Atlanta Journal-Constitution  
Georgia mental patients in 'jeopardy'
Report puts more pressure on Georgia Regional Hospital/Atlanta

The Atlanta Journal-Constitution
Published on: 08/01/08

In the latest blow to Georgia's beleaguered mental health system, federal regulators declared patients at Georgia Regional Hospital/Atlanta to be in "immediate jeopardy" of physical harm.

The hospital failed its most recent inspection, in July, despite a $3.4 million "turnaround" plan that was supposed to address persistently dangerous conditions. The federal government gave the state just three weeks to submit yet another plan for correcting violations of patient-care standards, under threat of withholding millions of dollars in Medicare and Medicaid payments.

The inspection found that overcrowding and inadequate staffing caused a sharp increase in incidents resulting in injuries to patients and staff members. From May to June, regulators said, the number of serious events in one hospital unit increased from 36 to 80. In June alone, one patient received a 1-inch laceration in a fight, another needed five sutures to heal an ear wound, and a third was punched and kneed in the stomach and was sent to an emergency room with a possibly ruptured eardrum.

This inspection echoed numerous other reviews by federal and state agencies, which have identified chronic problems at Georgia Regional and the other state hospitals.

But the timing of the latest citation is particularly troublesome for state officials, who are preparing a response to a separate investigation by the U.S. Justice Department. In a letter to Gov. Sonny Perdue on May 30, the department said conditions at Georgia Regional violate the civil rights of patients, and it threatened to take the state to court if it did not reverse practices that have resulted in preventable deaths, injuries and illnesses for patients.

Scrutiny of the state hospitals intensified last year after The Atlanta Journal-Constitution reported on widespread neglect and abuse that contributed to at least 136 deaths of patients from 2002 through late 2007. In addition to the Justice Department investigation, which is continuing, a commission created by Perdue has studied proposals to overhaul the state's mental-health care system.

Officials with the Georgia Department of Human Resources, which operates Georgia Regional and the other six state psychiatric hospitals, did not respond to requests for an interview Thursday.

In an e-mailed statement, an agency spokeswoman, Dena Smith, said: "We have submitted a plan of correction. The plan has been accepted and we will work the plan to completion." In a letter to federal authorities, Georgia Regional's administrator, Susan Trueblood, disputed some findings but said the facility has "addressed steps to ensure full compliance."

Two other times since 2002, federal authorities accepted the state's plans to correct deficiencies at Georgia Regional. But when regulators eventually returned, they cited similar violations, indicating the corrective actions were not successful.

State officials have contended recently that conditions at Georgia Regional have improved, saying the Justice Department's findings reflected conditions before corrective actions — more nurses, more treatment and assembling a "better complement" of medical staff members — took effect.

But the new report, by the federal Centers for Medicare & Medicaid Services, undercuts that claim.

In their five days at Georgia Regional, regulators concentrated on two units that house mentally ill adults. Their review found that in May, the hospital's West Unit exceeded its capacity of 46 patients 94 percent of the time. During the same month, the Central Unit exceeded its 38-patient capacity 71 percent of the time.

A nursing manager told regulators that at times the Central Unit had as many as 50 patients. On both units, extra patients sometimes had to sleep on cots or rollaway beds.

Hospital officials re-sponded to federal investigators that the state tried to deal with overcrowding by diverting 429 patients from Georgia Regional to private hospitals, at a cost of

$2.1 million.

Regulators found that both units frequently had fewer nurses and other staff members than called for in the hospital's policy (although hospital administrators disputed the methodology used in that assertion).

One physician told regulators that the Central Unit was "critically understaffed" to the degree that nurses could not deliver care. On weekends, the doctor said, staffing levels were "terrible."

Regulators found that hospital workers frequently did not perform routine medical assessments. For example, one patient's medical record showed that nurses failed to document his intake of solids and fluids, as well as his output, on 132 consecutive shifts. Many psychotropic medications are known to cause serious constipation. Failure to monitor bowel movements has been a repeated deficiency at Georgia Regional, and has been cited in the deaths of at least two patients: 14-year-old Sarah Crider and 59-year-old Michael Webb.

A doctor told regulators the short-staffing had caused patients to express concerns about their safety and some "could not sleep and were increasingly anxious about their environment."

Another physician said "staffing was so short that if things did not go well, there would not be enough staff to manage," regulators wrote. "The physician noted that it was difficult to control aggressive situations between two patients on a unit that had 30-plus male patients and only two male [technicians] to control this situation."

In one unit, regulators wrote, 116 serious incidents involving patients — such as fights, assaults on staff members and other disruptions — occurred in May and June. Fifty-six such incidents took place on the other unit.

More troubling, regulators indicated, is the response to reports of those incidents. They said hospital administrators have failed to track serious incidents and to attempt to prevent repeat occurrences. Hospital officials responded by saying they now collect data on serious incidents — as of July 24.

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