Credit: Darrow Montgomery

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In February 2020, a patient at St. Elizabeths Hospital was given psychotropic medication to restrain her, which she did not consent to but was told by staff that she had to accept. The patient, Lisa Morgan, has a documented history of trauma and sexual abuse, and requested that a female nurse administer the drugs.

Though a female nurse was assigned to give patients their medication that day, it was a male nurse who administered Morgan’s injection. The male nurse pulled her pants and underwear down so he could inject the medication into her buttocks, and Morgan later called the experience traumatizing.

The experience of Lisa Morgan, a pseudonym, was documented in a new report released by Disability Rights DC (DRDC) program at University Legal Services, which monitors patient treatment at various local hospitals, including St. Elizabeths, D.C.’s only public psychiatric hospital. In the first three months of 2020 alone, DRDC’s review found, St. Elizabeths staff restrained patients 149 times and secluded patients 55 times.

After reviewing video footage and records from that day in February, DRDC concluded that Morgan was calm when nurses at St. Elizabeths forcibly administered the so-called chemical restraint. Its report says she had “walked calmly” into the seclusion room, and another nurse notes that she “displayed no immediate signs of aggression.” Seven staff members, five of them men, walked into the room. It was one of those male nurses—whose Maryland nursing license was suspended in July 2012 for “abusing a psychiatric patient,” a DRDC investigation found—administered the drugs. Morgan lay still on a mat in the seclusion for one hour and 40 minutes.  

DRDC reported an disturbingly high use of restraints and seclusions in two previous reports, City Paper previously reported, and multiple accounts included in them indicate that hospital staff’s use of restraint and seclusion were either abusive or, in some cases, legally dubious. Morgan’s case was also featured in a July 2019 report, as she was restrained or secluded seven times between April and May of that year. According to DRDC’s latest report, a separate investigation by the Department of Behavioral Health—the government agency with oversight of St. Elizabeths—substantiated that the psychiatric hospital violated District law in some cases. Generally speaking, D.C. law and regulations bar the use of restraint and seclusion; exceptions are narrow.

The psychological consequences of that practice, DRDC found, are profound. “Hospital policy recognizes that patients with a trauma history are particularly vulnerable to psychological harm from restraint and seclusion, noting that they can be ‘trauma-inducing’ and lead to the ‘potential for physical and psychological harm and loss of dignity,’” the report says. “Ms. Morgan reports that each episode of seclusion and restraint has left her feeling traumatized, frightened and humiliated.” 

DBH implemented some of the recommendations DRDC outlined in its 2019 report, including the hiring of an independent consultant to investigate the hospital’s use of seclusion and restraint and develop strategies to reduce, and ultimately eliminate, their use. The agency hired Joan Gillece, a behavioral health policy expert who works at the National Association of State Mental Health Program Directors.

Yet the use of restraints and seclusion at St. Elizabeths has not abated, according to DRDC’s latest report, published Sept. 14. St. Elizabeths staff restrained patients 149 times and secluded patients 55 times in the first three months of 2020. (That figure is based on DRDC’s review of the hospital’s “major unusual incident reports,” which staff are required to submit each time they seclude or restrain a patient.) For context, staff used restraints 252 times and seclusion 66 times between January 2019 and April 2019, or the last time period when the hospital published restraint and seclusion data. In the first six months of 2020, staff used medication as a restraint 207 times. And staff used chemical restraints on patients 606 times in the year between July 2019 and June 2020. 

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“I don’t know why, since they hired her, we keep seeing this,” says Andrea Procaccino, a staff attorney at DRDC, about Gillece. “It’s discouraging.”

St. Elizabeths Hospital and the Department of Behavioral Health sent City Paper emailed statements in response to detailed questions about DRDC’s report.

“Saint Elizabeths Hospital is committed to the highest standards of patient care in a safe, dignified, therapeutic environment,” says Mark J. Chastang, the Chief Executive Officer at Saint Elizabeths Hospital. “Our aim is for every patient to get the best and most appropriate treatment to recover and thrive to their fullest potential with family and friends back in the community.”

A DBH official says: “Saint Elizabeths Hospital uses alternative interventions including de-escalation techniques to maintain a safe, supportive environment for patients and staff.  As a last resource in extreme circumstances, restraint and seclusion may be used to prevent an aggressive patient from harming themselves, other patients or staff.  The time patients spend in restraint or seclusion consistently is below the national average for psychiatric hospitals.”

In institutions that see a high use of restraints and seclusion, staff fail to deescalate situations properly or aren’t properly trained in trauma-informed care, Procaccino says. It’s often also symptomatic of leadership failures, she says.

In a November 2019 hearing before the D.C. Council, DBH Director Barbara Bazron said that DC Health found that “no patient abuse took place” at St. Elizabeths, after ordering a review of seclusion and restraint policies and practices. Her chief clinical officer and the Accountability Administration, however, recommended more staff training. 

The use of restraints and seclusion isn’t the only problem patients at St. Elizabeths face. Most notably, patients and hospital staff went a month without running water, using bottled water for drinking and cooking and wipes for bathing. The dangerous bacteria in the hospital’s water supply was first reported by City Paper. Most recently, St. Elizabeths patients sued the hospital for not protecting them from the coronavirus. As of Sept. 15, the city reports that 14 patients there have died due to complications related to COVID-19. (Procaccino says her team was assured that St. Elizabeths staff was not using restraint or seclusion to enforce social distancing requirements, and has not heard reports to suggest staff has.)  

In 2002, the U.S. Department of Justice investigated the conditions at St. Elizabeths and ultimately filed a lawsuit against D.C. As part of its settlement with the federal government, St. Elizabeths had to reform its policies around seclusion and restraint, including training staff to use “less restrictive interventions.” In 2014, the federal government agreed to dismiss the lawsuit as long as University Legal Services monitored the hospital. 

“On multiple occasions, St. Elizabeths staff disregarded the legal and policy requirements of using restraint and seclusion that were promulgated to prevent widespread use and abuse,” according to the latest report from DRDC at University Legal Services. 

In Morgan’s case, DRDC found “no evidence showing that staff attempted or implemented meaningful therapeutic measures, offered her support, or tried to comfort her” after staff injected drugs to restrain her that left her traumatized. DRDC also says staff violated D.C. law by falsifying documentation—staff documents say Morgan was “anxious and yelling,” so she could not leave the seclusion room, but surveillance footage reviewed by DRDC disproves that allegation.   

Staff put another patient—in the report identified as Anne Williams, also a pseudonym—in either a physical hold, mechanical restraint, and/or seclusion over 65 times in the six-month period between November 2019 and May 2020. Staff used restraint or seclusion on Williams multiple times in one day, in one case locked in a single restraint for over four hours. Williams has an intellectual disability, as well as a history of trauma and neglect, and DRDC found no evidence to support that hospital staff attempted to use less aggressive restraint techniques on her, or even that they completed the required post-event debriefing. 

“St. Elizabeths Hospital’s own vision statement professes that, ‘[o]ur team of clinicians and behavioral health support staff are committed to making sure that each person who comes through our doors is treated with respect, dignity, and sensitivity to spiritual and cultural norms,’” the report concludes. “Widely used, abusive restraints and seclusions are far from respectful or dignified treatment. Locking patients alone in their room, strapping their arms and legs to a bed, and forcibly injecting them with powerful psychotropic medications are all treatment failures.” 

DRDC made more reform recommendations in its most recent report, as it did in the version published in July 2019. Those include holding St. Elizabeths Hospital leadership and administration accountable for continued abuse of restraint and seclusion practices.

The story has been updated to include comment from St. Elizabeths and the Department of Behavioral Health.