E. H. v. Matin

• Decision Date: 10 November 1981
• Docket Number: No. 15278,15278
• Court: West Virginia Supreme Court
• Parties: E. H., et al. v. Khan MATIN, M.D., Etc., et al.

Page 232

284 S.E.2d 232

168 W.Va. 248

E. H., et al. v. Khan MATIN, M.D., Etc., et al.

No. 15278.

Supreme Court of Appeals of West Virginia.

Nov. 10, 1981.

Syllabus by the Court

1. W. Va. Code, 27-5-9 [1977] provides specific rights to all mental patients confined in the State hospitals of West Virginia and these rights may be enforced by an action in mandamus against the responsible state officials.

2. W. Va. Code, 27-5-9 [1977] requires a system of custody and treatment in State mental hospitals which reflects the competent application of current, available scientific knowledge.

3. It is the obligation of the State to provide the resources necessary to accord inmates of State mental institutions the rights which the State has granted them under W. Va. Code, 27-5-9 [1977].

E. Gail Falk, Glen D. Moffett and Daniel F. Hedges, Charleston, for petitioners.

Chauncey H. Browning, Atty. Gen. and Curtis G. Power, Asst. Atty. Gen., Charleston, for respondents.

NEELY, Justice:

Once again this Court's attention must be focused on the "Dickensian Squalor of unconscionable magnitudes" of West Virginia's mental institutions. State ex rel. Hawks v. Lazaro, 157 W.Va. 417, 202 S.E.2d 109, 120 (1974). The four petitioners, who bring this consolidated mandamus action pursuant to this Court's original jurisdiction, allege that they are confined as mental patients in Huntington State Hospital under conditions which violate W.Va. Code, 27-5-9 [1977] which accords all patients a right to both humane conditions of custody and therapeutic treatment. ¹

Petitioners seek an order from this Court requiring the respondent clinical director of the Huntington State Hospital and respondent director of the West Virginia Department of Health to provide them with the services to which they are entitled under Code, 27-5-9 [1977]. The case was submitted to this Court upon a record developed through depositions of the staff of Huntington State Hospital and depositions from expert witnesses who evaluated the clinical and custodial program at the hospital.

I THE PETITIONERS

E. H. is a 42-year-old Huntington resident who has been in and out of Huntington State Hospital on numerous occasions in recent years. She is diagnosed as suffering from manic depression illness (circular type) and alcohol addiction. When in a disturbed state she exhibits aggressive, destructive and delusional behavior. Between her disturbed periods, she is lucid and interacts appropriately in conversation. She was involuntarily committed to Huntington State Hospital most recently in March 1981. Before the present law suit was filed, no treatment plan had been devised for her, although she had been placed in locked seclusion on twelve separate occasions.

Petitioner L. S. is a 25-year-old woman who exhibits a high level of intelligence and skill in personal interaction. She was involuntarily committed to Huntington State Hospital in April 1981, in a highly disturbed state characterized by sexual promiscuity, severely diminished mental functioning, and poor memory combined with uncommunicative behavior. At the time of her commitment, it was not known whether her problems were caused by mental illness or drug addiction. Nevertheless, at the time this action was filed, she had yet to receive a psychiatric evaluation. As a result of inadequate staff coordination and the absence of a proper evaluation, there are a variety of conflicting reports in her records: the respondent clinical director diagnoses her as having an "atypical psychosis"; a staff member writes, "Even during the times of aggressive behavior, the patient has always been friendly"; the staff psychologist concludes, "Since she has not improved significantly in the month she has been here, probably her schizophrenia is chronic."

Petitioner S. W. is a 39-year-old Beckley resident. She has a long history of mental illness (diagnosed as schizophrenia) and alcoholism, but before her current hospitalization she maintained herself in a community setting with only occasional hospitalization. She was committed in March 1981 and has been kept in Ward 2 where few trained staff are available to treat her.

Petitioner M. R. is a 25-year-old, severely retarded woman of small stature, who can walk with an unsteady or shuffling gait at best. She lives in Ward 11 with 30 to 40 women who are all older than she and who all suffer from a combination of severe mental and physical handicaps. Ms. R. is unable to talk although she screams on occasion. She is unable to dress herself, feed herself with utensils, or care for her own toileting needs although she is considered potentially capable of learning those skills with appropriate training. Before being moved to Huntington State Hospital, she had been trained to feed herself by the staff at Lakin Hospital. She has since lost that skill. She also exhibits aggressive and self-abusive behavior, and has a history of repeatedly burning herself on the ward heater.

II THE FACILITIES

Ward 2, where petitioner W. stays, is entered through a series of double-locked doors. A visitor is immediately impressed by the bleak and squalid atmosphere of the ward. Its green walls are utterly bare and cheerless. There are always between 30 and 40 psychiatric patients in Ward 2, many of whom mill about aimlessly throughout the day. The staff usually remain in the nursing station; their only contact with the patients occurs when they deliver medication through a two-piece door, the top part of which can be opened independently. The ward has a distinctive odor caused by patient incontinence.

Ward 11, where Ms. R. is now a resident, is similar to Ward 2 in terms of bleakness. The nurses' station is behind iron bars and is centrally located in the circular ward. Again the ambulatory patients mill about and there are occasional outbursts from the patients.

The two other petitioners were staying in what is called the pre-discharge unit. It has two floors with small rooms where group meetings can take place. Each patient has an independent, unlocked room with a footlocker. There are curtains on the windows and the atmosphere is more like that of an old house than that of a hospital. Consequently, the custodial facilities for these patients appear to meet minimal humane standards relating to the custodial setting, although we are uninformed about the relationship between the custodial setting and a program of appropriate therapy.

III STAFF COORDINATION

One of the great problems at Huntington State Hospital is that when a treatment plan is drafted for a patient (which is all too seldom), it is often drafted during a meeting at which no one who has worked with the patient is present. Worse, there is often no one present with psychiatric training. One of the physicians at the hospital has no advanced training in psychiatry, nor do many of the attending nurses. Obviously when treatment plans are drafted by untrained people with no personal knowledge of the patients, they seldom meet the needs of the patients.

Even when a good plan is drafted it is seldom implemented consistently or at all by the three different shifts of staff who work with the patient each day. An example of this problem is best shown in the response to M. R's. screaming. The psychiatric aide in charge of Ward 11 during the day shift thinks that petitioner R's. screaming is an attempt by the patient to communicate; therefore, the aide responds with positive reinforcement. However, the staff members on other shifts generally think that the screaming is symptomatic of a psychiatric problem and respond with control techniques. This failure of treatment at such a basic level is symptomatic of an overall dearth of professional administration of the health services at the hospital.

Another critical problem with staff coordination is that no individual staff member is assigned the responsibility for follow-up work to assure compliance with the treatment plans. When certain therapy is recommended, there is never a listing of those responsible for conducting the therapy, when it will be conducted, and who is responsible for reviewing the patient's progress. When E. H. was moved from a ward to the pre-discharge unit, the staff of the pre-discharge unit drew up a treatment plan for her without reviewing either her old treatment plan or her other records at the hospital. As a result, her new treatment plan had no mention of the fact that she had alcohol problems. The irony of this omission concerning a woman who has virtually a lifelong chronic alcohol addiction is staggering and points out the sad problems encountered when there is no coordination and no detailed responsibility for treatment, follow-up, or supervision.

In a psychiatric ward a patient interacts with many staff members during the course of each day. It is critical that all of the staff members be instructed concerning the patients' problems and needs in order that each staff member will know what is expected of him. In the case of L. S. a doctor diagnosed her as having an "atypical psychosis." This evaluation was made without the benefit of an in-depth examination. Worse, this diagnosis is extremely rare, and few of the lesser trained staff would have any idea what it means either in terms of her actual problem or in terms of proper treatment. Unfortunately, her record is devoid of any explanation of the diagnosis, which leaves the staff in utter ignorance about a proper response.

Lack of adequate documentation is the most easily observed shortcoming at the Huntington State Hospital. Documentation fulfills a critical function in psychiatric treatment. Clinical records are the basis for planning and continuity of patient care. They provide a means of communication among all the mental health professionals who are involved in the patient's program. These documents list continuing treatments and the observations about the patient's response to treatments as they are...