State officials have just over a week to file a legal response to court claims that patients at New Jersey’s Greystone Park Psychiatric Hospital are at risk of imminent death or injury; and the officials have roughly a month before they must appear on the matter before a federal judge in Newark.
The plaintiffs in the case are 11 current and former patients at Greystone. According to them and to staff affidavits, Greystone administrators and their bosses at the State Department of Health, in Trenton, have failed to ensure there are enough psychiatrists at the hospital; they allege that this has led patients to decompensate — to suffer more from their mental illnesses than they otherwise would — and become angry and violent. One doctor called it “more of a zoo than a hospital” and said patients are treated “like animals.”
In addition, the suit argues that doctors and nurses are overwhelmed and overworked, afraid for their own safety, and don’t have adequate training and proper tools to effectively respond to patient outbursts or medical emergencies.
A federal district judge in Newark issued an order late Friday that compels the state to explain why the court should not force it to immediately step up training and oversight, staffing levels and emergency protocols, plus make physical improvements to the troubled Morris County hospital. The court is also considering requiring a temporary independent monitor to oversee the process.
The order from U.S. District Court Judge Esther Salas is the latest development in a lawsuit that was filed by the New Jersey Office of the Public Defender in December on behalf of the plaintiffs. The litigation has intensified in recent months, as the state attempted to dismiss the claims, and the public defender filed additional motions, plus sworn statements from a half dozen current and former hospital employees that appear to back up the troubling allegations.
Sounding the alarm
“If this Court does not immediately intervene and issue a preliminary injunction to halt the unlawful and unconstitutional conduct of the Defendants, more people will die from what would otherwise be a preventable death,” public defender Joseph Krakora and his team argued in papers submitted to the court late last week.
While state officials indicate reforms are well underway, the public defenders suggested little had changed for hospital patients in the past six months. “Defendants continue to lie to the public, the courts, and their own employees regarding the dangers at Greystone. People are getting hurt and worse,” the attorneys wrote.
Officials at the health department and Office of the Attorney General, which is handling the state’s legal response, declined to comment on the litigation, as is their policy. The suit names Gov. Phil Murphy, health commissioner Dr. Shereef Elnahal and several other current and former state officials, plus Greystone CEO Tomika Carter and a handful of other hospital administrators.
The problems date back years, if not decades, and grew under former Gov. Chris Christie, a Republican, who did not prioritize investments in the state’s mental health system. When Murphy, a Democrat, hired Elnahal in early 2018, the health commissioner pledged to improve operations and treatment outcomes at Greystone and the state’s three other public psychiatric hospitals, which together house more than 1,200 New Jersey residents with serious mental illness and behaviors that can endanger themselves or others. (Many are placed there by the courts.)
“Our main focus is on enhancing the quality of care in all of the psychiatric hospitals,” Elnahal said in March 2018, as reform plans began to take shape.
‘Culture of futility’
The state used a consultant’s assessment, commissioned by the previous administration as the basis for an 18-month strategy to overhaul the system, which it unveiled last August; that assessment identified a host of deep-seated operations and governance problems, along with a “culture of futility” permeating the four psychiatric hospitals.
“The single, most important goal for the psychiatric hospitals is to bring their systems of care to a level that will allow an adequately staffed clinical workforce to achieve care delivery that service recipients deserve,” the state noted in its reform strategy.
This work is paying off, according to a mid-term report the DOH released in March. The state has hired hundreds of additional doctors and nurses for the psychiatric hospital system since early 2018, including a dozen additional psychiatrists. Six of these psychiatrists were assigned to Greystone, which now has 18 total, the department said.
In addition, the population has declined system-wide, state numbers show; Greystone, built to accommodate some 560 residents in its main building and cottages, was down to 420 patients in January and 383 in May. These changes and others have helped reduce violence at the Morris County hospital, the DOH said, with major or moderate incidents down nearly 30 percent in the first quarter of this year, when compared with the same period in 2018.
But, according to the Greystone plaintiffs, these numbers don’t tell the whole story. For one, the state is only recording injuries that require medical treatment, they note, so minor incidents that don’t require medical attention aren’t included in the count. And the population decline at the hospital reflects a planned decrease in admissions and a diversion of at least a dozen patients to private facilities that are contracted by the state to care for overflow patients, while the state sought to ramp up the hiring of psychiatrists and other healthcare clinicians.
Not enough psychiatrists?
In particular, the lawsuit claims the state has failed to provide Greystone with enough psychiatrists to properly care for and monitor patients; in addition, existing doctors said they rarely have time to properly assess patients for critical court hearings that could determine how long they must remain committed to a state hospital.
“The shortage of psychiatrists has directly caused patients to decompensate and become violent. Due to the Administration’s policies, the staff is ill-equipped to deal with these dangers,” warned Dr. Walter Bakun, a longtime Greystone employee who has led the Medical Staff Organization since 2017. The MSO has repeatedly confronted the hospital management and Bakun was temporarily suspended earlier this year in what he said was retaliation for his vocal criticism.
“Under the current Greystone Administration’s policies and procedures, Greystone patients will continue to die,” Bakun wrote in a June 12 statement presented to the court. Among other things, he raised concerns about changes to the emergency response protocols that he said endanger patients and staff, and recounted in detail how hospital leaders essentially dismissed his efforts to save a woman who attempted suicide from bleeding to death.
According to the state, all psychiatric hospital staff has been appropriately trained and each facility is stocked with the proper life-saving equipment; Bakun insists more in-depth training is needed, given the complex medical condition of many psychiatric patients.
The two sides also dispute physical modifications made at Greystone, including wiring behind ceiling tiles that patients have repeatedly accessed in attempts to hang themselves. The DOH insists it has made changes to reduce “ligature risks” system-wide, but Bakun claims in his statement the danger at Greystone remains the same.
Claims that some doctors are fueling discord
While the lawsuit’s plaintiffs are current or former patients — identified by initials or as John or Robert Doe — some observers suggest that it is Bakun and a handful of doctors who have continued to fuel the discord with the state, even as the new administration has attempted to turn Greystone around.
According to the consultant’s report released last spring, the Medical Staff Organization, or MSO, was created to hold clinicians accountable for patient care and outcomes. “However, many physicians no longer appreciate this fact. Within the (state’s psychiatric hospital system) they tend to view the Medical Staff Organization as a political body whose purpose is to foster physicians’ interests that are not necessarily aligned with the hospital’s administration,” according to its findings, which also took into account the work of these groups in hospitals in other states.
But others suggest that, regardless of individual motivation — and the state’s commitment and efforts to reform the troubled system — the lawsuit brings much-needed attention to the embattled state hospitals.
And according to Judge Salas in Newark, the plaintiffs have made “a clear and specific showing” of “good and sufficient reasons” why the matter cannot be resolved through the usual court process, which could drag on for years. She gave the state until June 26 to respond on paper and set a date of July 19 for them to appear in court.
“This court is our last hope for intervention, because the Greystone Administration have demonstrated time and again that they will lie, threaten and retaliate in the face of these life-threatening conditions,” said Dr. Anthony Gotay, who has worked at Greystone for two years and is vice-president of the MSO, in his affidavit. “If drastic changes do not come in the immediate future, it is my professional judgment that more patients will be seriously harmed.”