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. 

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"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