Evidence to the effect of Montana State Hospital's inability to get their shit together. Just like Arizona State Hospital. Literally.

INTRODUCTION. In late 2013, and again in 2014, the Federal Centers for Medicare and Medicaid Services (CMS) completed several lengthy and in-depth investigations of the Arizona State Hospital (ASH), Phoenix, AZ. The subsequent CMS report(s) determined that ASH was operating in violation of a wide range of federally mandated regulations by which ASH is licensed to operate, including the facility's failure to maintain required patient to staff quotients (ratio). Consequently, CMS issued a "Notice of Jeopardy" wherein ASH's license to operate was at risk of being terminated. As per standard protocol, CMS granted the Hospital to get it's shit together within and allotted time period. At the conclusion of that time period, in early 2014 CMS determined that this had not occurred, leading to more direct federal oversight that did lead to the summary firing of no less then seven individuals directly directly associated with the operation of ASH, including the Hospital's CEO, the Department of Health/Behavioral Health Services' Deputy Director, one state employed attorney, and several lower ranking staff at ASH itself.   

In recent articles, the staff of PJ Reed The Arizona State Hospital and Patient Abuse and Montana State Hospital. Montana's Forgotten Suicides have described the fact that in fall 2016, CMS was notified that the Montana State Hospital (MSH) was failing to maintain required patient to staff quotients (ratio). Just like ASH in 2013-14. And just like ASH, MSH is still today failing to get its shit together. 

Below are several mainstream press articles specific to MSH history in context, circa January 2017 to the present. 

It should be noted that reporter Holly Nichols interviewed me at MSH in December, 2017, and again in late January, 2017, following which she published the first of a series of articles about these issues. While in 2013, an investigative reporter named David Biscobing of the Phoenix area ABC news affiliate, KNVX/Ch15, contacted me through this blog publication with a request to collaborate in order for him to initiate his own formal investigation of ASH. 

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State Psychiatric Hospital Changes Policies After Lockdown

Associated Press. May 31, 2018.

The Montana State Hospital has changed some policies and plans to increase staffing and improve training after a unit of the psychiatric hospital was locked down in November due to a lack of staffing and two patients were unnecessarily held in seclusion.

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Warm Springs Assaults blamed on chronic, 

pervasive staff shortages. 

HOLLY NICHOLS. Lee Newspapers. March 08, 2017

A recently recently released federal inspection details why the Montana State Hospital at Warm Springs, which is home to civilly and criminally committed patients with mental illness, was at risk of losing its federal certification for twelve days in January. Documents from the Federal Centers for Medicare and Medicaid, which certifies parts of the hospital, say "chronic, pervasive staff shortages" led to the attacks. 

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Feds find state hospital put patients at risk,
almost terminated agreement.

HOLLY NICHOLS. Lee Newspapers January 27, 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.

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IN CLOSING: Collaboration between mainstream and independently produced media is an increasingly common feature to investigative journalism today. The advent of the internet, the emergence of blog formats (including blogspot.com), and the realization that independent investigations of issues critical to the public interest are useful to mainstream media outlets, are granting the public a much firmer understanding of exactly what goes on in shadowed corners that, for the most part, have historically been out of sight, out of mind. This most definitely applies to state managed mental hospitals such as ASH and MSH.

On countless occasions in the history of this publication, I have stated that it was never my intent to become a central source of information about the realities in state hospitals. This is still the case. When I showed up at MSH in spring, 2015, I had no predisposition to the effect that I would run into the same degree of shortsightedness that ASH is so well known for (and that's putting it nicely). Likewise, I had no desire to fall into the same level of dedication about the affairs of the MSH patient community that I was compelled to engage in on behalf of my former patient-peers at ASH.

But there you go, right? Different meadow, same cow pies. 

paoloreed@gmail.com

How It's Done II. RE: Bringing about oversight and accountability when state managed mental hospitals are being mismanaged and in violation of licensure, federal and state law and policy.

-THE LETTER-

RECAP OF THE JULY 02, 2018 ARTICLE: 

As discussed, when I was hospitalized at the Montana State Hospital (MSH) in late spring, 2015, I filed several good faith grievances about a rogue staff psychiatrist named Dr. Colby Wang, on the basis of his abusive use of language, his threat to keep me hospitalized there at his leisure regardless of my state of health, and other such features to his behavior and conduct.

Upon being readmitted for to MSH for the 2nd time in late August, 2016, Wang willfully directly, personally interfered with my admission in direct response to the grievances that I had filed in 2015, which I deduced  to be retaliative in nature. Retaliation of any kind is patently forbidden by my protections specific to the Americans With Disabilities Act. I thus filed a grievance about the issue immediately after this act was imposed upon me. 

In subsequent weeks, MSH administrators refused to acknowledge my grievance as having any merit. This refusal was shared by the Hospital's own in-house "patient's lawyer", Craig Fitch.

(Colby Wang was summarily fired in early October, 2016)

I thus took it upon myself to take close note of any issues occurring at MSH that I felt to be wrongful, unlawful, or otherwise harmful to the wellbeing of the MSH patient community; and went so far, in fact, as to give Fitch fair warning as to this intent.

In October, 2016, during my second month of being readmitted to MSH, it became readily apparent to me that the Hospital was experiencing graphic staff shortages, an issue that I knew to be in violation of the federal standards that all such state mental hospitals are required to adhere to, and which I also knew posed grave risk of harm to patients and staff alike.

I initially suggested to my patient-peers on the MSH Resident Advisory Committee (RAC) that we as a group submit a report of this issue to the governor of Montana. During the RAC meeting where I brought this up, a staff person interfered with us and insisted that we take the issue to the Hospital CEO, Jay Pottenger.

Jay Pottenger

Chief Executive Officer
Montana State Hospital
2016-present.

At a subsequent RAC meeting, Pottenger refused to acknowledge the significance of this issue, declaring that his role in the matter was out of his control.

This compelled me send a personal reporting of the matter to Montana Senators Ron Lehi (R-Hamilton) and Debbie Barrett (R-Dillon). I did so in a handwritten two page letter, shown below. 

In late November, 2016, not long before my pending discharge, the federal Centers for Medicare and Medicaid Services (CMS)- which licenses the operation of MSH- initiated a drawn out formal investigation of all aspects of the MSH operation. This investigation culminated in a final report that identified over one hundred eleven (111) violations of the standards by which MSH is licensed.

After giving MSH administrators a period of time to correct these concerns, CMS was forced to issue a Notice of Jeopardy on the basis of these concerns not being addressed. (This is precisely what happened at the Arizona State Hospital.)

As stated, I am not able right now to enlarge the images above, but will be able to in short order. For now, suffice it to say that this letter included all details specific to the process by which I was compelled to draft it, as well the significance of the issue of staff shortages, which I knew not only were occurring in violation of federal standards, but which also poses grave risk of harm to staff and patients alike. Low ranking staff, that is, and not the fat-cat bureaucrats like Jay Pottenger, who traditionally are so disconnected to the realities of what really goes on in these places, that they hardy really give a damn when information of this sort is provided to them.

But they do this at their own risk. As proven by the most recent trouble that Arizona State Hospital experienced (emphasis here on most recent, because it sure as hell isn't the first time), and by the ongoing developments at Montana State Hospital, which is even today- more then eighteen months after they were sanctioned by the federal government- yet to be resolved.

So be it.

IN CLOSING: There is no just cause for any administrative member of state managed mental hospitals to ignore well intentioned efforts of patients who express concern about their experiences. But just as with my time at the Arizona State Hospital, where none of my good faith, well drafted as per protocol grievances found any degree of resolution, these patterns of abject negligence occur away up in Montana, too. And very likely, throughout the nation. This is wrong, wrong, wrong. 

It is clear to me by now, as a man affected and disabled by serious mental illness who has accrued three full years in more then one state managed mental hospital, that the sole reason for why this occurs has to do with my status as a man affected and disabled by serious mental illness. Were such issues to be raised in a non-mental health care facility, private, county, whatever, there is no way in hell that hospital administrators would risk ignoring such matters, on the basis of liability, if nothing else. 

But in state managed hospitals, where a pervasive attitude of "What happens in (Vegas) stays in (Vegas)" exists as a matter of standard practice, such issues are swept under the rug, with no regard for the rights or care needs of the involved patient, etc. Virtually all individuals hospitalized in these places are disabled under state and federal law. It follows, thus, that this is patent discrimination on the basis of disability, and nothing less. 

Even in this day in age, it is that bad. I attest to it, and have only one choice:  To continue reporting it all in my writing and reporting in this blog, and elsewhere. I and my staff refuse to relent until reform oriented towards addressing these issues meets our satisfaction, most specifically in a context of getting state managed mental hospitals out of the habit of defying medical standards once and for all. 

MORE LATER. AS ALWAYS.

paoloreed@gmail.com