Wednesday, July 10, 2019

Of Craig Fitch, Montana Attorney at Law.


 "Montana to audit end-of-life care at state mental hospital."


  •   

    RE: Attorney Craig Fitch has worked as a representative of the Office of the Montana Governor, more specifically, on the governor appointed Board of Visitors, for over seventeen years. As such, this is the only client that Fitch has actually worked for in service to for the entirety of that time, the state's own administration. No state citizen is able to acquire Fitch's actual legal representation, or that of the above Board of Visitors. Rather, state government, including the Montana Department of Health Services and The Montana State Hospital, are the actual entity(s) that Fitch is contracted to serve in his capacity as a licensed attorney.

    "Things had really fallen apart a tiny bit...."
              July 05, 2019.  This is Fitch's official, as in formal public response to the issue of substandard care practices on Montana State Hospital's (MSH) Spratt unit, which is specifically designated and responsible for the care of the facility's geriatric citizen-patient consumers ("consumers" of public tax funded state services)A treatment setting responsible for a deeply vulnerable population of persons disabled by not only mental illness, but by old age, as well. This statement was documented in the above cited news article, wherein a state audit of the Spratt unit was reported by David McCumber of the Montana Standard newspaper.    

    "Well, maybe you'll know better next time, that this is a risk you take when you do that sort of thing...."
                   
            October 12, 2016. I attest that Fitch stated this to me is in a one on one discussion about why I was forced from the appropriate- as per formal designation and protocol-  treatment unit at MSH and onto another far more dangerous unit with a treatment designation having no relation to established my diagnosis and directly associated care needs. He stated this- "...when you do that sort of thing..."- in undeniable reference to my having reported an MSH psychiatrist's abusive misconduct towards me when engaged in  formal 1:1 treatment sessions during my first hospitalization at MSH in 2015. 

            That doctor's name is Colby Wang, who had his contract to work for the state of Montana terminated in late October, 2016 only a few weeks after Fitch stated this to me. Fired, in other words. This was
    Fitch's second justification of retaliation towards my, and if only follows, any patient's who might exercise our constitutional right to report staff misconduct or literally any other well grounded concerns about the flow of treatment at MSH. 
      
    "It happens all the time...."

            August 22, 2016. This was Fitch's verbatim reaction when I turned to him immediately following the above described issue of retaliation. More specifically, after Colby Wang-  who I had previously filed several well intentioned grievances about in 2015-  directly interfered with my late August, 2016, re-commitment to MSH, and willfully altered my placement for treatment on the formally designated treatment unit, and forced me onto unit designated to treat persons with vastly different diagnosis(s)to my own. This was Fitch's first exhibition of his willingness to condone an issue that can and does pose very real risk of harm to the well being and interests of all/any MSH patients. Which, as already described above, stands as justification of retaliation against me or any other like patient-consumer at MSH who has disagreement with the performance of staff members, including and foremost in my actual case, senior ranking medical staff.

    "I am the 'patients' lawyer'..."

        This is Fitch's uniform self characterization of who he is and what he does there at MSH. I have heard him state these exact words on too many occasions to count, including at least once, during an actual district court proceeding. He utilizes this language as means to deceive and wrongfully acquire the trust of the MSH patient community. 

    Could not make it up if I had to. 

    INTRODUCTION.

    Of Arizona, of Montana.

    Arizona, 2011-2012. When I was hospitalized for thirteen months at Arizona's sole long term public mental hospital, Arizona State Hospital, in Phoenix, AZ (ASH), ASH's chief medical officer, Dr. Steven Dingle, worked in complicity with ASH's chief executive officer at the time, Cory Nelson in subjecting me to overt retaliation. They did this after I had made clear to my assigned ASH primary care providers that  I was not going to ignore incidents and events that I felt were harmful to myself and my patient-peers, and they did so by summarily forcing me off the appropriate treatment unit- as per my diagnosis and directly associated care needs- and moving me instead onto one of ASH's most violent treatment units, which is not designated to treat persons diagnosed as I am, affected by major depressive disorder.

    FACT: All state managed public hospitals, be they a mental hospital or not, are required by federal health care standards to place any citizen(s) admitted to such facilities onto the proper type of medical treatment unit. This is only common sense. There is no justification to place an individual diagnosed with lung disease, for bright line example, on onto a treatment unit designated to treat persons with orthopedic health problems. But as described above and as described below, as well, I have learned more then once- the hard way- that senior medical staff and administrators in state mental hospitals are willing to defy this very established approach to health care as a matter of standard practice. Indeed, such highly entrusted public health care employees are willing to violate this principle as means to thwart any patient-consumer's willing and right to disagree with the flow of treatment that they are subjected in such mental facilities; in attempting, more succinctly, to cow such individuals into submission by forcing them into dangerous treatment settings that are graphically inadequate and directly incapable of ensuring reasonably optimized care practices and actual treatment.  


    Circa the the period 1993-2015, a staff attorney in the Arizona Office of the Attorney General (OAG), Joel Rudd, was assigned to the AZ State Hospital (ASH) circa 2001-2016, supposedly in order to ensure that ASH was being operated in compliance with state and federal law and policy, was centrally involved in condoning a vast range of legal wrongs there (including my time at ASH, 2011-12). Those issues did in 2014-15 lead to formal federal intervention on the basis of information we began publishing herein in April, 2012, and subsequent investigation by Phoenix's ABC news affiliate, which we did contribute to.

    From the website www.azag.gov:


    "The Arizona Attorney General serves as the chief legal officer of the State. The Attorney General is mandated by our constitution and elected to a four-year term by the people of Arizona.

    The Attorney General's Office represents and provides legal advice to most State agencies; enforces consumer protection and civil rights laws; and prosecutes criminals charged with complex financial crimes and certain conspiracies involving illegal drugs. In addition, all appeals statewide from felony convictions are handled by this Office.
    The Arizona Attorney General’s Office, through the Child and  Family Protection Division, provides legal services to all the divisions of the Department of Economic Security (DES), including the Division of Child Support Services (DCSS). It also provides legal services to the Department of Child Safety.
    The Attorney General’s Office brings and defends lawsuits on behalf of the State and prepares formal legal opinions requested by State officers, legislators, or county attorneys on issues of law.


    The Attorney General’s Office has jurisdiction over Arizona's Consumer Fraud Act, white collar crime, organized crime, public corruption, environmental laws, civil rights laws, and crimes committed in more than one county. Additionally, this Office prosecutes cases normally handled by county attorneys when they have a conflict."

    It is a plain fact that Rudd was very much at the table when all formal decisions about the operational practices at ASH were made when he was appointed there, including when I was hospitalized there in 2011-2012. As such, and in direct association with the fact that the function of OAG is required first and foremost to preserve the interests of all persons residing as citizens in the state of Arizona, particularly with regard for civil rights law and policy (see above, second paragraph), Rudd acted in gross violation of the terms by which he was employed to work at ASH. The Rat Bastard managed to get away with this shit by working in abject complicity with ASH's corrupted administrative officers, unethical senior ranking medical staff, and shortsighted officials in the state's Department of Health Services.

    As of 2016, however, Rudd is no longer employed by OAG. He has since gone into private practice as a common construction contract lawyer, a position having no relation to the laws and policy factors that apply to any state managed health care facility. Whether he was forced out of his other job, perhaps a response to my having written a formal letter to Rudd's boss, AZ Attorney General Greg Brnovich, about what I know about him, I don't know. But he is no longer there, and this is a very good thing. 


    Montana, 2015-2019. The situation is little different at Montana State Hospital, but only in the sense that a governor appointed attorney working in a state health care agency, Craig Fitch- versus in the office of state's attorney general- is the sole legal representative at this state's sole long term mental health care facility, the Montana State Hospital (MSH) in Warm Springs, MT. Fitch has played this role for at least seventeen full years (see further below), and I could not be more accurate in characterizing his conduct as theatrical acting.

          "Craig Fitch, the acting director of the Montana Mental Disabilities Board of Visitors, said the psychiatrists were working on the Spratt unit late last year, at a time that 'it had really fallen apart a tiny bit....' " 
                    July 05, 2019. 

    (cfitch@mt.gov 406-693-7037).

    The following is a partial portion of the statute by which this Board exists. The full statute, Montana Annotated Code 53-21-104, is included at the conclusion of this essay.

    In sum, this statute requires one central thematic duty, as dictated in the following, and as per the rights and care needs of all/any disabled Montanans being treated in any mental health care facility in the state:


    Montana Annotated Code 53-21-104. (1985). Powers and duties of mental disabilities board of visitors. 

    To ensure that the treatment of all persons either voluntarily or involuntarily admitted to a mental factilty in Montana is humane, is consistent with established clinical and other professional standards, and meets the requirements set forth in part. 

    The board shall employ and is responsible for full-time legal counsel at the state hospital, whose responsibility is to act on behalf of all patients at the state hospital. The board shall ensure that there are sufficient legal staff and facilities to ensure availability to all patients and shall require that the appointed counsel periodically interview every patient and 
    examine the patient's files and records. The board may employ additional legal counsel for representation of patients in a similar manner at any other mental health facility having inpatient capability.

    Since early 2017, Montana State Hospital  has been subject to formal oversight by both the federal government, as well as state based agencies, on the basis of exposed failures of the hospital to adhere to established law and policy. (See: "Feds find state hospital put patients at risk, almost terminated agreement." By Holly Michels. Lee News [January 27, 2017]; "Warm Springs assaults blamed on chronic, endemic staff shortages" Holly Michels. Lee News [March 08, 2017]). In only this narrow period of time, for no explainable or justifiable reason, state employed lawyer, Craig Fitch, willfully failed to bring the issues at stake in to light in his own right.

    This is the same degree of abject dereliction of duty that  arose during Joel Rudd's very questionable time at Arizona State Hospital. Both of them, Rudd and Fitch, employed and highly entrusted via the public trust, are licensed attorneys who are required to adhere their respective job descriptions, but have proven themselves instead as being incapable of even a modicum of diligence in context. Professional negligence and malpractice with respect for the care needs, rights, and interests of citizen-consumers who are committed by the court(s) for treatment at these specific hospitals.


    ---------------------------------------
    DISCUSSION  

    2015-2016. 

    Dr. Colby Wang.
    Former-since fired (2016)
    staff psychiatrist.
    Montana State Hospital.

    For the record, (timeline July, 2019), Montana attorney Craig Fitch has been assigned on a full time basis at Montana State Hospital (MSH) for at least seventeen years (see below),  functioning there as a supposed legal advocacy resource in the interest of the legal needs of each and every disabled citizen-consumer at MSH is provided with reasonably optimum care. Fitch is contracted and employed in this capacity with the Montana Board of Visitors ("BOV" hereafter), which is governor appointed entity therein created not to legitimately represent the interests of Montana citizens hospitalized  at MSH, but rather, to represent the interests of the state government. This very necessarily includes defending the Hospital itself, even if only through public discourse, regardless of how questionable the issues at stake or the risks of harm posed to the MSH patient community due to such issues may happen to be.


     "Montana to audit end-of-life care at state mental hospital."


  •  

    As to theater, then. The following information about Fitch's supposed role at MSH is included on BOV's state website. It is critical and outlandish to realize that this is official version of Montana state government about what Fitch does, in fact.

    • "Craig has been with the Mental Disabilities Board of Visitors since October 15, 2002 and has 17 years experience working in the mental health field as an attorney for Montana State Hospital patients."
      •       
      • (TO SEE THIS VISIT: http://boardofvisitors.mt.gov/staff)
    The statement, "working... as an attorney for Montana State Hospital  patients" is patently false. Herein, the theatrical aspect of it all.  Fitch has no formal, actual status as lawyer contracted to represent the interests of any individual hospitalized at MSH. As already described, this particular Rat Bastard is plainly, irrefutably employed and contracted as an attorney for and in the interest of the state of Montana. His singular client is state government, and state employees or representatives. But Fitch has a standard practice of verbally referring to himself in these words: 


    "I'm the patients' lawyer." 

    With direct respect for the above falsehood that Fitch relies on in communicating with the MSH patient community, the reality is that he has the very specific duty to represent the interests of the state, and in is in no way obligated or- quite frankly- even allowed to put the interests of any individual patient-consumer or that of the greater patient community ahead of his specific duty, as described herein. This is Orwellian word speak, at best.

    However, and well after my first interactions with Fitch in 2015, I was only first alerted in fall, 2016, to the fact that Fitch willfully acts in this deceptive manner following an overt act of retaliation against me by a since fired MSH psychiatrist, Dr. Colby Wang (see photo at top of this essay). This retaliation occurred in the same precise manner that this happened to me in the Arizona State Hospital in 2011, by willfully neglecting my my well established diagnosis and associated care needs with respect for the specific form of treatment that I needed, and forcing me into an environment not only lacking the care and treatment format I am am deserving of, but which also posed very real threat to my very life and limb. 

    As follows:

    I was hospitalized at MSH for the first time in early summer, 2015. During that time, I was admitted onto the appropriate treatment unit, Bravo, as per my diagnosis and associated care needs. There is established protocol, developed and issued by the Montana department of health, whereby the various treatment units at MSH have very specific treatment designations in relation any admitted patient's diagnosis.


    Bravo unit is where I encountered Colby Wang, he being my assigned primary attending psychiatrist at the time. I thus learned the hard way of Wang's very real and grossly abusive mannerisms and behavior. This literally arose for the first time in my initial  1:1 interaction with Wang. He also flagrantly breached my right to informed consent during thenby failing at one point to inform me that he had prescribed an additional medication to my daily medication therapy. I only learned of this when I was getting my standard medications one morning. Specifically speaking, Wang outrageously prescribed the medication Abilify, which is an known anti-psychotic medication (for the record, I have never been diagnosed with any form of psychosis), and he did so without even discussing it with me in advance, a patent violation of my rights. 


    The standard of informed consent is fundamental to medical practice across the board, and yet Dr. Colby Wang proved himself incapable of abiding by this very established standard of care, an overt exhibition of contemptible incompetence and deeply unjust conduct that is forbidden by law and policy.
    And as already stated above, it also plain fact that I have never been diagnosed as being affected by any degree of psychosis.  


    In fall of 2016 I was committed to MSH for the second time. I attest that I had more then a few concerns as this went down about the fact that I had formally reported Wang's  incompetence and abuse, and that I would very possibly be subject to the same precise nature of retribution that I was subjected to at Arizona State Hospital in 2011-12, on the simple basis of my having lawfully reported staff misconduct and substandard care practices.  However,  my initial admission to MS at the time was processed in a manner consistent with Hospital protocol, which is the say that I  was again to be placed on the appropriate treatment unit, where persons with my specific diagnostic features are to be treated, which was a nearly profound relief. I did, in fact, ask the nurse handling my admission about which unit I was to be placed on for treatment, and her response was "Bravo," consistent with Hospital protocol and dictate.

    But even I sat there in front of this admission nurse's desk, Wang personally contacted her by phone, and redirected my placement onto away from the Bravounit, and onto a treatment unit specifically designated to treat acute psychosis. For the record, I have never been diagnosed with any degree of psychosis, much less so acute psychosis. 

    Wang's action was a clear execution of illegal retaliation. No question about it. I knew this, because I had been through it already. In Arizona, in the exact same manner, on the same specific basis,


    The plain fact of the matter is that Wang acted in precisely the same manner that the administrators at ASH did when they, too, retaliated against me as a  consequence of  my known willingness to report staff misconduct and directly related shortfalls in patient care.  did so by interfering with my 2015 admission to MSH, and forcing me onto an MSH treatment unit specifically designated to care for persons affected by acute psychosis. For the record, I have never been diagnosed with psychosis, period, much less acute psychosis. As such, Wang did this in defiance of the facility's own guidelines, which are established in keeping with federal law and policy. And he did so with the full support of attorney Craig Fitch.   

    Fact is, too, that I immediately turned to Fitch in the hope that he would defend my right to receive treatment in that part (treatment unit) of MSH specifically designated to treat persons affected by emotional disorder, as I am. Major depressive disorder, specifically speaking, versus acute psychosis. The appropriate unit in the context of  me care needs is called "Bravo" unit, while the unit that Wang forced me onto, "Alpha", has a distinct and irrefutable designation to treat persons suffering from acute psychosis. This latter diagnosis and the form of specific medical treatment that persons affected by acute psychosis require (e.g. persons affected by schizophrenia) is greatly different from my actual diagnosis and my associated care needs applicable to treatment practices. .


    I turned to Fitch at that time with respect for my constitutional right to report issues that I believe to be unlawful or in any way harmful to my care needs, as I had done in 2015, and my associated federal protections against retaliation on this such basis, as per the dictate of The Americans With Disabilities Act. 


    Fitch's verbatim response to me, September, 2016:  



    "It happens all the time."

    For Fitch to excuse this crap as being something that happens all the time is ridiculous. As though these such actions are allowable simply because they occur as a matter of standard practice. 

    Fitch also stated at that time that this act of retaliation was my own fault, implying that I should have "known better" in choosing to raise the issue of Wang's abject misbehavior in 2015, me deserving, in this vein, that I had such retaliation coming to me. Clearly proving that Fitch agrees with this nature of illegal conduct, and that he would further be willing to involve himself in it all.

    For only one bright line example of this concern, in January, 2017, despite Fitch's full time presence at MSH, the federal government conducted a formal inspection of MSH, wherein it was found that this particular public mental health care facility was not operating in a manner consistent with the state's obligations (to provide safe and humane medical care) in violation of law and policy , and subsequently-consequently imposed formal intervention at MSH in the interests of the patient communiy there. 


    "In violation of law and policy...." This is a role that Craig Fitch and the governor appointed BOV is supposed to fill, as per the statements provided in a state sanctioned web site.

    Such direct intervention by federal authorities only occurs when it is determined through routine and formalized inspection that state managed medical facilities such as MSH and ASH are operating in violation of a range of federal laws established to ensure that the rights and care needs of all/any disabled American citizen(s) in such places. These such laws very necessarily apply to the operational conditions and associated care practices in state managed mental hospitals. 


    Given that Fitch- an attorney- is stationed there, at the hospital itself and in a clear position to identify the existence of such violations, there is no justification for him not having addressed these matters before federal intervention arose, the fiscal costs of which were imposed on state tax payers, just as Fitch's salary is provided. 


    Such direct intervention by federal authorities only occurs when it is determined through routine and formalized inspection that state managed medical facilities such as MSH are operating in violation of a range of federal laws established to protect the rights and care needs of all/any disabled American citizen(s) today. These such laws very necessarily apply to the operational conditions and associated care practices in state managed mental hospitals. 


    I attest to having discussed this with Craig Fitch in fall, 2016, during my second period of hospitalization at MSH. He personally affirmed this reality, his undeniable status as an attorney obligated to protect his employer and the interests of state government, and not as a legitimate "patients' lawyer" (a self  designation that Fitch loves to claim). This affirmation occurred when I advised the man of my awareness of this issue, which I contend proves his arguable lack of professional character, wherein he does, on a day in-day out basis, claim to be the "patients' lawyer" at MSH. Fitch's actual role RADICALLY deviates from the care needs and rights of the MSH patient community, extending instead to various state agencies, such as the Montana Department of Health, and the department's Division of Addictive and Mental Disorders, both of which are directly responsible for the operation of MSH. 


    These such agencies are the actual entities that Fitch has as clientele. He is in no way whatsoever an attorney contracted to represent the rights or actual interests of the MSH patient community. Period.  


    And yet it also follows that, even as a state employee versus a patient's lawyer, in being stationed at MSH on a full time basis, Fitch was and is still in an undeniable position to identify the existence of such violations. Which is to say that there's  no justification for this highly entrusted state employee to have not acted in addressing such issues before the need for federal intervention arises, 100% on point with presence of Joel Rudd at ASH at one time.
      
    I also attest to Fitch's personal responses, as described above, when I came to him in the hope that he would defend my right to receive treatment in that part (treatment unit) of MSH specifically designated to treat persons affected by emotional disorder, as I am, and just as critically, my right to not be subject to retaliation.  

    2019

    In this vein, then, let's just consider for a moment some more of Fitch's specific language in the last few months, as documented in the above cited July 05, 2019, news article: "Montana to audit end-of-life care at state  mental hospital." This issue arose in direct relation to MSH's geriatric patient-consumers, who are generally subject to treatment in the Hospital's Spratt Unit. I see such individuals as doubly disabled, affected in this sense by arguably common  forms of mental illness, such as depression or schizophrenia, or perhaps by more specific age related problems, such as dementia, Alzheimers disease, and Parkinson's disease; and affected, as well, by age related physical challenges, too, such as cerbrovascular disorder (stroke) and cardiovascular disease, macular degeneration (blindness), and on the list can go in this sense.

       "Doubly disabled." Doubly at risk of neglect, abuse, and any number of other known risk factors. 

    Upon being asked to comment about this most recent exposure of substandard care practices and conditions in MSH's geriatric unit (Spratt unit),  Fitch stated verbatim that, well within his scope of awareness in recent years, if not longer, the Spratt treatment unit had:

    ".... really had fallen apart a tiny bit..."

        "...had REALLY fallen apart..." 
         As in truly, very much so, seriously so, and clearly deserving of formal attention.
      "...a TINY BIT..." 
        As in minutely, insignificantly, understandably, and/or in any way acceptable to the public interest.

    Could not make it up if I had to. Patently deceptive abuse of language, the same sort of crap that often give lawyers a bad name. Nonsense, in effect, stated by a licensed attorney working at a state mental hospital and designed to dupe the public. And no less twisted then the terminology state bureaucrats so often utilize as means to deny the public factual and truthful information about the function of state managed public agencies across the board.

    Conclusion

    All aspects of this matter are directly akin to the unlawful and highly inept misconduct of the attorney who was required to ensure that Arizona State Hospital (ASH) was operating alignment with state and federal law circa my time there as a patient-consumer (2011-12). Joel Rudd, that is (also characterized by some as "Angel of Darkness", "Mortician"),  who along with numerous other staff at ASH who were fired, or vacated or otherwise exited their positions in Arizona's public agency construct only three years following my February, 2012, discharge from ASH, and the founding of this publication. I can attest, as such, to the fact that Rudd was centrally involved in all elements of the outrageous scandal first reported herein.

    While away the hell up in Montana, state employed attorney Craig Fitch has in recent years been equally involved in a range of issues that did, on the basis of reported violations of the standards by which MSH is licensed, repeatedly lead to federal oversight and intervention at MSH. 

    100% on point with what ASH has been subject to since my time there. Including but not limited to systematic retaliation aimed at me simply because I exercised my constitutional rights and related civic duty as an American citizen bearing knowledge about abject abuses of myself and my patient-consumer peers.  

    Via  nothing short of very real personal experiences in both mental health care facilities, as well as more standard hospital settings, I firmly believe that it is only in state managed mental hospitals that one will encounter administrative ineptitude to this degree of a fault. As a matter of standard practice, and as attested to by Fitch, illegal misconduct that "happens all the time."

    paoloreed@gmail.com



    Montana Annotated Code 53-21-104 (1985) (in full).

    Powers and duties of mental disabilities board of visitors.


    (1) The board is an independent board of inquiry and review that is responsible to ensure that the treatment of all persons either voluntarily or involuntarily admitted to a mental facility in Montana is humane, is consistent with established clinical and other professional standards, and meets the requirements set forth in this part. 

    (2) The board shall review all plans for experimental research involving persons admitted to a mental health facility to ensure that each research project is humane and not unduly hazardous and that it complies with the principles of the statement on the use of human subjects for research of the American association on mental deficiency and with the principles for research involving human subjects required by the United States department of health and human services. An activity considered to be an experimental research project and that involves a person or persons admitted to a mental health facility affected by this part may not be commenced unless it is approved by the mental disabilities board of visitors. 

    (3) (a) The board shall inspect every mental health facility that provides treatment or evaluation to any person pursuant to this part. 

         (b) The board shall annually establish a schedule for the inspection of mental health facilities that enables the board to meet its obligation under subsection (1). 

         (c) The board's authority to inspect mental health facilities may not be waived or precluded by other treatment review, licensing, or accreditation requirements or protocols. The board may exercise the prerogative to inspect any mental health facility at any time independent of its facility inspection schedule. 

         (d) The board shall produce a written report of each inspection of a mental health facility that must include specific recommendations for improvements that the board concludes are necessary in order for the inspected facility to meet the requirements in this part. 

         (e) The board shall provide a draft of each written report within 30 calendar days of the completion of each mental health facility inspection to the professional person in charge of the inspected facility for review prior to publication. 

         (f) The professional person in charge of the inspected facility shall provide a written response to the board's written report within 30 calendar days of receipt of the report. The response must include one of the following for each recommendation:

         (i) a specific plan for implementation of the recommended action; or 
         (ii) a specific rationale that explains why the recommendation cannot be implemented. 
        (g) The board shall include the inspected facility's written response in the board's final published written report.
      (h) The board shall include in subsequent inspections an assessment of each facility's implementation of the recommendations. 
        (i) The board shall report in writing to the director of the department and the governor when it determines that a mental health facility has not either implemented written recommendations or provided a specific rationale that explains why any recommendations cannot be implemented.

    (4) (a) The board, by applying a sampling process during a scheduled inspection of a mental health facility, shall ensure that a treatment plan and a discharge plan exists and is being implemented for each patient admitted or committed to the mental health facility being inspected under this part. 
         (b) The board, during a scheduled inspection of a mental health facility, shall review all aspects of the treatment of persons admitted to mental health facilities and review the use of treatment procedures that involve behavior control, including but not limited to the use of any type of mechanical restraints, locked and unlocked seclusion or isolation, time out, or any other procedure involving physical control.
          (c) The board shall ensure that the use of treatment procedures described in subsection (4)(b) at inspected mental health facilities is clinically justified, is monitored closely by a medical doctor and other mental health professionals, is implemented only when other less restrictive measures have failed, and is implemented to the least extent necessary to protect the safety and health of the affected individual or others in the immediate environment.
         (d) The board may exercise the prerogative to inquire about and ensure the existence and implementation of treatment plans and discharge plans for any person admitted to a mental health facility and to inquire about and ensure the appropriate use of treatment procedures described in subsection (4)(b) with any person admitted to a mental health facility independent of its facility inspection schedule. 

         (5) The board may assist any person who is receiving or who has received treatment at a mental health facility in resolving any grievance the person may have concerning the person's admission or course of treatment in the facility. 

         (6) The board shall employ and is responsible for full-time legal counsel at the state hospital, whose responsibility is to act on behalf of all patients at the state hospital. The board shall ensure that there are sufficient legal staff and facilities to ensure availability to all patients and shall require that the appointed counsel periodically interview every patient and examine the patient's files and records. The board may employ additional legal counsel for representation of patients in a similar manner at any other mental health facility having inpatient capability.

         (7) (a) If the board believes that any facility is failing to comply with the provisions of this part in regard to its physical facilities or its treatment of any person, it shall report its findings in writing to the professional person in charge of the facility and the director of the department.
         (b) The professional person in charge of the facility shall submit a written response to the board within 10 working days of the receipt of the board's written findings provided for in subsection (7)(a) that includes an explanation of the facility's point of view regarding the board's concerns, including areas of disagreement and agreement. If the facility is in full or partial agreement with the board's concerns, its written response must include actions that it has taken or that it plans to take to address the concerns
         (c) If the facility's written response does not resolve the concerns to the board's satisfaction, the board and the professional person in charge of the facility shall meet in person within 15 working days of the board's receipt of the facility's response to seek a mutually agreed upon resolution.

         (8) The board shall publish standards for its inspections of mental health facilities. 

         (9) The board shall report annually to the governor concerning: 
         (a) the status of the mental health facilities and treatment programs that it has inspected since the last annual report; and 

         (b) occurrences of the administration of medications against the wishes of persons receiving treatment in mental health facilities and the effectiveness of the review procedure required by MCA  53-21-127 (6) in protecting persons from unnecessary or excessive medication.





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