Illustrated Daily; 6109; New Mexico Mental Health Services

Now I feel that there is a real commitment from the staff here to have a good hospital and

to deliver very good patient care. I can't say that I think we're where we want to be at all and I think that's fine. The Illustrated Daily, Managing Editor Howe Roads. Good evening. New Mexico's mental health care system is under attack. A year ago, following local news accounts, the problem surfaced nationally at hearings before a committee of the United States Senate chaired by Republican Senator Lowell Wiker

of Connecticut. This past winter, Ralph Nader's Public Health Research Group raided the state's mental health care programs near the bottom in the nation. But on top of all that, the United States Justice Department is reportedly investigating alleged civil rights violation at the state hospital in Las Vegas. It is a situation which admittedly concerns officials of the Anaya administration in Santa Bay and which is occasioned a number of investigations by state officials as well. A look at this matter tonight with Elizabeth Maralat, legislative chairman for the Alliance for the Mentally Ill, headquartered in Albuquerque. Dr. Thomas Diker, hospital administrator at the Las Vegas Medical Center, formerly known as the state hospital. Charles Rivesky, better known as Charlie Z, whose news accounts on radio station KUNM FM, are widely credited with having broken this story and the secretary of the state health

and environment department, Chris Crailing. Most however, Louise Maffet has this background report. Since the summer of 1984, when a media team began exposing problems, the state hospital, or Las Vegas Medical Center, as it's now called, has been the subject of numerous investigations and reports. Alligations have ranged from patient abuse and neglect, including unwarranted deaths, to untrained and unlicensed staff, bad management, fiscal irregularities, and patronage. Headway through his term of office, Governor Tony Anaya initiated an investigation which confirmed the existence of problems, and shortly thereafter, in a controversial appointment, selected Vicki Scarfioati as health management consultant for the health and environment department, of which the state hospital is a part, to look into the hospital's compliance with national standards for accreditation. We found a number of deficiencies, and I was looking at direct clinical services and the documentation of direct clinical services.

At that time, we found staff shortages, and we found poor or inconsistent documentation with regards to treatment. We also found lack of training, specifically for nursing personnel, which is inclusive of attendance and the attendant level. There's been a major emphasis from the department to garner all the support that's necessary to seek accreditation for the hospital within this year. The main focus would be to develop policies and procedures to see that those are implemented, from those policies and procedures, to implement that into each client record, so that there's documentation that's uniform and consistent for each client record at the facility, and that's now occurring. The total implementation is what we're in the process of doing, and my office is doing status compliance checks to assure that that process is happening. JCH and the accreditation process, I think, is an important step for New Mexico, but I don't think that the outcome is the certification itself. I see that the outcome is that we've increased the accountability at the hospital, and we've

accepted national standards for looking at objectively looking at patient care. In addition to the systematic approach at the department level, the hospital itself has instituted training programs for both professional and lower-level staff, created an incident reporting and review procedure, and now employ only fully licensed medical and clinical professional staff. Registered nurse Helen Lopez, who testified at the United States Senate hearings to witness in many incidents of patient abuse in neglected state hospital, now feels hopeful. I feel Dr. Diker has selected some very well-qualified staff, and we have very good clinical director. Dr. Hughes seems to be full of energy and enthusiasm, and David Escudero is in charge of the task force team that is trying to get the hospital in line for accreditation, and

he's doing a beautiful job of organizing everything, putting it together, and tackling the problems that they are seeing, or they see to correct them in order to correct them right away. So I feel that we are making headway. New clinical director Anne Hughes has reorganized her staff to provide more continuity of care. Really, what we've been doing is creating interdisciplinary teams, made up of all of the clinical people, psychiatry, medicine, psychology, social work, nursing, and putting these people together so that they are operating all across the hospital. I think it's been very effective as far as trying to develop better continuity of care, because when a patient is admitted, one team takes that patient, evaluates them, creates

a treatment plan, follows them, treats them, wherever they may move around the hospital. I heard when I came that there would be a lot of resistance to change, that there had been many changes, and people were sort of tired of that, and that there had been a lot of scandal in the past, and that morale was very low, and I literally have not found this. I have found an incredible energy toward growth. I feel that there is a real commitment from the staff here to have a good hospital and to deliver very good patient care. I can't say that I think we're where we want to be at all, and I think that's fine. So a point of departure for this look at New Mexico's mental health care system under

attacked. Elizabeth Merlatt and you said a testimony of just about a year ago at this very time, you compared the situation at the state hospital to a death camp. Yet just last month in a letter you addressed to members of the state legislature, you said and I quote, the deplorable situation at the state hospital has been turned around. That more progress has been made over the past year, under the new director, Dr. Dyker, than at any time over the past 20 years. Would you explain that? Well yes, I do sincerely feel that 20 years ago, or shortly before that, a psychotropic drugs came into existence, and at that time, I mean, perhaps we should explain what psychotropic drugs are. Those are medications which help a mental patient to overcome their voices, for example, if they're hearing voices, the synapses which come from the brain.

It has been pretty well established now that mental illness is biological illness. And the medications have done a great deal to help that. I'm sorry to have interrupted you, but I'm afraid some of your viewers would not have understood what a psychotropic drug is. That's right. Sometimes we feel that everyone knows these terms and all. But at that time, and since that time, there had been a trend in just then giving people a medication and saying you're dismissed from the hospital, and no follow-up. And this has been a problem since, and it grew and grew. There had been no real comprehensive care for mental patients, for example, after they were discharged from the state hospital, care in their communities.

And so, at this time, it was my sincere feeling that Dr. Diker in one year after the direction of the hospital had been turned over to him, had really accomplished more in controlling abuses, and as Ms. Scarifatti said, establishing accountability, which that and education are some of the most important developments that have taken place here. And we still have a long way to go. Are you saying the Mexico is out of the woods now? You know, we still have a long way to go, I feel, not only at the state hospital, but in the rest of the care that these people need, mostly because they need a lifetime of follow-up to see that they stay on their medication, to see that their housing is adequate.

Other states have in place already case workers, for example, lifetime case workers that stay with a mentally ill patient to the end of their days, and see that their needs no. Well, where do you lie to the problem, as you see it, is it a lack of will to do something about it, is it a matter of money, is it simply a matter of time? I think will is the most important thing for starters. If we can cooperate, and I've seen good examples of it in other states, and Dr. Diker has been a wonderful start as far as the state hospital aspect, but if we can cooperate with our Secretary of HED, the advocates, the parents, the families, the patients themselves, there isn't anything that we can do as far as there is no limit, as far as advancing the

welfare of these people. I think that money, it's been admitted by Dr. Diker himself, that he's a year ago, he told Dr. Sender Waker's committee that funds was not the problem. It was the administration and the distribution of those funds. That's the will to get on with it. Well, let me ask Dr. Diker, you have been complimented by Mrs. Merrillett here. You found yourself, of course, in a mess when you entered upon this job. As I understand it, you developed in the course of your initial tenure at the state hospital, a plan in which you identified, in excess of 300 significant, 350 significant problems in the state hospital, how did New Mexico get itself into such a deplorable situation? That's 332 was the exact number of deficiencies or alleged deficiencies.

That's something I wouldn't really be accurately in a position to address the history. But you must have some instincts about that. My notion is that all major organizations, public-private institutional or industrial tend towards mediocrity unless you put in place things to lean very strongly against that. What we did, I guess, is a starting point, was to punt on the validity of the allegations but to address putting systems in place that would prevent the day in which it could be said these things are true. So it was kind of a never again cradle or philosophy. And rather than close a door that's open or fix a toilet that's broken, we wanted to put in things in which those deficiencies would be noted in the future and that was the major thrust. Ralph Nader's group called the Mexico's mental health care system, one of the worst right at the very bottom in the nation, allegations of corruptions. People talk about nepotism at the state-hospital pace and abuse.

What are the impediments to improvements to a situation like this? What kind of impediments are we talking about here as far as improving this kind of a situation? There are none. The problems of systems, our systems problems are almost never problems of resources. New Mexico, as the native report noted, has average or above average per capita funding for mental health services. It's our job to make those resources address the priority needs of the state, which change over time. So there are no resource limitations to what we do. All right, then let's just talk about specific problems, nepotism. How have you addressed nepotism? By setting up an airtight, you will be fired if you do it policy in which everybody unemployment is required to declare their relationships. And then we've given a one-year grace period to allow anybody in an epotistic relationship to move out of that.

We are down now literally to a single remaining individual who we are given the balance of the year to move out of that relationship. All right. How did you handle the problem with patient abuse and neglect? The simplest mechanism of all is to ask patients themselves directly the day they leave the hospital and has anyone abused or neglected you and then to set in place internal investigation procedures. So how do you know that patient abuse isn't occurring that you don't even aren't even aware of? I mean, how do you check on something like that? Well, the system I've told you about, the first thing you need to do is know it as you suggest. Once you know it, then you can solve the problem of patient abuse. And in order to know it, you have to have some systematic, random, safe way to directly ask patients. If you have that, then you will get recurring complaints about recurring areas, shifts, individuals in the hospital. We've done that, and as a result of that, we have removed a number of individuals. People haven't replaced. We hear calls for a decentralized community-based mental health care system or program here in New Mexico as opposed to the concentration of resources at the state hospital in Las

Vegas. Where are you taking us in this respect and why? That's a system-wide answer that I must defer to my secretary on, but I will leave him where the conversation ended when he took over, which was to move in the direction of using the existing four facilities the state has, as if you will, one stop shop so that individuals going to, for it bared in the Las Cruces quadrant, would have access to both substance abuse and mental health services, where we in Las Vegas would develop the capability to provide developmental disability services, which we don't currently do. So we believe that within the existing institutions we have, we can regionalize the mental health system so that people don't have to cross mountains and drive across a very large state to get to those services. All right. We'll talk to the secretary about this momentarily. Thank you, Dr. Docker. Charlie Z. You won the Associated Press Award for Best Radio Documentary last year as a consequence

of your work on the state hospital story. How would you characterize that story today? I've heard Mrs. Merrill Lath and you've heard Dr. Dyker. Well, hell, I don't mean to say by any means that nothing's been done at the state hospital in the last two years from the day that the intermediate team first went to Las Vegas. There's two points I'd like to make. One is that there's a long way that the state hospital has to go in terms of quality of care. And I think the second point is that quality of care has not been the focus in many studies that the state has made. They've done many management studies over the last two years. And they really haven't addressed the quality of care issue. I think that there's still a lot of problems, similar problems that the intermediate team found and other media investigations that Senator Lowell Wiker found. There's still no same kind of problems existing at the state hospital today. I thought I heard Dr. Dyker say in the fact that some of the quality of care issues are in fact management issues.

Are you taking exception to that characterization? No, I think that's probably true. I think when it has to be a policy that quality of care is a priority at the state hospital. And I think that has to come from the Secretary's office right on down to the psych texts and the RNs and the LPNs on the floors. I just think there's still some problems in that area. For example, we've talked to some of our sources that we had two years ago. And they say that patients are still being kept over their commitment period. The case load for doctors that are in direct contact with the patients are so large that the patients can't see the doctors soon enough and just last year a patient committed suicide because that individual cannot see their psychiatry soon enough. Also treatment guardians are not being consulted as far as medicating the people that they're in advice of giving medication to. So there's still some similar problems that we found two years ago. All right.

Tell us what you can about this investigation we have been hearing about which will be taking place by officials of the United States Justice Department and to allegations of civil rights violations at the state hospital. What if anything can you tell us about that from your own sources? Well the Justice Department, to my knowledge, is coming in under the Civil Rights of Institutionalized Persons Act and they're aware of the investigation that was done by the Intermediate Team. They're also aware of other media reports and I'm sure they followed Senator Wiker subcommittee hearings very closely in Washington a year ago. So they have just about as much information as people here in New Mexico have. And I think it was the decision of the Justice Department and I don't mean to speak for the United States government. But they- No, I'm asking you as a journalist. Sure, of course. They have the same knowledge that we have here in New Mexico and I think they see some serious shortcomings and they'd like to come in and check them out. Okay Charli Z. Thanks a lot. Secretary Chris Craling, five and a half years ago on this very program I did a story. On some of the very things we've been talking about here this evening, patient abuse, nepotism,

mismanagement. Now that was a different administration under a different governor, many health and environment secretaries ago. But at that time all of the principals protested that they had been wronged and there was a lot of buckpassing back and forth. Is it going to take yet another governor and yet another health and environment secretary before this thing gets straightened out? Do you still have time in your term of office to do it? I think we have time in this term of office during the United Administration certainly to move the hospital in the right direction. I think you have to realize when you're looking at JCH accreditation, you're looking at JCH. Now people won't know what that is. I should have warned you about actions on accreditation in the hospital. I think it's possible. Joy Commission on the accreditation of hospital. Right. Anytime you go through a process like this to eliminate the kinds of things you're talking about that you did a show on five years ago, it's a lengthy time consuming effort. It requires the involvement of all levels of the department from the secretary's office

down to the clinicians on the ward. That's the direction that we've been moving, certainly that's the direction that Dr. Dyker has been moving in the last year or so. That's the direction we will continue to move during the remainder of this administration. I guess in my own mind I sort of find it difficult to establish a benchmark or some kind of criteria to say we have finally eliminated all these things that you talked about. I think you will always have problems within a state mental institution. I don't think you will ever have a perfect situation. I think the objective and the goal of our administration, and I'm sure of the next administration whoever that might be, is to continue to improve the quality of care as Charlie said. I think that's the most important thing to emphasize, certainly that's the direction we plan to go throughout this administration, hopefully we'll get there. Let me pick up on what Dr. Dyker and I were talking about the moment ago. The governor's own task force on health and environment department management suggested the department give greater autonomy and perhaps greater emphasis to community-based programs of the sort, Mrs. Marelet was talking about the moment ago, and perhaps work towards

a linear state hospital operation that Dr. Deferred to you on that matter. Are you interested in taking us in that direction? Yeah, I think generally speaking, yes, I think that it is impossible from a clinical perspective to ever eliminate the need for state residential care and residential institutions. We will always have that. We will always have that in New Mexico and all other states as well. What I think in terms of providing a greater efficiency of service, a more consistent service in terms of family involvement, in terms of involvement of case workers, as Elizabeth mentioned earlier, the community-based programs offer that opportunity much better than the residential situation. There are a number of needs that the long-term mentally ill have that can be better provided I think in a community-based situation. Not only are they closer to their families, but they're closer to people who can work with them in terms of social security needs, in terms of food stamps, in terms of housing, in terms of negotiating a lease agreement for an apartment, a number of basic human needs

that these people have that they can receive a little bit more easily in a community situation. And I think we probably do need to move in that direction. I think if nothing else, probably the drying up, shall we say, of federal dollars in some of these programs and the difficult revenue projections we have in New Mexico are going to force us to seek out methods of getting a little bit better investment on our dollar. I was going to ask you about the problem, the drugs of which Mrs. Merlat spoke at the beginning of the program, which gives some relieved persons who are mentally ill, have to be administered, but very often they do not have resources within their communities we are told to which they can return to make sure those drugs are administered. And so very often they are found wandering aimlessly upon the streets. That, as I understand it, is a critical problem in our mental health care system here in New Mexico. Is there any way to address that? Sure.

I think the main way to address that is to assure that within the community programs you have proper medical services, proper medical supervision so that those kinds of conditions don't exist. If you can't do that then you have to resort I think to the residential care. In the eight months which remain to you as Secretary of Health and Environment I am assuming you will probably not stay in the next administration, but perhaps you will know that at all. I hope you do if you want to. But we are told that the JCAA, the Joint Commission on Hospital Accreditation, accreditation of hospitals requires that for accreditation to take place that there be some kind of evidence of an efficient transfer of responsibilities from one administration to another administration and a concrete plan, a mental health care general plan for the state. Will that be in place for the time you leave office? Yeah, I am confident that that will be how. We have established a governing body to oversee the administration of the state hospital. Currently I chair the governing body, but it is also made up of the others within the line of authority from our department directly to the state hospital in Las Vegas.

They will undoubtedly remain in place or most likely will remain in place during the next administration. That should provide some continuity of direction and continuity of managerial skills. In addition to that, I would think that Dr. Dyker certainly will probably remain during the next administration. That in itself, I also, in itself would I think guarantee a continuity of program and I think that is very important. I think it is something that the next governor when he comes in is probably going to take a good look at and not want to go through the same problems that we have gone through in the last few years. One of the issues that has been raised, Charlie, is in effect local political interference in the affairs of the state hospital. Did you encounter, uncover any evidence to that effect in your own investigations? We had covered that at many levels, how we uncovered it right from the top down. There were people that were putting pressure on the hospital as far as hiring certain individuals. And I would have a minute, I want to know, do you feel those pressures, Dr. Dyker?

We have had no opportunity except here and now I think to directly talk to the public. The day in which the state hospital can be hit like a dead horse one more time I think is over. I would like to address a few things. I have about 30 seconds. The justice department, once the worker hearings were in place, had to come to the hospital. He met with them, they have no allegations, more current than two years ago. That situation, if it ever exists, does not exist anymore. What we do, we feel, is establish one of the most credible clinical operations that the people of this state should take pride in and should benefit from. So I would like anybody who has any current allegations to be a little more specific. All right. Well, we're going to have a leave out of that and wait for those allegations later where time is up. That is it for tonight. Tomorrow it is the city of Albuquerque versus the state land office over dumping trash or developing the area known as Mesa del Sol.

Meanwhile, thank you for joining us. I'm Hal Rose. Have a good night.