bella
05-01-2003, 09:14 PM
Medical Care at Jail Still Work in Progress
April 9, 2003
It's been three years since the federal government swooped into the Nassau County jail to investigate the fatal beating of an inmate by correction officers and to determine why his medical care had been so poor.
It's been two years since the county - under pressure to make improvements in inmate care - relinquished the medical and mental health program to the Nassau University Medical Center in East Meadow.
And it took another year for the county, the hospital and the federal government to formally agree on how to raise the standards of care in the wake of a federal lawsuit.
But despite all this time and scrutiny, the program still seems to be, at best, a work in progress.
Just last week, the family of the beaten inmate, Thomas Pizzuto, settled its own lawsuit with the county for $7.75 million. Family lawyers, who originally pressed for systemic changes relating to use of force, agreed to settle after seeing a recent federal report saying the jail in East Meadow had made "substantial progress" in that area.
But the government also has monitors looking at the medical and mental health care at the jail. And they had a much different impression.
The latest report on medical care done by a federal monitor, from last September, said the hospital was "seriously deficient" in several areas.
The latest federal report on mental health care, dated Dec. 18, 2002, and recently obtained by Newsday, says the jail's mental health care has "substantial deficiencies" in areas such as suicide screening, daily sick call, training and medication management. In fact, the hospital did not comply with federal standards in a majority of vital areas.
County officials and hospital officials have been feuding for months over who was to blame for the continuing problems. Last fall, county officials were calling for the ouster of medical director James Neal and said the hospital had violated its contract.
For now, they have stopped fighting and formed joint committees to look at the cost and quality of the care. But county officials say privately they are still looking at whether they could get better and cheaper care elsewhere.
Meanwhile, Richard Turan, chief executive officer of NUMC, said he meets weekly with high-level county officials to make sure the program is on track. "We're making great progress," he said.
But the quality of care still has a long way to go and if it doesn't improve, the federal government could ask a judge to impose sanctions.
The report on mental health care at the jail, written by Dr. Ray Patterson, a psychiatrist from Washington, D.C., found that hospital policies didn't meet federal standards, or those set by the state Commission on Correction and the American Psychiatric Association.
Janet Ades, who heads the Nassau Legal Aid Society's social work bureau, which represents the mentally ill, said the program is better but she agrees the program continues to have serious flaws, mostly stemming from lack of staff and a lack of hospital leadership.
Medical director Neal said in an interview that many deficiencies cited in the report have been fixed and others are being worked on. He said that employee turnover and civil service issues have hampered his ability to maintain a full staff of psychiatric social workers, but he has hired new staff in other areas.
But the report found even basic sick call was "not being appropriately managed." It took several weeks for staff to respond to inmates' written requests for assistance and between one-third and one-half of inmates were either not seen or seen "for very little time."
Now, Neal said, inmates requesting mental health care are examined within 48 hours and those in crisis receive attention within 24 hours. The report also noted that correction officers had to be better trained in dealing with the mentally ill. Sheriff Ed Reilly said corrrection officers who work with mentally ill inmates now receive 16 hours of specialized training.
The December report found hospitalized inmates were not given daily suicide screening, although they had to wear paper gowns and use paper sheets to prevent them from hurting themselves. Neal says psychiatrists now do that screening.
The report said the hospital lacked proper record-keeping on medication and didn't keep vital anti-psychotic drugs. Neal says those drugs are provided and he is continuing to overhaul the medication program.
Patterson said the jail's care of mentally ill inmates consisted of observation and medication but no real treatment. "There are no group therapies or other interventions at NUMC ... while medication management is an important aspect of mental health care, it is certainly not the only intervention that should be provided," the report said.
Neal said there are some recreational therapies available and others are being pursued.
The report also said there is a major "disconnect" between the jail and NUMC regarding the care of mentally ill inmates, resulting in a lack of coordination and follow-up for an inmate who moves in or out of the hospital.
Neal, who acknowledges he has work to do in many areas, said officials are trying to improve communication whenever an inmate is hospitalized or discharged.
Copyright © 2003, Newsday, Inc.
April 9, 2003
It's been three years since the federal government swooped into the Nassau County jail to investigate the fatal beating of an inmate by correction officers and to determine why his medical care had been so poor.
It's been two years since the county - under pressure to make improvements in inmate care - relinquished the medical and mental health program to the Nassau University Medical Center in East Meadow.
And it took another year for the county, the hospital and the federal government to formally agree on how to raise the standards of care in the wake of a federal lawsuit.
But despite all this time and scrutiny, the program still seems to be, at best, a work in progress.
Just last week, the family of the beaten inmate, Thomas Pizzuto, settled its own lawsuit with the county for $7.75 million. Family lawyers, who originally pressed for systemic changes relating to use of force, agreed to settle after seeing a recent federal report saying the jail in East Meadow had made "substantial progress" in that area.
But the government also has monitors looking at the medical and mental health care at the jail. And they had a much different impression.
The latest report on medical care done by a federal monitor, from last September, said the hospital was "seriously deficient" in several areas.
The latest federal report on mental health care, dated Dec. 18, 2002, and recently obtained by Newsday, says the jail's mental health care has "substantial deficiencies" in areas such as suicide screening, daily sick call, training and medication management. In fact, the hospital did not comply with federal standards in a majority of vital areas.
County officials and hospital officials have been feuding for months over who was to blame for the continuing problems. Last fall, county officials were calling for the ouster of medical director James Neal and said the hospital had violated its contract.
For now, they have stopped fighting and formed joint committees to look at the cost and quality of the care. But county officials say privately they are still looking at whether they could get better and cheaper care elsewhere.
Meanwhile, Richard Turan, chief executive officer of NUMC, said he meets weekly with high-level county officials to make sure the program is on track. "We're making great progress," he said.
But the quality of care still has a long way to go and if it doesn't improve, the federal government could ask a judge to impose sanctions.
The report on mental health care at the jail, written by Dr. Ray Patterson, a psychiatrist from Washington, D.C., found that hospital policies didn't meet federal standards, or those set by the state Commission on Correction and the American Psychiatric Association.
Janet Ades, who heads the Nassau Legal Aid Society's social work bureau, which represents the mentally ill, said the program is better but she agrees the program continues to have serious flaws, mostly stemming from lack of staff and a lack of hospital leadership.
Medical director Neal said in an interview that many deficiencies cited in the report have been fixed and others are being worked on. He said that employee turnover and civil service issues have hampered his ability to maintain a full staff of psychiatric social workers, but he has hired new staff in other areas.
But the report found even basic sick call was "not being appropriately managed." It took several weeks for staff to respond to inmates' written requests for assistance and between one-third and one-half of inmates were either not seen or seen "for very little time."
Now, Neal said, inmates requesting mental health care are examined within 48 hours and those in crisis receive attention within 24 hours. The report also noted that correction officers had to be better trained in dealing with the mentally ill. Sheriff Ed Reilly said corrrection officers who work with mentally ill inmates now receive 16 hours of specialized training.
The December report found hospitalized inmates were not given daily suicide screening, although they had to wear paper gowns and use paper sheets to prevent them from hurting themselves. Neal says psychiatrists now do that screening.
The report said the hospital lacked proper record-keeping on medication and didn't keep vital anti-psychotic drugs. Neal says those drugs are provided and he is continuing to overhaul the medication program.
Patterson said the jail's care of mentally ill inmates consisted of observation and medication but no real treatment. "There are no group therapies or other interventions at NUMC ... while medication management is an important aspect of mental health care, it is certainly not the only intervention that should be provided," the report said.
Neal said there are some recreational therapies available and others are being pursued.
The report also said there is a major "disconnect" between the jail and NUMC regarding the care of mentally ill inmates, resulting in a lack of coordination and follow-up for an inmate who moves in or out of the hospital.
Neal, who acknowledges he has work to do in many areas, said officials are trying to improve communication whenever an inmate is hospitalized or discharged.
Copyright © 2003, Newsday, Inc.