As the novel coronavirus continues to wreak havoc around the globe, whistleblowers at American psychiatric facilities paint a picture of mismanaged COVID-19 responses and lax safety protocols, putting patients, workers, and the surrounding communities in harm’s way. Some allege coverups of deaths.
News outlets nationwide report being contacted by fearful workers and family members, who insist on anonymity to avoid retaliation. Employees of Manhattan Psychiatric Center in New York told POLITICO that the hospital, which is run by the state’s Office of Mental Health, has “rejected workers’ requests to work from home and has threatened retaliation against those who do not come in.” Workers at a Milwaukee public psychiatric hospital told the Milwaukee Journal-Sentinel that supervisors threatened to write them up for wearing protective gear. And patients at St. Elizabeths, the District of Columbia’s only public hospital, have had enough of the unsafe conditions and are now suing the institution.
To make matters worse, there has been a dearth of information from psychiatric facilities, leading to chaos and confusion. A recent report by the Judge David L. Bazelon Center for Mental Health Law noted that “Psychiatric hospitals, like correctional facilities, are potential incubators for the virus. While the danger has been recognized, little information is available about the steps states, localities, and the hospitals themselves are taking to mitigate the danger.”
The Bazelon Center reported that the American Psychiatric Association’s guide to state actions in response to COVID-19 focused on risk mitigation in correctional facilities but not in psychiatric hospitals.
State-Run Facilities Decimated by the Virus
Psychiatric hospitals’ mismanagement of their response to COVID-19 has taken on a disturbingly similar pattern from coast to coast, with many state-run facilities that were underfunded prior to the pandemic being particularly hard hit. Hospital workers say they were being systematically prevented from wearing PPE until an outbreak or the death of a staff member or patient occurred, at which point such policies were reversed, but serious problems persist. Here is a sampling of just some of the news reports emerging from around the country.
On April 3, The Trentonian reported that the Trenton Psychiatric Hospital administration may have covered up the COVID-19 death of a 60-year old man, said to be the first such death within the walls of New Jersey’s four state psychiatric facilities. Further, staffers at TSP told The Trentonian that the hospital’s CEO, Robyn Wramage-Caporoso, “exploded and abruptly ended” a call with union officials regarding conditions at the hospital. Employees allege ongoing coverups of deaths.
Health commissioner Judy Persichilli on Tuesday acknowledged dozens of infections but not deaths at state's four psychiatric hospitals. That's not what staff at Trenton Psych have told @Trentonian https://t.co/UmZozcp6MA
— Isaac Avilucea (@IsaacAvilucea) April 7, 2020
Wramage-Caproso is also accused of “blatantly ignoring” social distancing mandates, forcing staff to attend meetings where they are sitting in close contact. PPE has not been provided, workers said. And someone connected with the hospital started a Change.org petition about the unsafe conditions directed to New Jersey Governor Phil Murphy, which reached nearly 1,000 signatures.
On April 10, a NJ Advance Media investigation found that the number of patients and employees testing positive for COVID-19 within the state’s psychiatric hospitals had tripled over the course of the previous week, to over 200 cases. Employees from Ancora and Greystone Park hospitals had sent letters to NJ Advance Media alleging that senior management had not been transparent with staff about the real-time numbers of infections.
According to the most recent data reported by the New Jersey Department of Health, 97 patients and 237 staff have tested positive for the virus, and 6 people living in the state’s four psychiatric facilities have died.
District of Columbia
A COVID-19 emergency has been steadily escalating at the District of Columbia’s only public psychiatric hospital, with advocates warning from the start of the pandemic that the institution was not prepared to practice the necessary precautions to contain the spread of the virus.
Civil rights groups had been fighting for better conditions at St. Elizabeths even before the pandemic. The American Civil Liberties Union (ACLU) of DC, the Washington Lawyers’ Committee, and others filed a federal class-action lawsuit against the hospital in October 2019 after it lacked clean, running water for 27 days last year, forcing residents to live in “disgusting” and “unsafe” conditions.
Beginning in mid-March, the activist network Black Lives Matter DC began to sound the alarm about the hospital’s lack of preparedness for a potential outbreak, urging residents of the District of Columbia to call Mayor Muriel Bowser.
‼️ St. Elizabeths hospital is NOT ready for novel #coronavirus. ‼️
– Still accepting admissions & visitors but not screening for #COVID19
– Not providing masks
– Hand sanitizer has zero alcohol
— BlackLivesMatter DC (@DMVBlackLives) March 17, 2020
Also in March, the Washington Lawyers’ Committee began writing a series of letters to the hospital’s administration, citing concerns about the speed at which patients were being evaluated for release, as well as the conditions within the hospital itself.
St Elizabeths patients are at risk from COVID 19. Any patient who can be supported in the community should not be in the hospital and intensive infection controls imposed for those who remain. Washington Lawyers' Committee seeking plans from DC. https://t.co/xpLQiYHL2q
— Jonathan Smith (@JonSmithWLC) March 16, 2020
Initial reports about workers and patients testing positive for the virus began to surface on April 1. That day, Andrea Procaccino, a Disability Rights D.C. attorney who advocates for residents of St. Elizabeths, told The Washington Post that her agency had already been contacted several times by patients concerned for their safety. “St. Elizabeths does not have as robust of an infectious disease department as medical hospitals do,” she told the Post. “We are concerned that the infectious disease staff is not prepared for an outbreak and will not have adequate resources and personnel.”
In a letter dated April 2, the Washington Lawyers Committee wrote to the D.C. Department of Behavioral Health, pleading for the hospital to reduce the population: “We renew our request that you evaluate every patient for community placement and either release or make appropriate recommendations to the Court to place patients in community settings.”
We are requesting:
✅The Emergency Preparedness Plan
✅Details of the infection control campaign
✅Number of patients by category
✅Number of patients released on 3/11
✅Number of patients admitted since 3/11
✅Plans to mitigate admission
✅Plans to evaluate patients for release
— Washington Lawyers' Committee (@WashLaw4CR) April 3, 2020
The D.C. Public Defender Service filed an emergency motion in the D.C. Superior Court on April 3, requesting the release of people charged with misdemeanors undergoing competency proceedings in St. Elizabeths and the D.C. Jail.
That same week, D.C. health officials announced the death of the first patient at the hospital. By April 10, DC attorney James Ziegler Tweeted, “There is a crisis at St. Elizabeths, the District’s public psychiatric hospital.”
There is a crisis at St. Elizabeths, the District's public psychiatric hospital. https://t.co/3sw2ugwAnf
— James Zeigler (@jameskzeigler) April 11, 2020
Other attorneys and activists took to Twitter to express their outrage:
10 days ago, just 1 patient at St Es—D.C.'s only public psych hospital—had tested positive. Now 15 patients have, and reportedly 3 have died. State psychiatric hospitals are ill-equipped for infection control, and patients at St Es are there under court order and can't leave. https://t.co/zNGL6xlgeY
— Josh Kaplan (@js_kaplan) April 11, 2020
So much for a plan. 3 patients have died. As of last evening: 15 patients and 30 staff had tested positive, 142 patients in “quarantine or isolation due to exposure to or symptoms consistent with COVID-19,” and 73 staff “in quarantine due to COVID-19.” Definitely more today.
— Luke Barnekow (@LBarnekow) April 11, 2020
3 patients from DC’s psychiatric hospital have now died from COVID-19. Still, no public comment or confirmation from @MayorBowser or @DBHRecoversDC. Are they trying to hide these deaths or do they just not care?
— Luke Barnekow (@LBarnekow) April 10, 2020
In a striking new development reported by WAMU-FM on April 17, residents of St. Elizabeths are now suing the hospital. Represented by the same civil rights groups that filed last year’s class-action lawsuit on the water stoppage, the patients say it is impossible to practice social distancing, that they don’t have masks or PPE, and that the hospital was not quarantining those exposed, but not exhibiting symptoms. The Washington Post reports that most hospital residents are now under quarantine.
Four patients are known to have died from the virus as of this writing, and court documents say nearly 80 other patients and workers are positive for COVID-19.
Kaitlin Banner, deputy legal director at the Washington Lawyers’ Committee for Civil Rights and Urban Affairs, said in an April 16 statement that the facility serves a large population of people of color, many of whom live in poverty, and all of whom are disabled. “The lack of regard for their lives and safety is breathtaking,” Banner said.
— Washington Lawyers' Committee (@WashLaw4CR) April 17, 2020
The notorious Central State Hospital in Milledgeville, Georgia began to make local headlines after a nurse died from COVID-19-related complications at the end of March. Local news station 13WMAZ Verify reported on April 1 that it had received over a dozen calls from hospital employees, who provided evidence that the administration had prevented them from using personal protective equipment (PPE), claiming that it violated the hospital dress code.
However, after a worker’s death, administrators began allowing staff to bring their own PPE into the hospital. In an April 6 statement, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) said that it was lacking an adequate reserve of PPE, and announced the arrival of a mask shipment five days later. On April 9, the Georgia National Guard’s Infection Control Team was brought in to begin decontaminating the hospital.
13 WMAZ Verify reported that Governor Brian Kemp sent a memo on the evening of April 11 to all hospital staff notifying them that a second worker at the hospital had died from COVID-19 complications. As of that date, 12 patients and 24 employees had tested positive for the virus.
They waited 10 days after the death of the first worker to do any testing at all and refused to test more than a handful of people. They threatened to fire anyone who didn’t show up for work even if they were showing symptoms and declared PPE/face masks against dress code.
— PenelopePickles (@penelopepickles) April 12, 2020
DBHDD Commissioner Judy Fitzgerald, who had visited the hospital during the second week in April, told the Oconee Radio Group that the hospital was “walking alongside” public health guidelines regarding testing.
On April 14, Governor Kemp announced that the state would be sending additional workers to relieve worker shortages in facilities across the state, with twenty additional employees heading to Milledgeville.
Most recent state data confirm 48 cases of the virus at the hospital as of April 17.
At Western State Hospital, the state’s largest psychiatric facility just outside of Tacoma, more than five staff members and two patients had tested positive for COVID-19 by the end of last month, prompting the Washington Federation of State Employees (WFSE), which represents the 2,700 workers at the hospital, to demand that administrators of the 850-bed facility improve safety measures. The union said that state agencies had waited three weeks to come to the table and had not presented any tangible safety plans as of the end of March.
Staff at Western State Hospital are on the front lines of the COVID-19 crisis while caring for some of the most complex mental health patients in the state. So far, @waDSHS's response to the crisis falls short of what caregivers need. https://t.co/LYS4ns19G2
— SEIUHealthcare1199NW (@SEIU1199NW) April 8, 2020
Behavioral Health assistant secretary Sean Murphy told the Northwest News Network last month that the thermometers being used to screen employees at the door were not taking accurate readings. Murphy said that by the time the hospital realized that the batch of thermometers was faulty, supply shortages indefinitely delayed a further shipment. Hospital employees were then required to attest verbally to being symptom-free upon entrance.
Like other hospital employees around the country, the staff at Western State complained that they were initially restricted from wearing PPE, even as the virus steadily spread throughout the sprawling complex. After the union went to the Department of Social and Health Services (DSHS) management, the hospital reversed its policy and began allowing employees to wear their own PPE “at their own risk.”
Following the first COVID-19 patient death, on April 3 the hospital announced plans to discharge sixty civilly-committed patients to community placements. Murphy told The Associated Press on April 3 that Western State had already faced staffing shortages prior to the pandemic and, following the outbreak, had released some of the high-risk staff for their own safety, which further exacerbated the shortage.
A recent report on the hospital in The Seattle Times cited an “entanglement of challenges” including “aging buildings ill-adapted for 21st-century psychiatric care” and “a lack of beds elsewhere in Washington for patients ready to be discharged.”
Tensions between employees and the hospital’s management remain ongoing.
Early on, Oregon State Hospital, which primarily houses people found “not guilty by reason of insanity” (NGRI) and people undergoing competency restoration to participate in court proceedings, severely restricted new admissions to prevent the virus from entering the hospital.
In a March 14 memo, hospital CEO Dolly Matteucci announced a new policy that resulted in a halt in admissions of people deemed unable to “aid and assist” their attorneys in their own defense, leaving them stranded in jail during a pandemic. This policy put the hospital in violation of a 2002 judge’s order requiring that criminal defendants court-ordered into psychiatric care be moved from jails to the hospital within one week.
“The implication of the policy is that the vast majority of people deemed unable to aid and assist their attorneys would not be admitted to the state hospital, but would instead remain incarcerated at a local county jail,” Disability Rights Oregon wrote in a letter to state officials on March 19. “There is no definite end to how long this prolonged confinement would last, and no one is currently in a position to make predictions.”
Even before the pandemic, the hospital had been out of compliance with the judge’s admissions order for nine months in 2019.
@DisabilityRtsOR Legal Dir. Emily Cooper: "The state hospital is leaving people in serious psychiatric crisis in jails indefinitely, leaving them vulnerable both to further mental deterioration and to COVID-19 infection." https://t.co/fCeBrKT3UR
— DisabilityRtsOR (@DisabilityRtsOR) April 9, 2020
By mid-April, the hospital suddenly reversed course and announced that it would resume the admissions process for “aid and assist” defendants.
Panic on Social Media
While multiple news reports and investigations have rightly focused on the spread of COVID-19 in U.S. jails, prisons, and nursing homes, much less media attention has been paid to what is happening in psychiatric facilities, where individuals are often not free to leave. Media coverage has typically begins only in the wake of a patient or staff death from the virus. Current and former patients, hospital workers, and loved ones have been taking to social media to express their dismay and to attract the attention of policymakers and the media.
Here are just some of their frantic Tweets:
I’m not even close to being on the front lines, but this shit is getting real now. Please stay home. I’m moving in with some coworkers until the patients are cleared because my parents can’t stay home and neither can I. Please stay at home. Please.
— lauren smith (@xlaurenxsmithx) March 27, 2020
My friend who works at Western State Hospital has texted me that the administration has banned their employees from wearing masks that would protect them from COVID-19. Can anyone explain this to me? #GiveThemMasks
— kathryn acosta (@AcostaKathryn) April 1, 2020
My husband works in a hospital psych unit. All he has is a cloth mask they gave him a few days ago. Before that he wasn't allowed to wear one at all. There is no decon between his wing and the ICU and ER. Betrayed is exactly how we feel. #coronavirus #covid19 https://t.co/rGUMRxwJ4l
— Trinity (@Trinitydraco1) April 11, 2020
I work in a purely psychiatric hospital that is planning on dedicating a small unit to covid-19 patients. We have no medical equipment, no training on how to work on an infectious unit, no negative pressure rooms and the air circulation is a disaster, no ability to open windows
— Invincible Rat 🎷🐀 (@invincible_rat) April 3, 2020
And now, I can’t even imagine the terror that must be going through the prisons, jails, and state psych hospitals now as they are sitting ducks for a spreading pandemic. Having no control and knowing that the people in power are treating your life with reckless indifference.
— Ms. Frizzle goes to Court (@pennylope) April 3, 2020
Some psychiatric hospital staff have simply decided not to come back to work, citing unsafe conditions. As this former worker Tweeted, “Yeah, I’m good.”
I had second thoughts about leaving my psych hospital job and now they’re forcing their staff to work in different units (they weren’t trained for) to work with covid pts/staff and forcing to fire them if they refuse. Yeah I’m good
— Jenneh (@PoshJay) April 9, 2020
Putting Profit Over Patients
Reports of poor management of the COVID-19 crisis extend beyond the state-run facilities to for-profit hospitals, including the poshest of private psychiatric hospitals.
Employees at the StoneCrest Center, a private 162-bed facility in Detroit, accuse the company of cutting corners when it comes to safety. “You’re putting profit over your personnel, you’re putting profit over your patients. And that’s really what the environment, that’s what we feel,” workers told WXYZ Detroit. Only last week did the hospital enact proper social distancing protocols. Prior to that time, employees told the news station, group therapy was being conducted with as many as fifteen patients sitting close to one another. At least five staff have tested positive for the virus, but employees still do not have proper PPE and are using cloth masks.
And at CenterPointe, a small private psychiatric hospital in St. Charles, Missouri, employees went to the media with allegations of mismanagement similar to those at the state-run facilities. A veteran staff member at the hospital complained to NBC 5 On Your Side about the hospital’s new corporate management, citing “many irregularities in the last year especially, but now with COVID-19, this is life or death.”
Employees told the news station that the hospital was not conducting proper sanitation or decontamination protocols and that they were told to bring their own cleaning supplies. Employees recount having to beg for masks, not receiving them until March 25, four days after the first patient tested positive for the virus. As of the most recent reports, more than 20 staff and three patients have tested positive for COVID-19.
Families of patients also contacted the news station to say that the hospital had lied to them about the outbreak and didn’t provide them with information about loved ones who had been exposed to the virus prior to discharge. “Think about the lives you’re affecting. Be honest with people. We can handle the truth and we deserve to know the truth,” family members told the station.
After whistleblowers went to the media, the hospital halted admissions temporarily to begin the decontamination process, and reopened on April 10.
Amidst a Pandemic, Familiar Policy Debates Arise
For decades, there has been a longstanding conflict between those advocates who call for abolishing the asylum and those who argue that it should be rebuilt. But as COVID-19 spreads through psychiatric institutions, pre-existing policy debates have taken on a new urgency.
Disability rights organizations and legal advocates had been fighting abuse and neglect in institutional settings long before the pandemic hit. They have argued consistently for fully-funded community supports and housing, which would reduce the demand for institutional care. These advocates were among the first to come forward when the nature and seriousness of the virus were coming to light.
When I describe how inpatient psych is different from other hospital care, I often point out how pts can't have loved ones "at the bedside" & therefore have limited external monitors of quality/safety & advocacy.
COVID-19 makes these implications more accessible/relatable.
— Morgan C. Shields (@MorganCShields) March 31, 2020
COVID-19 threatens the health & human rights of persons w disabilities in institutions: jails, forensic hospitals & psych facilities. Viruses spread quickly in these overcrowded spaces, w impoverished access to health care & where social distancing is impossible #socialmurder
— Tess Sheldon (@tesssheldon) April 6, 2020
In a blog for the National Health Law Program last month, attorneys Abigail Coursolle and Jennifer Lav argued that psychiatric hospitals face a “unique challenge” in mitigating the spread of the virus. “Like other health care settings, people in these settings often eat and bathe in shared facilities. An added challenge that is unique to behavioral health facilities is that many facilities still rely on restraint, seclusion, and involuntary medication—interventions which, while already dangerous, now have increased risk due to close contact,” they wrote.
Amidst a clear and troubling pattern of COVID-19 mismanagement within congregate care facilities resulting in employee and patient deaths, advocates continue to call for ongoing access to institutional care. Some are upset about new regulations from the Trump administration allowing the use of inpatient psychiatric beds for COVID-19 cases, according to the blog of journalist Pete Earley.
Others continue to advocate for a repeal of what is known as the “Institutions of Mental Disease (IMD) Exclusion.” This rule was enacted at the beginning of the Medicaid program in 1965 to de-incentivize states from overreliance on institutional settings and limits Medicaid funding to psychiatric institutions with more than 16 beds that are not attached to a general hospital. The IMD Exclusion has been a continued flashpoint between civil rights groups, disabled people, and ex-psychiatric patients on one hand and caregivers, law enforcement, and medical advocates on the other.
On March 25, pro-involuntary treatment advocate DJ Jaffe, writing in the National Review, called for a “swift suspension” of the IMD rule during the COVID-19 crisis: “The prohibitions on using Medicaid for the incarcerated and hospitalized mentally ill should be waived during the pandemic so that they can be treated appropriately.”
An Oregon State Hospital worker who chose to remain anonymous for fear of retaliation told Mad in America that he finds such proposals disturbing. “My life experience tells me that these people know ‘when the sun is out, it’s time to make hay.’ It’s an opportunity to continue to move forward an agenda that they have been promoting for decades.”
Policy proposals to increase access to institutional care during a pandemic run directly counter to guidance put forth by the Substance Abuse and Mental Health Services Administration (SAMHSA). A SAMHSA document from March 20 said: “Because of the substantial risk of coronavirus spread with congregation of individuals in a limited space such as in an inpatient or residential facility, SAMHSA is advising that outpatient treatment options be used to the greatest extent possible. Inpatient facilities should be reserved for those for whom outpatient measures are not considered an adequate clinical option.”
On April 9, President Donald Trump held a call about mental health and coronavirus with 177 “invitation only” listeners, according to Earley’s blog. Earley said that the purpose of the call was to “thank mental health workers who are risking their lives to serve individuals in need, and to tout what the administration is doing to help Americans with opioid addictions and mental illnesses.”
Both President Trump and Vice President Mike Pence referred to the mental health call during that day’s Coronavirus Task Force press briefing. An insider familiar with the contents of the call told Mad in America that while the use of psychiatric beds for COVID-19 patients was discussed, outbreaks in psychiatric facilities were not.
Still Waiting on the Promise of Olmstead
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, recently documented her own experience trying to obtain a test for COVID-19 while navigating debilitating symptoms.
Flaherty told Mad in America that she has been frustrated by the lack of media coverage as the number of COVID-19 cases rises across facilities run by the Department of Mental Health and Addiction Services (DMHAS). “What will it take before the spread of COVID-19 within congregate settings for people with disabilities is deemed a higher priority?” she asks. “Will it take someone dying?”
Flaherty has been reaching out regularly to reporters and posting on social media about the situation at the state hospitals. According to the latest state data, 16 patients and 29 staff have tested positive, with the majority at Connecticut Valley Hospital and Whiting Forensic Hospital. The CT News Junkie reported last week on a doctor who contracted the virus in a DMHAS facility, who alleges the state is not doing enough to protect workers and residents.
In a Twitter thread on April 11, Flaherty shared a set of policy recommendations from the Connecticut Legal Rights Project. In the thread, Flaherty called for the state of Connecticut “to do what it can to prevent new involuntary admissions to congregate settings through the process of civil commitment,” “to discharge people to community settings with services and supports,” and to “ensure that people are receiving treatment in the least restrictive environment,” among other proposals. Flaherty also advocates for competency restoration in pending criminal cases to proceed “in the community rather than in a hospital setting.”
You may have seen other people on here put forward their policy proposals when it comes to people with psychiatric labels in this time of COVID19. These are mine (which means they also represent the official position of @CTLegalRights) [thread]
— Kathy Flaherty (@ConnConnection) April 11, 2020
In an April 16 statement, the Bazelon Center for Mental Health Law called for “serious efforts to be made” to discharge people from psychiatric hospitals to community supports:
Access to housing must be increased, including to meet the needs of people with serious mental illness who in other circumstances would be hospitalized. Newly available housing subsidies made available through the CARES Act should be used. Vacant hotel rooms and college dorms should be used. Trailers including those provided by the Federal Emergency Management Agency (FEMA) and even recreational vehicles should be deployed as needed.
In many cases, families will offer to temporarily house and care for relatives being discharged from or not admitted to hospitals. More will do so if support is available from community providers. Many nursing home residents are being discharged to live with families. The same can happen with psychiatric patients.
Last month, advocates in Oregon advanced a similar proposal for expanding care capacity outside of dangerous congregate settings. Disability Rights Oregon encouraged the state to use its emergency powers to lease or purchase rooms, with contracted staff on hand to provide care, so that those trapped in jail could have a safer place to go. The state declined this recommendation, saying that “establishing a hospital level of care in a non-hospital setting (such as a hotel) is simply impossible during the current surge.”
“The Supreme Court ruled in Olmstead v. L.C. in 1999 that people have the constitutional right to receive services in the least restrictive setting,” Flaherty added. “Unfortunately, our states have never fulfilled the promise of Olmstead by adequately funding a community-based system of voluntary services and supports. We need to end a system that relies far too much on coercion and treatment over objection.”
Flaherty continued, “It has never been more clear that a bed in a psychiatric hospital or any other congregate environment (jail, prison) is a danger to someone’s health and safety. We are showing that it is possible to provide shelter to the unhoused in ways that support their dignity and privacy. We can and must do better.”
Coming Thursday, April 23: Part 2 of Report on Life Inside Psychiatric Facilities During the Pandemic: Insider Accounts
MIA Reports are supported, in part, by a grant from the Open Society Foundations