Four patients at D.C.’s only public psychiatric hospital have died of COVID-19 and 32 others have tested positive, as of April 15. Approximately nine of the 12 units at St. Elizabeths Hospital, or 60 percent of patients, are under quarantine. Reports of how the hospital has responded to infections so far deeply trouble patients advocates. Meanwhile, city officials have defended the hospital’s response to the coronavirus pandemic so far.

The facility, owned by D.C. for more than a century, is for individuals with serious and persistent mental illness who need support, along with patients committed by courts.

On March 26, one patient reportedly had a fever. Staff treated his fever, though he was not quarantined and allowed to walk freely around the unit for the next few days. On March 29, he collapsed and was found on the floor, then rushed to George Washington University Hospital. The man, who suffered a brain bleed, tested positive for COVID-19 on April 1. He was one of the first St. Es patients to test positive.

“I can’t explain why they let him walk around and I’m sure he infected staff and patients,”says Andrea Procaccino, a staff attorney with Disability Rights DC. Procaccino became aware of information documented in the man’s medical record and relayed information to City Paper that would not compromise his identity.

Procaccino, who’s spoken with eight patients at St. Elizabeths and other stakeholders over the course of the pandemic, says Disability Rights DC has been told that the situation at the hospital is “chaotic and deteriorating.” There is some confusion among patients, particularly around the isolation and quarantine policies. Multiple patients whose units are under quarantine told Procaccino that some patients are walking around freely and eating together in the communal dining room.

St. Elizabeths staff members say it is difficult to practice social distancing when patients leave their rooms for meals or other needs given the population they are treating. Susan Nelson-Pierre, a registered nurse at St. Elizabeths for more than 20 years, says the units under quarantine that she knows of try to have people sit two at a table in the dining room. 

“Sometimes, it’s not always practical,” Nelson-Pierre says of social distancing. “Sometimes in this environment, it’s kind of hard to control that because of maybe paranoia or some kind of psychiatric disability.”

Disability Rights DC started expressing concerns to the Department of Behavioral Health on March 17 about whether the hospital was prepared to deal with COVID-19, particularly after they recorded allegations of abuse and neglect at the facility. This is the same hospital that went without running water for roughly a month last year. Patients have already told Disability Rights DC they fear the situation will “get out of control.” Some feel as though they are already “on their own.”

“I wasn’t confident they had a plan,” says Procaccino.“It is just going to get worse and worse. It’s just spreading so fast.”

The staff felt ill equipped in the beginning. “Initially, we were more reactive than proactive,” says Nelson-Pierre, who also serves as the union president for nurses at St. Elizabeths. “I don’t think initially we were actually prepared.”

Now, 30 nurses are out because they either tested positive for COVID-19 or are under a doctor’s order to stay home. The nurses still working are under immense stress, working 12-hour shifts and giving up their time off. With 60 percent of patients under quarantine, nurses are worried they’ve been exposed to COVID-19 and that their personal protective equipment is ineffective because they are having to reuse N95 masks.

A mental health technician who’s worked at the hospital for 12 years says she’s been using the same N95 mask for three weeks. The technician, who asked not to be named for fear of retaliation, says staff members were not adequately trained on PPE use. She was just shown photos of health care workers in gloves, gowns, masks, and N95 respirators.

“Everybody is worried about the possibility of having this COVID-19. Then we have to go home to our family,” says Nelson-Pierre. To perform their job more effectively, Nelson-Pierre is asking that every nurse have access to rapid testing. The policy right now only allows those with symptoms to be tested.At least one St. Elizabeths nurse who tested positive for COVID-19 is in intensive care. The husband of the nurse told FOX 5 that she was “not given access to personal protective equipment in the weeks preceding her becoming ill.”

On Wednesday, Mayor Muriel Bowser described how the city government is protecting its most vulnerable populations, including patients at St. Elizabeths. Public visitation was stopped and anyone entering the hospital, including staff, has their temperature taken. DBH is also looking to discharge patients who are “clinically appropriate” to live in supported housing in residential communities. Since March 20, seven patients have been discharged and another four are expected to be discharged in the coming week.

“We have worked directly with the leadership with St. Elizabeths to ensure that they have adequate staffing as well as adequate personal protective equipment to care for the patients in their custody,” DC Health Director Dr.LaQuandra Nesbitt said during an April 15 press conference when asked about staff shortages due to COVID-19. When later pressed on whether staff got PPE late, Nesbitt said: “We have provided St. Elizabeths with all the personal protective equipment that they need in a full spectrum of personal protective equipment as quickly as they requested.”   

DBH says a patient who tests positive or shows COVID-19 symptoms is closely monitored and appropriate care is provided. In units under quarantine, group activities, including meals, are no longer allowed. If patients have to leave their room, they should do so one at a time or in very small groups. These units are not supposed to interact with patients in the three units not under quarantine. 

Nesbit stressed St. Elizabeths is not an acute care hospital so if a patient requires hospital care for COVID-19, they are taken to another facility. “But for their psychiatrist diagnosis, many of these individuals would be recovering at home with their COVID-19,” Nesbit said.  

Procaccino is concerned whether St. Elizabeths Hospital staff can respond to the pandemic alone. She recommends the kind of support Maryland Gov. Larry Hogan directed to nursing homes, which includes a clinical team that can provide medical triage and stabilize patients on-site.

The first St. Elizabeths patient to die of COVID-19 was 69-year-old Kenneth Ellison, who was “found unresponsive” on the morning of April 9, according to the Post. Two of the four other individuals whose lives were cut short due to COVID-19 are Eugene Carter, 77, and Salvador Rivero, 86. “He was loved,” Jilma Lasso, Rivero’s court-appointed guardian, tells the Post. 

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