St. Elizabeths Hospital after completion of new construction in 2010. Water issues are in this building. Credit: Photo courtesy Department of Behavioral Health

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After operating for 27 days without running water, St. Elizabeths Hospital’s water supply is safe to use again. However, the fallout from the water crisis is only beginning. On Wednesday, civil rights groups filed a federal class-action lawsuit against Department of Behavioral Health Director Barbara Bazron, hospital CEO Mark Chastang, and the District of Columbia “for the horrifying conditions at the hospital during a weeks-long water outage.” 

The suit was filed on behalf of four patients at the hospital, and claims the city violated their constitutional rights—both by forcing patients to live in “disgusting” and “unsafe” conditions this past month, and by failing to provide them with adequate treatment.

The outage began on Sept. 26, after a routine water quality test uncovered dangerous bacteria in the supply. In the almost month since then, patients and staff at St. Elizabeths—the District’s only public psychiatric hospital, operated by the Department of Behavioral Health (DBH)—relied on bottled water, hand sanitizers, personal care body wipes, and body wash spray. Portable showers were also brought in after a few days. 

Yesterday, Bazron said that the problem was finally resolved. “The final round of testing for bacteria in the water supply at Saint Elizabeths Hospital today showed the water is safe,” she explained in a statement. “Workers are reinstalling about 800 faucet handles starting in the patient units to resume normal water usage this evening. With the advice of water management experts, the Hospital is identifying possible sources of the bacteria and putting practices in place to prevent a reoccurrence.”

This was Saint Elizabeths’ second extended water outage in three years—a potentially perilous situation that increases the risk patients will contract dangerous infections. 

“I can’t overstate how egregious the conditions are at the hospital,” Margaret Hart, counsel at the Washington Lawyers’ Committee for Civil Rights and Urban Affairs, said in a statement. The Washington Lawyers’ Committee brought the class-action along with ACLU-DC and the firm Arnold & Porter LLP.

“These patients have been deprived of the very services St. Elizabeths is supposed to provide, intensive mental health treatment,” Hart continued, “and the District’s response has put the patients’ mental and physical health at risk. The lack of attention from the District’s leaders is shameful.”

DBH has not immediately responded to City Paper’s request for comment. We will update this post if we hear back.

The class action complaint alleges that during the outage, the hospital “severely curtailed or suspended the psychiatric care on which patients depend.” One patient in the suit says he usually receives 40 hours of therapy a week; during the outage, he says he only got two hours a day (10 hours a week). The attorneys also say it was the wrong therapy: He was placed in a “competency restoration group,” meant for criminal defendants declared incompetent to stand trial, even though the patient “is already competent.”

Additionally, the complaint states that some Narcotics Anonymous meetings were cancelled due to the water crisis, and that the “Treatment Mall”—where patients exercise, receive music and art therapy, and participate in other activities—was closed. They say this meant patients had to “remain on their locked wards.” 

The suit also says that the outage resulted in severely unhygienic conditions. When running water was shut off from the toilets, they had to be flushed manually by pouring in bottled water. “Staff are only flushing the toilets twice per day, leading to the accumulation of feces, urine, and menstrual blood,” the attorneys said. “The toilets are overflowing and human waste is flowing onto the floors in some bathrooms.”

These conditions allegedly created a tense environment at the already-strained hospital, and resulted in an uptick in violence. “There has been an increase in fights and physical aggression between patients… [and] in the use of seclusion and restraint of the patients following the water outage,” the class-action claims. Seclusion is when a patient is kept locked alone in a room, and restraint refers to anything restricting their motion, typically staff tying them by their arms and legs to a bed. 

St. Elizabeths has already come under fire this year for the way it uses both practices, which advocates say are being radically overused, sometimes to the point of patient abuse. The hospital recently kept several patients locked alone in seclusion for weeks on end, which patients’ rights attorneys said was dangerous and illegal. And in August, Disability Rights DC released a report detailing three instances of alleged staff abuse during the use of restraint. One patient’s hip and arm were broken during the process of tying him down, and then after breaking his bones, staff kept him tied by all fours to a bed for almost two hours. They didn’t get him to a hospital until 24 hours later. (Restraint is legally supposed to be a last resort, but the hospital used it more than twice a day in 2018; by comparison, in 2013, they used it just four times all year.)

The attorneys also state that during the outage, patients were not always given enough bottled water to brush their teeth, and that one patient was allowed to shower only once a week in the hospital’s portable showers. The portable showers were outside during a chilly October, and they say the water was cold. Additionally, “the portable showers are being overseen by male security guards only,” the complaint states. “Many women at Saint Elizabeths are survivors of sexual assault and do not feel safe using the portable showers. As a result, some of the women have not showered for more than four weeks.”

Andrea Procaccino, staff attorney at Disability Rights DC (not a party to the suit), tells City Paper that she likewise spoke to a female patient who felt uncomfortable showering around the male guards. After her first shower, she decided she’d rather just do without.

Procaccino further emphasized that the showers weren’t wheelchair-accessible. She says last week, one geriatric patient in a wheelchair told her, “I haven’t had a shower in three weeks. My hair’s falling out—I haven’t washed my hair in three weeks! I just want to go home.”

As of 2018, Saint Elizabeths had an average of 270 patients on any given day. Many are involuntarily committed and cannot check themselves out of the hospital. It continued accepting patients throughout the water crisis.

The outage was due to pseudomonas and legionella bacteria found in the facility’s water supply. Legionella is particularly dangerous, and can cause Legionnaire’s disease. The contagion was limited to the hospital’s plumbing, but the problem proved difficult to resolve. (According to the Federal News Network, it did not even affect a Department of Homeland Security building located on St. Elizabeths’ campus). Phyllis Jones, DBH’s chief of staff, said the hospital settled on a plan to treat the water eight days after cutting it off. However, three weeks after the outage began, Fox 5 DC reported that the first attempt to eradicate the bacteria didn’t work—extending the outage even further.

St. Elizabeths already went through this sort of ordeal before, quite recently. On the evening of Aug. 6, 2016, the hospital cut off its water after an old pipe ruptured, contaminating the supply. It was five days before patients could wash their hands again, and six before they could drink out of the taps.

In addition to relief for the patients impacted by the recent outage, the class-action lawsuit asks for “a permanent injunction that the District have a plan for hospital operations in the event of future water problems.” The attorneys also want the court to require that advocates and the broader community have input on how any future outages will be handled.

“The patients at St. Elizabeths, like so many with mental health needs, have been out-of-sight and out-of-mind for too long,” said ACLU-DC Executive Director Monica Hopkins in a statement. “It is now critical for the court to intervene to ensure this kind of thing never happens again.”