As St.

Elizabeths Crumbles, Many Advise Closing

It; D.C.'s Fiscal Crisis Adds To Aging Hospital's
Woes
Strauss, Valerie . The Washington Post (pre-1997 Fulltext) ; Washington, D.C. [Washington, D.C]23 Jan
1996: A.01.

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ABSTRACT (ABSTRACT)
 
The hospital, which treats about 850 patients, is one of three major health care facilities run by the D.C.
government where care has become so bad that specialists have discussed or called for a shutdown. D.C. Village,
the only city-operated nursing home, is closing this year after the Justice Department determined that some
patients there died unnecessarily. And municipal officials are studying whether to shut D.C. General Hospital,
another old and troubled institution, or merge it with another facility.
Decrepit buildings. An antiquated boiler and steam distribution system has failed repeatedly this winter, leaving
patients shivering for days. In some buildings, hot water is intermittent, creating unsanitary conditions in which
doctors must wash their hands with cold water and patients go several weeks without showers while wearing dirty
clothes, according to patients and staff members.
Insufficient staffing. About 500 of the hospital's 2,900 workers -- more than one out of six -- have left within the last
18 months because of buyouts aimed at reducing the city's payroll, according to Guido K. Zanni, the District's
commissioner of mental health and the hospital's director. Patients and staff members say there are so few
occupational therapists that some patients spend much of their day doing nothing. And St. Elizabeths has only
two staff plumbers to service hundreds of toilets, some of which stay clogged for weeks.

FULL TEXT
 
Freezing wards, sporadic hot water, medication shortages and inadequate staffing have devastated patient care at
the District's St. Elizabeths Hospital and have convinced a growing number of mental health specialists that the
once-celebrated facility should be closed.
Saddled with a huge and crumbling campus that the city's impoverished government cannot begin to repair, even
the hospital's administrators and longtime supporters describe its situation as dire and offer only pained defenses
of "St. E's," a complex of 120 aging, red-brick buildings that sprawls over 326 acres in Southeast Washington.
The hospital, which treats about 850 patients, is one of three major health care facilities run by the D.C.
government where care has become so bad that specialists have discussed or called for a shutdown. D.C. Village,
the only city-operated nursing home, is closing this year after the Justice Department determined that some
patients there died unnecessarily. And municipal officials are studying whether to shut D.C. General Hospital,
another old and troubled institution, or merge it with another facility.
"Given the terrible conditions at St. Elizabeths . . . it makes sense to move people into community beds," said
Judith Johnson, executive director of Green Door, an outpatient program for the mentally ill.
Anita Shelton, executive director of the Mental Health Association of the District of Columbia, said, "In the mental
health field, we agree, without unanimity but something close, that it should be either completely remodeled or not
used at all."

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St. Elizabeths has been in decline for years, but many people familiar with it say the city's financial crisis has
worsened care there dramatically in recent months. Rising costs have been exacerbated by the city's inability to
pay vendors on time. Among the hospital's problems:
Decrepit buildings. An antiquated boiler and steam distribution system has failed repeatedly this winter, leaving
patients shivering for days. In some buildings, hot water is intermittent, creating unsanitary conditions in which
doctors must wash their hands with cold water and patients go several weeks without showers while wearing dirty
clothes, according to patients and staff members.
Medicine shortages. St. Elizabeths periodically has run out of some antipsychotic and antidepressant medications,
such as Clozaril and Zoloft, according to doctors and patients. There also are complaints that patients cannot
benefit from some of the most modern and effective drugs because they are so expensive the hospital cannot
afford them.
Insufficient staffing. About 500 of the hospital's 2,900 workers -- more than one out of six -- have left within the last
18 months because of buyouts aimed at reducing the city's payroll, according to Guido K. Zanni, the District's
commissioner of mental health and the hospital's director. Patients and staff members say there are so few
occupational therapists that some patients spend much of their day doing nothing. And St. Elizabeths has only
two staff plumbers to service hundreds of toilets, some of which stay clogged for weeks.
A lack of equipment. Not only is some medical equipment broken but most copy and fax machines have been out
of action for months. Doctors said that problem sometimes prevents the hospital from forwarding the records of
patients who have been released to community mental health clinics, which can deprive those patients of proper
care or medication. Doctors said one released patient received an unneeded injection, while others have not had
prescriptions filled.
Poor security. A rise in burglaries at the campus -- officials did not disclose numbers but acknowledged an
increase -- has coincided with a reduction in the security force. Computer equipment and software has been stolen,
offices vandalized, and in one case, an employee was injured by a thief, hospital officials said.
The current condition of the hospital, federally operated until the District took control in 1987, belies a renowned
past. Earlier in the century, St. Elizabeths earned a worldwide reputation for humane and progressive treatment,
including the first use of music therapy and psychodrama. In the 1950s and '60s, it was home to as many as 7,200
patients and functioned almost as a self-sufficient city.
The hospital cared for many famous patients, including poet Ezra Pound, whose 12-year commitment after World
War II spared him the consequences of a treason indictment. Its best-known patient today is John W. Hinckley Jr.,
who attempted to assassinate President Ronald Reagan. Hinckley is incarcerated with about 270 other "forensic"
patients who either are awaiting criminal trials or have been acquitted by reason of insanity.
But in recent years, mental health specialists have moved away from massive hospitals such as St. Elizabeths and
have advocated treating patients in smaller, community facilities. They have argued that care usually is better in
smaller facilities than in huge "warehouses" -- although the District's outpatient mental health system is plagued
with problems of its own. Even Zanni said that "large facilities such as {St. Elizabeths} have obviously outlived their
usefulness."
Part of the reason for that is money. The city handles about 7,000 people in its mental health system, most of them
as outpatients or in community facilities. The average cost of caring for a patient in a community-based bed is
about $36,000, Zanni said. At St. Elizabeths, with the enormous task of maintaining its infrastructure, the cost is
$114,000 a year for each patient.
"If we had the money," Zanni said, "it would be cheaper to build a 500-bed hospital."
One of the major problems at St. Elizabeths is its advanced age. Founded 141 years ago, many of the hospital's
buildings have stood for more than a century. The boiler system is more than 70 years old.
A single heating system that includes 25 miles of underground steam tunnels serves the entire campus. Many of
the tunnels are so riddled with holes that the grounds are dotted with hundreds of billowy smoke plumes rising
aimlessly into the air. And fixing leaks means shutting down much of the system.

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Officials have struggled in recent weeks to install separate boilers in some buildings at a cost of hundreds of
thousands of dollars, but patients continue to shiver. On Dec. 28, patient Connie Coleman said in a court affidavit,
"It was so cold that I started crying."
But St. Elizabeths has other significant problems not related to the condition of its buildings. Mental health
specialists say that the hospital not only has too few staff members but also that some of those it has are poorly
trained. And shortages of all kinds hamper care.
For example, patients and others say, some wards have urine-soaked mattresses, clogged toilets and grimy floors.
Other wards are clean but dreary.
Last March 13, when some children in two units were served only rice, gravy and jello for dinner, the youngsters
staged a violent disturbance. Officials later said the incident was aggravated by revelations that staff members
were eating patients' food. And there are charges that staffers have restrained patients unnecessarily.
"The problem is that the {staff} attitude toward the patients is very authoritarian," said Hanna Schussheim, head of
the Friends of St. Elizabeths advisory group. "There is very little opportunity for {long-term patients} to develop
independence and learn how to act on their own."
Some say staff attitudes go beyond authoritarian. One outpatient said he had been beaten in the face by staff
members, an allegation that staff members deny. Several patients and their parents, who asked not to be
identified, said patients are sometimes put in restraints for more than 24 hours without adequate monitoring.
One mother said her adult son was put in restraints for 36 hours when he became agitated after a trip outside the
hospital. "All he needed were a few cigarettes on the porch," she said, "but the weekend staff didn't know what to
do with him."
Meanwhile, the city's inability to pay its vendors on time means that medicine sometimes runs short. Zanni said
there has never been a time when the hospital was out of a particular medicine entirely, although not all dosages
of a drug might be available. Some doctors and former patients said, however, there were times when a specific
medication had briefly run out.
Furthermore, many long-term patients have little to do and therapy that ought to be underway is not, said Claudia
Schlosberg, a lawyer for the Bazelon Center for Mental Health Law who serves as an advocate for St. Elizabeths
patients.
"The behavior modification unit is an example," she said. "There are severe behavioral problems there. Patients
defecate, urinate, expose themselves, and some serious interventions are supposed to be going on. But nothing is
happening, and people are existing on this animal level."
Nevertheless, many dedicated staffers try to make the best out of a miserable situation. For example, one nursing
assistant has for years organized a bridge club for patients on his own time. Some workers have paid money out of
their own pockets to buy clothes for patients, and some take considerable risks to help difficult patients.
But as the problems at St. Elizabeths multiply, more scrutiny is being given to alternatives.
"It's an old institution that has outlived its usefulness in terms of today's psychiatric services that should be
provided to patients," said Jean Harris, president of the Alliance for the Mentally Ill, an advocacy group with about
200 members. "Now is the time for major change in the way we deliver psychiatric care. . . . Even for those who
need custodial care for the major part of their lives, I'm not sure St. Elizabeths is the best place."
Credit: Washington Post Staff Writer

DETAILS

Company: St. Elizabeths Hospital

Publication title: The Washington Post (pre-1997 Fulltext); Washington, D.C.

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 Pages: A.01

Number of pages: 0

Publication year: 1996

Publication date: Jan 23, 1996

Section: A SECTION

Publisher: WP Company LLC d/b/a The Washington Post

Place of publication: Washington, D.C.

Country of publication: United States, Washington, D.C.

Publication subject: General Interest Periodicals--United States

ISSN: 01908286

Source type: Newspapers

Language of publication: English

Document type: NEWS DC

ProQuest document ID: 307920166

Document URL: https://search.proquest.com/docview/307920166?accountid=46320

Copyright: Copyright The Washington Post Company Jan 23, 1996

Last updated: 2014-05-07

Database: The Washington Post

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