Montana State Hospital February 2017. RE "Patients' Attorney" Craig Fitch, and the Hospital's policy of discharging patients into homelessness.

INTRODUCTION

   In June, 2013, the federally managed Centers for Medicare and Medicaid Services (CMS) issued a Notice of Immediate Jeopardy to Arizona's sole long term public mental health care facility, Arizona State Hospital (ASH) on the basis of that facility's willingness to flaunt state and federal law. This action in short time led direct sanction upon  the operation of ASH. Central to the earliest evidence that brought on this sanction was the fact that ASH was failing to maintain required staff to patient quotient (ratios). And while it took another 14 months before the hammer fully came down on ASH (September, 2014 and beyond), this due to the facility's ongoing refusal to bring its operation up to standard, it was indeed the CMS intervention that got the ball rolling.

    In association with the role that the staff of PJ Reed The Arizona State Hospital and Patient Abuse played in bringing about the critically needed oversight and accountability at ASH, mental health advocates refer to that story as "The ugliest public mental health scandal in the new millennium."  

   In winter 2016-2017, following several inspections at Montana State Hospital, CMS issued a virtually identical Notice of Jeopardy on the basis of the plain fact that MSH is today engaging in the same patterns of abject defiance specific to state and federally mandated regulations that did in time lead to the scandal at ASH. In January, 2017, CMS issued a sixty one (61) page report specific to over 110 violations of federally mandated regulations; and at this time, June, 2017, MSH is operating under direct federal sanction.

    It's that bad. Arizona all over again. 

------------------------------------------

"Morally reprehensible." Representative Ellie Hill Smith (D-Missoula), 02/17/2017.

Pre-mature discharge and recidivism. Montana State Hospital's so-called "Patient's Attorney", Craig Fitch of the Governor appointed Board of Visitors.

"Montana House of Representatives endorses bill to stop dumping mentally ill patients. Bill would end practice of dumping homeless patients and force health officials to arrange housing." (Matt Volz. Associated Press. February 07, 2017) 

This is a HUGE problem facing any Montana consumer seeking medical-mental health care in the state's sole long term public mental health care facility. The subject poses grave threat to any individual discharged into the greater community prior to having reasonably stabilized during their time at Montana State Hospital (MSH), Warm Springs, Montana.

And it is going on RIGHT NOW.

At least one recent story emerged in media reports less then two weeks ago about MSH' willingness to discharge patients into homelessness. It's taking the direct action of the Montana legislature to even acknowledge that this issue exists. Because the state's department of health officials are engaging in the same abject patterns of uniform denials that AZ health care officials engaged in circa 2010-2015.

"Rep. Ellie Hill Smith, D-Missoula, said her bill would end the practice of dumping homeless patients and force health officials to include housing arrangements in their discharge plans from Montana’s only state-run psychiatric hospital in Warm Springs."

"When Warm Springs discharges them, they are often still in their hospital clothes and they are given seven days of medication,' Hill Smith said. 'It is, frankly, morally reprehensible and it’s fiscally unsound.' "

In Montana at the time of this writing, this issue only scratches the surface of far broader implications. MT's Department of Health and Human Services, and its sub-agency Addictive and Mental Disorders Division (Zoe Barnard, Director), bears the responsibility to ensure that persons affected by serious mental illness are provided with reasonably optimum services. This responsibility directly extends to the operation of Montana State Hospital (MSH).

The issue of discharge into homelessness has direct bearing on the the fact that MSH is currently subjecting their clients to a fast-food approach to providing care, and the issue of premature discharge, including in many cases into homelessness. Persons affected by serious mental illness are referred to MSH by the Montana's justice system. Involuntary commitment, most specifically, and the very clear statutory requirements in the Montana Annotated Code (MCA), that requires any individual posing risk to self or others to be detained, evaluated, and directed to MSH until such a time as the associated risk at issue is 100% resolved through reasonably effective treatment and care.

MSH patients are- as a matter of standard practice- being discharged from the Hospital while while still in states of confusion, agitation, and other like conditions of relative instability, often only a matter of days or weeks after being admitted following involuntary commitment by MT courts of law. Such discharges defy the meaning of statutes that serve to protect the safety and interests of the public, from those persons so committed to the greater public, including statutes by which MT citizens are committed to MSH.

But instead of thoroughly providing the treatment necessary to eliminate the associated risks, Montana State Hospital clinicians and administrators have fallen into a pattern of prioritizing discharge over the very real needs of MSH patients, at times near immediately discharging seriously mentally ill client-consumer-patients as a matter of standard practice.

In some of these cases, such prematurely discharged are placed at grave risk of harm, and associated risks that extend to the interests of the greater public, as well. In the most tragic cases, some of these patients die, as a direct consequence of these policies and practices.  Conversely, many such persons return to MSH, sometimes in a matter of days. This revolving door policy is not only fiscally unsound, but it graphically unethical, as well.

It is that bad, indeed.

Enter Craig Fitch, lawyer, who loves to state "I am the Patient's Attorney" at Montana State Hospital. Who, in March, 2017, testified in direct opposition to the above described bill, therein playing a major role in shelving this well intentioned effort to better the interests of Montana's mental health community. 

Beyond the simple question "Why in the hell did this man not play a role in reporting the issues exposed by a major federal investigation circa winter 2016-17?", I would ask why this so called patient advocate didn't seek to work in cooperation with Montana House Representative Ellie Boldman Hill-Smith  when she was drafting this bill? Instead, Fitch worked in complicity with MT Department of Health and Human Services (MTDHHS) attorney George Quintana in order to quash this bill, making no effort whatsoever to discuss his sentiments with Montana State Hospital's patient community, including and foremost the Hospital's Resident Advisory Committee.

There is ample evidence to the effect that Craig Fitch has long been involved in furthering the presence of sub-standstard care practices at MSH, including ignoring the abjectly corrupted patient grievance system and process. Said evidence includes the bare bones fact that no until fall 2016, no one submitted patient grievance in the last five years was processed beyond the third step of a five step framework that is required to ensure that no MSH based client-consumer of MTDHHS services is subjected to violations of their given rights.

There is no possible way that none of the hundreds if not thousands of patient submitted grievance documents over the last five years had sufficient merit in terms of advancing beyond the third step of this process. This issue has been exposed in recent years at other state managed mental hospitals, including but far from limited to to the Arizona State Hospital, and therein served as evidence proving that the administrators of such hospital's willfully deprived their patients of their given civil and human rights.

Fitch's justification for opposing this bill, which he presented at a May, 2017, meeting of the MSH Resident Advisory Council (RAC) (well after the bill had been introduced, and after his above described testimony), relies upon his belief that, if MSH were to implement a discharge process capable of ensuring that no patient be unreasonably forced into homelessness, the civil rights of all MSH patients would be at risk. This rationale is slanted towards preserving MSH current policy as it stands. Fitch was made aware of Representative Hill-Smith's intent to introduce this bill at a time when he could easily have contacted her and cooperatively worked with her.

Likewise, prior to his March testimony in opposition to the bill, Fitch could very easily have sought feedback and input from MSH patient community, including from the patients serving on RAC at that time. But in neither of these instances did this so called patient advocate exercise his due diligence in a context of his repetitive claim, "I am the patients' attorney."

IN CLOSING: Fair warning to each and every state employed individual involved in the emerging scandal specific to Montana State Hospital. You know who you are. There is no excuse at this late date for any of you to continue denying the significance of the crisis that MSH is in today. And when you time comes, there will be no justifiable excuses to make. 

This is, in no uncertain terms: ARIZONA ALL OVER AGAIN. 

paoloreed@gmail.com

May 31, 2017.

Staff Shortages at Montana State Hospital. "Feds find state hospital put patients at risk, almost terminated agreement."

Centrally involved parties at the time include but are not limited to: Facility CEO Jay Pottenger, Montana Addiction and Mental Disorders Director Zoe Barnard, Montana Board of Visitors staff (onsite) attorney Craig Fitch, Montana DHS attorneys Jorge Quintana and Paulette Coleman, Montana DHS Director Richard Opper.

(As always, we the author's of this material are fully aware that only some of the staff at Montana State Hospital are crappy at what they do. And that, in fact, there are many good people at MSH who are willing to do their best. It is our intent to serve not only the interests of MSH' patient community, but those of the good staff at MSH, as well. For we know all too well that these good staff struggle to do their best as a direct consequence of the Rat Bastards most responsible for issues at stake. Thank you to all staff who have the sense of conscience necessary when it comes to working in state mental health care facilities. Without you, the patient community would be lost. )        

"Feds find state hospital put patients at risk, almost terminated agreement."
                      By Holly Michels. Lee Newspapers. January 28, 2017. 

HELENA — Montana State Hospital, the state’s publicly run psychiatric facility, was set to lose its federal agreement in February because of what’s called an “immediate jeopardy,” a situation where the hospital’s noncompliance with federal regulations was considered serious enough to risk death or serious injury to a resident.

"CMS is on your case for good reason." As stated to Montana State Hospital charge nurse Deeana Dugdale, May 05, 2017.

Her verbatim response to this author: "No they're not. That's all a bunch of lies, and you know it."

Background: Following a series of formal inspections conducted in fall, 2017, by the federal agency, Centers for Medicaid and Medicare Services (CMS), which licenses the operation of Montana's sole long term public mental health care facility, Montana State Hospital (MSH), that agency issued a "Notice of Immediate Jeopardy" in accompaniment with a related "Notice of Termination of Contract." Notice of jeopardy in this nature of situation only arises due to identified substandard conditions and care practices, putting the patients at risk of grave harm (as clarified in the above news byte); while termination of contract relates to the fact that such facilities have failed to meaningfully respond to earlier direction by the involved federal agency, in this case CMS. In this specific case, CMS identified no less then one hundred and eleven such violations, which the administrators of MSH failed to correct upon prior federal advisories,  leading in turn to the above described notices.  

Not to focus too much upon nurse Deena Dugdale's utter disconnection with reality, it is nonetheless worth noting that the cover-up of wrongdoing is often far worse then the wrongdoing itself. In this context, no one such bit of evidence stands more strongly then patterns of abject denial when state operated mental hospitals are identified as being in crisis due to irrefutable evidence produced by formal investigations.

And as usual, denials in this context come out of the mouths of persons in relative authority specific to their given positions- and therein directly associated involvement in such issues- be it nurse managers, mid-level facility managers, licensed physicians; as well as Hospital administrators and their given superiors in state managed health departments, including department employed lawyers, and on that list can go. 

These are the people interested in only one thing- maintaining status quo as it applies to the selfish interests- and willing to declare behind closed doors:

To hell with the needs and rights of the consumer/patient clientele we are obligated to serve. 

All that matters is us and our selfish interests.

When it comes to state hospitals, that is, and other like state operated facilities and agencies bearing the responsibility of caring for vulnerable persons who have no other choice but to rely on such entities, be it at-risk children, the elderly, or the mentally ill. Patent denial, in absolute defiance of the production of such evidence, wherein persons 100% aware of the fact that serious problems exist nonetheless adhere to the same behavior they are so accustomed to. Therein identifying themselves as the ones most responsible for it all. Whether due to ignorance or outright stupidity, these patterns of denial prove that such people are representative of the overall history of such state hospitals, which so often attract society's most malicious individuals. 

Monsters. Predators. Miscreants. As seen in Arizona circa 2011-2014 (ongoing), Washington state circa 2012-2014 (ongoing), Pennsylvania circa 2014-2017 (ongoing), and now Montana (definitely ongoing).

As the theme has so long stood:  

        WE COULD NOT MAKE THIS SHIT UP IF WE HAD TO

PLAIN FACT: On the basis of dozens upon dozens of documented violations of federal policy standards, on January 27, 2017, Montana State Hospital's operational contract with the United States Department of Health and Human Services (US DPHHS) and the facility's associated license to operate was effectively terminated, giving the facility less then fifteen  business days to comprehensively organize a meaningful plan in order to avoid full termination of said contract.

Notice of this termination of contract was published in the legal records section of each and every Montana newspaper.

At this time, May 31, 2017, Montana State Hospital (MSH) is still functioning under federal sanction because the ones directly associated with the operation of the place are incapable of remedying the issues most at stake.  This includes failing to meet measures imposed by US DPHHS as a direct consequence of violations that Hospital administrators knowingly allowed to occur prior to the related federal inspection.

One of the central issues identified in this context relates to MSH's ongoing (May 31, 2017) direct care staff shortages, namely, technician and nursing staff; shortages in staff that pose grave risk of harm to patients. As well as to the same staff who have to deal with these shortages, direct care staff as described above, versus any of those staff responsible for these shortages, namely Hospital administrators and the undercharges.

With these administrators in mind, let it be clear as well, that the concerns of the federal agency in this matter include the absence of required governance that such Hospitals must provide if they are going to be allowed to function.

No element of these details is of surprise to those of us on the staff of  The Arizona State Hospital and Patient Abuse, for indeed we have witnessed such malfeasance before. 

Literally. In detail.

The following article was published in our directly associated activist blog, away back in April 2013. As such, the issue at stake in Arizona's sole long term public mental health care facility (ASH) at that time did in time lead to the ultimate consequences that the administrators at ASH faced in spring 2015, as detailed in a wide range of public media sources, including this blog source.  

  ---------------------------------------------

PJ Reed The Arizona State Hospital and Patient Abuse.

DATELINE APRIL 13, 2013.

Staff Shortages at Arizona State Hospital. Wherein the ongoing crisis at The Arizona State Hospital specific to shortages in behavioral health technician staff has grossly unjust impacts on the ASH patient community. 

Hi PJ

Here is the latest from SA… Due to the lack of staffing patients are being confined to day rooms for crowd control….  They are also shutting down mall privileges because of lack of staff.  They are telling the patients that it is only going to get worse. (April 09, 2013).

NUTSHELL: Generally speaking, the patients at The Arizona State Hospital are afforded a range of privileges designed to optimize their overall state of mental and physical health and well-being. These privileges include access to various recreational and therapeutic actives and related in-hospital resources, the bulk of which are provided at different locations throughout the hospital. Such resources include a gymnasium, library, exercise room, art therapy room(s), and so on; while on the Civil side of the hospital (where approximately half of the ASH patients reside), there is an open area referred to as "The Patient Mall", which is comprised of a roughly 1/4 mile long piece of concrete lined on each side by seating areas and other like amenities intended to provide patients with a reasonably comfortably environment not confined within the walls of specific treatment units. These various privileges and related amenities are central to extensive funding that the citizens of Arizona have provided on behalf of ASH's patients over the past 15-20 years, and as illustrated in the 2004 newspaper article that I posted two days ago (see "Teaser", Mon. 04/08/13), even the federal government has emphasized the importance of granting ASH patients clear opportunity(s) to participate in therapeutic and recreational opportunities away from the limited confines of unit "day rooms", where they have nothing more to do than watch t.v. or sleep in filthy overstuffed chairs that are thoroughly wiped down about once every decade while the more rambunctious individuals (staff included) carry on with nerve wracking episodic outbursts and other like mania.     

With respect for the revelations exposed in 1999-2000 by a Medicaid investigation at ASH, these are only a few of the specific details provided at that time:

Inspectors with the Centers for Medicare & Medicaid Services reviewed 12 patient cases during a May visit to the State Hospital, at 24th and Van Buren streets. They found a hospital where patients were plunked in front of televisions or allowed to wander instead of being engaged in treatment.

The review found:

Patients have cookie-cutter, incomplete or ineffective treatment plans. One patient who had been at the hospital four months told them he couldn’t remember any treatment other than “going to the library once,” “movies and popcorn” and “medicine.”

So long as the highest paid state employees in the Arizona Department of Health Services fail to do the right thing by directly addressing the graphic wrongdoing at ASH, things there are never going to change. As illustrated in recent news reports (see this blog: "RE: Security Cutbacks At The Arizona State Hospital" March 12, 2013), recent major changes to the basic management of The Arizona State Hospital have led to shockingly unreasonable staff shortages and related safety concerns, including but not limited to a number of patient escapes. 

These changes were implemented by ASH's current supervisor, Cory"crazycorycorner" Nelson, in order to establish what he and his superiors in the Arizona Department of Health Services (namely ADHS director Will Humble) have characterized as a "CULTURE OF CARE," and central to those changes, Nelson has laid off dozens of experienced ASH staff, including a thigh number of security staff. He has done while simultaneously ignoring increasing staff concerns that arose due to shocking incidents of violence that lest more than one staff person gravely injured, and in clear contradiction to promises that he made to staff during in the hiring process in summer, 2011. Now, over the past 12 weeks, there have been several highly publicized news reports that came about in response to reports generated by ASH staff specific to safety, and subsequent investigations of those reports exposed the issue of patient escapes; this, in turn, led to three specific interviews with Cory Nelson in which he patently denied the fact that these changes have had anything but positive results. In one case, for example, he flatly rejected the notion that reduced security staff contributed to a series of patient escapes (no less than 5 in 2012) on the 10 p.m. nightly news, which in the eyes of at least some viewers, greatly brought Nelson's character and capabilities as the man most responsible for managing ASH into question.  

Thanks as always to our sources. Consistent with these other reports, I am now receiving information about the direct impacts that these staff shortages are having on the patients at ASH. Specifically, one such recent report reads like this:

"Hi PJ

Here is the latest from S.A.C.… Due to the lack of staffing patients are being confined to day rooms for crowd control….  They are also shutting down mall privileges because of lack of staff.  They are telling the patients that it is only going to get worse." 

As usual, in this specific case, we are again seeing how the ineptitude of ASH's administrators is landing squarely on the heads of the Hospital's seriously mentally ill and disabled client-patients. Cory Nelson and Will Humble have absolute direct responsibility with respect for these matters at this time, along with various other executive staff at both ASH and in ADHS/Behavioral Health Services. But it is also critical to note that the primary care providers at ASH are also involved in these issues, for they are the ones most directly responsible for each and every ASH patients' welfare, and this direct responsibility flows straight to ASH's chief medical officer, Dr. Laxman P. Patel. All of these individuals are currently complicit in allowing for the patients at ASH to be denied the general resources available at ASH, and this is wrong. Not unusual, mind you, just wrong, wrong, wrong, and 100% consistent with the standard practices at ASH, as illustrated to date by this blog, and as increasingly reflected by prime time news reporting.  

I am not going to send to much time on this today. But you can be sure that there are other developments from my end in the works, even as I write. The administrators and senior clinicians at The Arizona State Hospital are willfully engaging in substandard medical-mental health care and practice, and they are getting away with! For now. For there are a number of people today looking directly at these matters, and I am increasingly confident that it is only a matter of time before these rat bastards are held accountable to the full extent of applicable state and federal law.   

PLEASE SEE: RESOURCES IDEAS: MARCH 13, 2013 I recently posted a new listing of resources and contact information specific to the affairs of The Arizona State Hospital, and I strongly encourage anybody of like mind to do whatever you feel comfortable with in terms of defending the dignity and rights of the patient community at ASH. The administrators and clinicians at ASH are maintaining that operation at a dismally substandard level of medical care and practice, and they are getting away with lock-stock-and barrel. Patient abuse is highly illegal and when it comes the care needs of the highly vulnerable, seriously mentally disabled patients at ASH, it is sickening to the core. Let's work together and see that this matter is resolved today. I welcome any and all contacts- INCLUDING ASH STAFF, AND I ASSURE YOU THAT YOUR IDENTITY WILL NOT BE PUT AT RISK- and want to extend my sincere thanks to those of you who I have come to know thus far through my writings, and I really appreciate your willingness to consider my concerns in this context.  

-------------------------------------

IN CLOSING.

TO THE ADMINISTRATORS OF MONTANA STATE HOSPITAL, MAY, 2017, AND EACH AND EVERY OTHER MSH STAFF PERSON INVOLVED IN THIS STILL EMERGING PUBLIC HEALTH CARE SCANDAL.

THIS PROCESS IS ONLY BEGINNING. 

YOU LIKELY HAVE LITTLE TO NO IDEA WITH THAT MEANS, BUT YOU MIGHT WANT TO CONSIDER THE FACT THAT CMS HAS YET TO BACK OFF. 

BUT YOU DO KNOW WHO YOU ARE. OR NOT, IF YOUR OWN SENSE OF CONSCIENCE IS SO LACKING THAT NOTHING WILL CONVINCE OF WHAT IT MEANS TO DO THE RIGHT THING IN THIS CONTEXT.

OR NOT, BECAUSE WE KNOW WHO YOU ARE. EVEN IF YOU DON'T.

YET.

CONSIDER YOURSELVES SO ADVISED. YOUR TIME HAS COME, THE JIG IS UP.

AND THE BALL IS NOW IN OUR COURT.  

paoloreed@gmail.com