to use CCTV in the seclusion room in the HDU,” the HSE said.

Stephen McMahon of the Patients’ Association said: “It’s a serious issue. CCTV should never be installed in the absence of a full ethical framework.

“If it is something that is being done for patient safety or staff safety, it should adhere strictly to ethical guidelines laid down by data protection and the ombudsman.

“Without such guidelines you can have ‘function creep’ where cameras are installed in the car-park, then in the corridors and before you know it in patients’ bedrooms and the toilet.”

The whole issue, he added, should be investigated by both the Data Protection Commissioner and the Information Ombudsman.

APPROVED
The report, which revealed the CCTV was one of the third batch of 2013 inspection reports that are being released at intervals throughout the year.

This particular batch looked at six approved centres – Connolly Hospital, University College Hospital Galway, the Central Mental Hospital, St James’s Hospital in Dublin, Kerry General Hospital and Carraig Mor Centre in Cork.

While the issue of CCTV surveillance only arose at Connolly Hospital, it was also found that the centre overall “had made significant progress in introducing an excellent individual care plan template” since the last inspection.

It did, however, require urgent maintenance and painting and “adequate seating areas and chairs still had not been provided” despite a previous recommendation.

At St James’s “medicine was not prescribed in accordance with Medical Council guidelines”.

The Central Mental Hospital had vacant psychology and occupational therapy posts.

In the Cork unit “there was no provision for privacy in the bathrooms or lavatories in the male areas of the ward”.

In Galway, the night inspection had no difficulties.

In Kerry, one resident was not given enough dignity in relation to clothing while in seclusion and was at risk of injury from the furnishings in the room.

Source: Clodagh Sheehy, “Hospital’s psychiatric patients ‘spied on’ with CCTV in their rooms,” Herald.ie, August 6, 2013.

Report criticizes Massachusetts school that uses shock “therapy”

Six years after two teenage students at a special-needs school were punished with dozens of electrical shocks in a three-hour period, an independent report evaluating safety at the school is calling for better training of staff and the hiring of an ombudsman to field complaints.

In addition to offering graphic detail of the abuse suffered by the two teens, the 128-page report, released Monday by the Massachusetts Attorney General’s office, also found that the controversial Judge Rotenberg Educational Center in Canton was not doing enough to teach staff about the behaviors that warranted electric shocks to students.

“There appears to be very little, if anything, contained in the Basic Training related to the types of behaviors typically addressed by the GED (Graduated Electronic Decelerator) and why these behaviors are appropriate for treatment with the GED,” the report written by retired Judge Isaac Borenstein stated.

The residential school and treatment program for disabled people with severe emotional problems is believed to be the only school in the country that uses electric-shock therapy to modify behavior.

It is called aversive therapy, and many students at the center continue to wear the electronic shock device in backpacks with wires connected to straps around an arm or leg. The device can deliver a two-second, surface-level shock meant to control behaviors related to serious mental disorders such as self-mutilation and aggression.

“The board of directors has already voted to accept all the recommendations and has implemented them,” said Michael Flammia, a Boston attorney who represents the Rotenberg school, said in commenting on the report.

Flammia said that about 80 students are currently approved to receive the electric shock treatments.

The evaluation from Borenstein was made public as a result of a plea deal two years ago after a special grand jury indicted the school’s founder, Dr. Matthew Israel, on charges that he misled a witness and destroyed a videotape related to the 2007 abuse of the two students.

In August 2007, a former student placed a prank call to a Rotenberg group home in Stoughton and coaxed workers into administering more than 100 shocks to the teens. One victim was from Halifax.

Israel agreed in Norfolk Superior Court to five years of probation and to step down as director of the school. Part of the deal was Borenstein’s year-long probe of practices at the school, which laid bare what the attorney general’s office called “flawed JRC policies and procedures.”

Sources: Chris Burrell, “Report criticizes Canton school that uses shock therapy,” The Patriot Ledger, May 07, 2013.

Psychologist John Cicconi loses license for sexual and abusive relationship with patient

A long-time psychologist who had an intimate and physically abusive relationship with a mentally ill patient has been de-registered.

Vincent Cicconi, who practiced in Moonee Ponds, was reprimanded and found guilty of professional misconduct for the three-year relationship with a female patient 20 years his junior.

The patient, who cannot be named, first met Mr Cicconi in April 2008 for treatment for her depression, anxiety and personality disorder, the Victorian Civil and Administrative Tribunal heard.

The patient abused alcohol, ecstasy and cannabis and Mr Cicconi described her to Centrelink as “basically homeless” and “unable to look for work, given her mental state”, the tribunal heard.

After the third consultation, the relationship between Mr Cicconi and his patient became “unorthodox” when he invited her to have lunch with him at a cafe. This was followed by repeated shared meals, him giving her lifts home after consultations, going to the cinema, restaurants and concerts together and him giving her money.

The professional relationship ended after about two months but the sexual relationship began a short time later.

The Australian Psychological Society’s code of ethics states that psychologists cannot have sex with a former patient for at least two years after the professional relationship has ended, and even then, it must be discussed with a senior psychologist. The patient is also encouraged to have independent counselling.

Mr Cicconi allowed his patient to stay overnight at his house and at the end of 2008, she moved into his home for about two months.

In their recently published judgment, VCAT deputy president Heather Lambrick and members John Farhall and Marian Power said the relationship between Mr Cicconi and his patient was “erratic and tumultuous” and “characterised by conflict, recriminations, separations and reconciliations”.

In March 2010, during an argument at his house, Mr Cicconi punched the patient in the face. Police later successfully sought an intervention order on her behalf against Mr Cicconi.

In February 2011, the pair had a “physical conflict” which left her with a bloody hand. Mr Cicconi was granted a diversion on an assault charge in court, meaning no conviction was recorded.

Despite this, contact between Mr Cicconi and the patient continued, and in 2012, they met again and had sex.

Months earlier, Mr Cicconi lied to the Psychology Board of Australia when it asked him for contact details for the patient.

The tribunal, describing the patient as “extremely vulnerable”, said the violence, sexual relationship and living arrangements between Mr Cicconi and the patient were “reprehensible”.

“Mr Cicconi should have realised that his own objectivity and capacity to provide appropriate treatment and care would be impaired,” the tribunal said. “The psychologist and patient relationship should have been immediately terminated with appropriate arrangements put in place for (the patient’s) ongoing care. This did not occur.”

The tribunal said that although it accepted Mr Cicconi was not adequately qualified to deal with the patient’s complex needs, he should have referred her on to someone who was, and not pursued a relationship.

It added that it could not rationalise the patient’s vulnerability and the inherent power imbalance in the relationship and that the entire profession was brought into disrepute when practitioners exploited professional relationships for their own advantage.

Mr Cicconi was reprimanded and his registration was cancelled, effective mid-May. He is not allowed to reapply for registration for 15 months after the cancellation begins, and will need to show that the conduct will not be repeated.

Source: Adrian Lowe, “Sex with patient costs psychologist his job,” The Age, April 30, 2013.

Universal Health Services: Protestors Claim Behavioral Health Center Puts Children in Danger

Weathering the wind and the low temperatures, a group of more than a dozen concerned parents, registered nurses, and other former employees of Michiana Behavioral Health Center in Plymouth made their voices heard yesterday evening as they stood along the side of Oak Road near the intersection of U.S. 30, holding signs expressing their discontent with the MBHC. The group of protestors claimed that the center is putting children in danger through a variety of policy violations, understaffing, and inadequate supervision, along with a hostile work environment that they allege has caused more than 50 employees to quit their jobs or be fired.

One of the protestors, a registered nurse and former six-and-a-half-year employee of MBHC, told WKVI that she could not sit idly by as the center committed what she claimed were a barrage of violations that put staff and patients alike in harm’s way.

“They’re directly endangering them, knowingly. It’s not an accident, and it’s not a maybe; it’s going to happen, and it has,” she said. “And I just couldn’t stomach it. These kids have been abused to death already.”

Protesters lined Oak Road voicing their outrage at  MBHC.

Diamond Campbell claims MBHC is dangerously understaffed, and any attempts made by staff members to follow correct policy – rather than the policies that she claims the administration makes up on the fly – often result in termination. She said the center has thrown out the policy book and alleges MBHC no longer follows state-mandated regulations put in place to protect patients from aggressive preteen children and adolescents.

“They have kids that are known sexual predators; they’re allowing them to be roomed with anybody and everybody. There is no increased level of observation, which, in the past, has always been implemented. When there was a child that came in that was known to be a predator, they would be either placed in a room by themselves or they would be placed with staff sitting outside their bedroom door, continuously, all the way throughout the night. Well, they decided that they were not going to do that any longer – it was not cost effective. So, really, they’re going against their own written policy,” she claimed.

On top of that, Campbell maintains that the center no longer segregates patients by age groups – that is, she claims the center will place preteen children, ages 3 to 12, in the same room as adolescents, ages 13 to 17.

She went on to assert that the center no longer takes into account violent or sexual histories when placing patients on increased observation, when they would previously assign a staff member to watch the patient at all times to prevent any incidents.

“They began violating it in December. They started putting out memos – I’ve got emails from the assistant director of nursing as well as the director of nursing stating that they were no longer going to place people on any increased level of observation due to past history,” Campbell claimed. “Well, past history is everything, because in the past they’ve molested, in the past they’ve raped, in the past they’ve abused. So it’s very pertinent, and that is what their intake process entails, is nothing but history of what kind of behaviors these children have.”

Campbell said she is disgusted by the behavior exhibited by the center’s CEO and director of nursing, and they’re not just picketing for awareness. She said the protestors would like to see a change in administration at MBHC.

“I would like them to stop endangering these kids,” Campbell said. “They’ve been abused enough. It needs to stop. They’re doing it for a dollar – that’s abundantly clear. I would like to see the CEO and the director of nursing out of there because, clearly, they have no moral standing. If you would do that to a child, as far as I’m concerned, they’re as bad as a pedophile – they’re serving them up; they’re putting them in a bedroom with known sexual predators, so how do they look themselves in the mirror? I don’t really know.”

More than a dozen former employees of MBHC compiled a collection of letters detailing alleged policy violations, HIPPA violations, employee discrimination, and various crimes such as falsification or destruction of legal documents, patient charts and other paperwork. This 27-page compilation has since been forwarded to various news agencies, Senator Joseph Donnelly, Governor Mike Pence, Indiana Attorney General Greg Zoeller, the Department of Labor, the State Department of Health, the Protection and Advices Service Commission of Indiana, the Department of Justice, CCHR International, the Family and Social Services Administration, the Joint Commission, Universal Health Services, Medicaid’s FSSA Compliance Division, and the Civil Rights Commission.

Attempts to reach the CEO of Michiana Behavior Health Center were unsuccessful, but officials at the center indicated he was out of town and will issue his response to these allegations at a later time.

Source: Ben Haut, “Protestors Claim Behavioral Health Center in Plymouth Puts Children in Danger, WKVI-FM 99.3, March 15, 2013.

Scottish psych nurse loses license for locking patient in room

A nurse at a Tayside psychiatric hospital has been suspended from practising for three months after locking a patient in a room and walking away.

Susan Sutherland trapped the man in a room at Murray Royal Hospital in Perth to “see what he would do”.

Ms Sutherland, who was sacked after the incident in December 2010, has always denied the charge against her.

A Nursing and Midwifery panel ruled that Ms Sutherland remains a risk and could put patients at unwarranted harm.

The panel heard from healthcare assistant Gary Boyle, who said he had managed to persuade Patient A into a bathroom in an attempt to bathe him, only for the patient to run out of the room naked.

The patient ran into and lay on the floor of a smoking room on the ward, before Ms Sutherland and Mr Boyle managed to convince the man to return to his room.

But when the patient returned to his room, an irate Ms Sutherland shut the door, locked it and told Mr Boyle she “was locking his door for five minutes to see what he would do before she “stormed off down the corridor away from Patient A’s room”.

The incident was reported to Margaret Cullen, the nurse in charge at Glenelg Ward and Ms Sutherland was suspended two days later.

Source: “Psychiatric nurse suspended after locking naked patient in room,” STV, January 13, 2013.

Inspectors criticize “appalling” conditions at psychiatric unit

PATIENTS in one ward in a psychiatric hospital were left in an “appalling” situation, without any therapy or stimulation, inspectors have found.

Residents in St Senan’s Hospital, Enniscorthy, Co Wexford, were suffering from “severe institutionalised” and problem behaviour more than likely contributed to by lack of stimulation and therapies.

The findings, in a report by inspectors from the Mental Health Commission, found the residents in St Christopher’s ward had no input from psychology, social work or occupational therapy.

“The only input was from medical and nursing staff, apart from one art session a week from a recreational therapist,” the report said.

“Staff were not trained in intellectual disability and mental illness and were not in a position to provide appropriate therapies for the residents.”

The hospital is due to close next March, and residents are to be moved to purpose-built accommodation.

A separate report on the unit in Waterford Regional Hospital found there had been significant slippage in the provision of individual care plans since the previous inspection.

It continued to provide a high standard of care in electric shock treatment, but mental health teams were under-resourced and this impacted on the scope of care provided.

Another report, into Teach Aisling, a 10-bed approved centre for people with severe and enduring mental illness in Co Mayo, found the physical care of residents was below standard.

The door to the hospital was routinely locked, and although a number of voluntary residents were free to leave they could not do so unless accompanied, and that was dependent on the availability of staff.

The inspectors criticised the physical state of the bedsits and said they needed to be urgently refurbished.

One resident asked that the main communal sitting area be painted with some colour and that flowers be planted in the garden.

The inspectors said it was a “pity to see the enclosed garden space untended, with weeds and cigarette butts, and the side herb garden overgrown with weeds”.

Source: Eilish O’Regan, “Inspectors criticise ‘appalling’ psychiatric unit,” Irish Independent, November 23, 2012.

China passes law to reduce psychiatric abuses

BEIJING (AP) — China’s legislature on Friday passed a long-awaited mental health law that aims to prevent people from being involuntarily held and unnecessarily treated in psychiatric facilities — abuses that have been used against government critics and triggered public outrage.

The law standardizes mental health care services, requiring general hospitals to set up special outpatient clinics or provide counseling, and calls for the training of more doctors.

Debated for years, the law attempts to address an imbalance in Chinese society — a lack of mental health care services for a population that has grown more prosperous but also more aware of modern-day stresses and the need for treatment. Psychiatrists who helped draft and improve the legislation welcomed its passage.

“The law will protect the rights of mental patients and prevent those who don’t need treatment from being forced to receive it,” said Dr. Liu Xiehe, an 85-year-old psychiatrist based in the southwestern city of Chengdu, who drafted the first version of the law in 1985.

“Our mental health law is in line with international standards. This shows the government pays attention to the development of mental health and the protection of people’s rights in this area,” Liu told The Associated Press by phone.

Pressure has grown on the government in recent years after state media and rights activists reported cases of people forced into mental hospitals when they did not require treatment. Some were placed there by employers with whom they had wage disputes, some by their family members in fights over money, and others — usually people with grievances against officials — by police who wanted to silence them.

The law states for the first time that mental health examinations and treatment must be conducted on a voluntary basis, unless a person is considered a danger to himself or others. Only psychiatrists have the authority to commit people to hospitals for treatment, and treatment may be compulsory for patients diagnosed with a severe mental illness, according to the law.

Under the law, police still may send people for diagnosis — a common practice in many countries. Significantly, the law gives people who feel they have been unnecessarily admitted into mental health facilities the right to appeal.

Though questions remain over how the law will be enforced and whether sufficient government funding will be provided to enable the expansion of services, psychiatrists said the passage of the legislation marked a milestone

“It’s very exciting. I honestly believe this will start a new trajectory,” said Dr. Michael Phillips, a Canadian psychiatrist who has worked in China for nearly three decades and now heads a suicide research center in Shanghai.

Phillips said the biggest change for the psychiatric system is the curb on involuntary admissions. At least 80 percent of hospital admissions are compulsory, he said.

The expansive scope of the law — covering treatment, stigma prevention, admissions and other areas — made it “revolutionary,” he added.

Source: “China passes law to curb abuse of mental hospitals,” Associated Press, October 26, 2012.

Nazi-era psychiatric patients were demeaned, starved, brutalized, and left to die

On November 23, 2010, Frank Schneider, President of the German Association for Psychiatry and Psychotherapy, made a public admission and apology for human rights atrocities committed by German psychiatry during World War II. In his opening comments, Schneider stated “Psychiatrists showed contempt towards the patients in their care; they lied to them, and deceived them and their families. They forced them to be sterilised, arranged their deaths and even performed killings themselves.”

Now, Austria is examing similar abuses by its own psychiatrists.

 

HALL, Austria (AP) — Forensic crews scraping away dirt from the remains of the Nazi-era psychiatric patients were puzzled: The skeletal fingers were entwined in rosary beads. Why, the experts wondered, would the Nazis — who considered these people less than human — respect them enough to let them take their religious symbols to their graves?

It turns out they didn’t.

A year after the first of 221 sets of remains were exhumed at a former Austrian hospital cemetery, investigators now believe the beads were likely nothing more than a cynical smokescreen, placed to mislead relatives attending the burials into thinking that the last stage of their loved ones’ lives was as dignified as their funerals.

But skeletons don’t lie. Forensic work shows that more than half of the victims had broken ribs and other bone fractures from blows likely dealt by hospital personnel. Many died from illnesses such as pneumonia, apparently caused by a combination of physical injuries, a lack of food and being immobilized for weeks at a time.

Neither do medical records, which show that medical personnel cursed their patients as “imbeciles,” ”idiots” and “useless eaters.”

Indeed, there is now little doubt that for many of the dead — mentally and physically disabled people considered by the Nazis to be human garbage — their final months were hell on Earth.

Nazi extermination of the mentally and physically deficient has been documented since the end of World War II. But information gathered from the hospital cemetery in Hall, an ancient Tyrolean town of narrow, cobble-stoned alleys, cozy inns and graceful church spires east of Innsbruck, has filled out the picture in chilling new ways.

Historians, anthropologists, physicians and archaeologists say the Hall project represents the first time that investigators can match hospital records with remains, allowing them to identify, for example, cases in which patients had broken ribs, noses and collarbones that were not listed in their medical histories, suggesting that the patients had been beaten by those responsible for their care.

Faced with the horrors of the findings, those involved in the probe struggle to maintain the detached attitude of an investigator.

“At first, I sat here and worked through these documents in a relatively dry manner from the point of view of a scientist,” psychiatrist Christian Haring said. “But as you read on at some point, you suddenly find yourself in a world where the goose-bumps appear.”

Anthropologist George McGlynn said more than half of the sets of remains have broken bones, many of them unexplained in the patients’ medical records.

“Why is a stubbed toe talked about in three different (documents), but six rib fractures that cause terrible pain isn’t even mentioned?” he asked.

While such injuries did not kill directly, they may often have led to death. Many of the patients are listed as dying of pneumonia, and McGlynn said the “scary conclusion” is that rib injuries combined with sedation and forced immobility — patients are suspected to have been strapped to their beds for weeks at a time — may have generated fatal incidences of the disease.

“Nobody is being executed here, like you see in concentration camps,” he said. “It was done in a more sinister, insidious way — people are loaded up with drugs until they get a lung infection.”

Forensic examination of the bones shows infection that started at the skin level then “goes right into the muscle and all the way to the bone,” McGlynn said.

Others apparently starved — if not to death, then to the point where they were susceptible to diseases that then killed them.

“We can assume that the patients suffered massively from hunger,” said Haring, the psychiatrist, speaking of “enormous” losses in weight.

The Nazis called people deemed too sick, weak or disabled to fit Hitler’s image of a master race “unworthy lives,” in the terrible culmination of the cult of eugenics that gained international popularity in the early 1900s as a way to improve the “racial quality” of future generations.

“Patients, who on the basis of human judgment are considered incurable, can be granted mercy death after a discerning diagnosis,” Hitler wrote in a 1939 decree that opened the flood gates to the mass killings.

More than 70,000 such people were killed, gassed to death or otherwise murdered between 1939 and 1941, when public protests stopped most wholesale massacres. From then until the end of the war in 1945, the killings continued at the hands of doctors and nurses. In all, at least 200,000 physically or mentally disabled people were killed by medication, starvation, neglect or in the gas chambers during the war.

After 1941, McGlynn said, “a lot of the smaller institutions were given carte blanche to take care of things themselves. No longer were people being transported to (killing) centers. They were being put to sleep right there.”

Hundreds of psychiatric patients from Hall were among those shipped to killing centers before 1941, but what happened there after that was unknown until two years ago, when an archivist searching through old hospital files discovered the graveyard during a hospital expansion.

The records show that as the war progressed, and able-bodied men and women became scarce behind the front lines, the Nazis made a cynical adjustment in their measurement of patients’ value.

“‘Worthy of life’ and ‘unworthy of life’ were the terms used back then,” Haring said. “The difference was ability to work or not.”

Excerpts of medical histories provided to The Associated Press described one of the patients as suffering from “imbecility,” but most were objective, bereft of demeaning descriptions. McGlynn, however, said he had examined records that show emotional abuse in addition to the physical violence the remains attest to.

“People are being threatened: ‘If you don’t do this we are going to stuff this tube down your nose and pump you full of stuff,'” he said. “These people were at the mercy of their captors.”

Other evidence backs up his findings.

Documents show that the cemetery was created in 1942, a year after the formal end of the mass-killing campaign meant that Hall patients could no longer be shipped to gas chambers. It was shut down and abandoned in 1945, when the war ended. During that time, deaths in the psychiatric ward rose from an average of 4 percent a month in early 1942 to as high as 20 percent in some months before the end of the war.

Haring, an affable, soft-spoken man, is visibly shaken as he speaks of the horrors perpetrated by the previous generation of psychiatrists. But he hesitates to assign individual guilt to anyone caught up in the inhuman machinery of the Third Reich.

“It is easy for us now to point the finger and say ‘what have they done?'” he said. “But … I am not sure that I would have acted differently. We were simply paralyzed.”

Source: George Jahn, “Austria probes gruesome fate of Nazi-era disabled,” Associated Press, October 19, 2012.