RERUN: DATE LINE JULY 2012


RE: Arizona Administrative Code
Title 9, Chapter 21, Article 402

Wherein, the Arizona Department of Health Services Office of Grievances and Appeals systematically rejects meeting its obligations in terms of investigating reported inhumane or otherwise substandard medical-mental health care CONDITIONS at The Arizona State Hospital.

February 09, 2012: Dear Ms. Ault, Following over eight (8) months of administrative wrangling specific to the procedural histories of the above grievances, I am at this time requesting an independent investigation into the general underlying condition(s) by which all of these grievance issues arose. It is clear to me that all of of fundamental dynamics by which each of these four seemingly exclusive issues arose are sequentially connected. This has come to light through my experiences as an AzSH/ADHS client, and I can prove it.(EXCERPT) 

Thank you. Sincerely, ------- (PJ Reed)

       2014 UPDATE: I SUBMITTED THE ABOVE DOCUMENT TO ADHS/BHS OFFICE OF GRIEVANCES AND APPEALS 12 DAYS BEFORE MY FEBRUARY 21, 2012, DISCHARGE FROM THE ARIZONA STATE HOSPITAL. THE FULL LETTER DOCUMENT IS INCLUDED BELOW. 

The Arizona Administrative Code is law. Codified through legislative authority in full accordance with all federally required obligations of the state of Arizona to meet nationally established standards in terms of administrative functions of every state agency, the Arizona Administrative Code (AAC) sets bright line rules and regulations by which the Arizona Department of Health Services (ADHS) must carry on its day to day functions as a tax funded and public state resource, including with respect for any/all of its subsidiaries (such as Behavioral Health Services [BHS]) and facilities (including ASH). Violations of AAC rules and regulations are violations of state law, bottom line, and when state laws are broken by employees of state agencies such as ADHS, the citizens of Arizona are deserving of the fundamental right to both report as well receive protection against such unlawful conduct, and individuals or agencies responsible for the misconduct are to be held fully accountable, as per all applicable law and policy.

        Below are some specific AAC provisions relating to come of the ADHS' requirements in this context:

Arizona Administrative Code, 
Title 9, Chapter 21, Article 402

General

 A. It is the policy of the Division to conduct investigations and bring matters to a resolution infour circumstances: First) in the event of a death of a client; Second) whenever there is alleged to have occurred a rights violation; Third) whenever there is alleged to exist a CONDITION 

requiring investigation because it is dangerous, illegal, or inhumane; and Fourth) in any other case where as investigation would be in the public interest, as determined  by the director of the Department or the deputy director of the Division. 

         The purpose of R9-21-402 through R9-21-410 is to implement that policy. All investigations according to R9-21-402 through R9-21-410 shall be carried out in a PROMPT and EQUITABLE MANNER and with due regard for the DIGNITY and RIGHTS of all persons involved. R9-21-402 through R9-21-410 do not obviate the need for systematically reporting, where appropriate, accidents and injuries involving clients. 

      Bodies of law such as the Arizona Administrative Code are designed to ensure diminish any possible disconnect(s) between state administrative office workers in agencies such as ADHS/BHS and the clients that they serve doesn't lead to violations of clients fundamental rights, because the clients of these agencies are citizens of this nation and as such are deserving of each and every protection afforded them through the constitution and other like mandates. Furthermore, given the vast difference between the environment of office workers/administrators and the clinical experiences of medical patients, there is a well recognized need for direct oversight and authoritative oversight anytime medical patients are the subject of state managed health care.  Thus, it is pretty clear to me what the intent of the above provision of law is and what the meaning of that intent stands for, and I highly doubt that anybody of reasonable mind and moral code would disagree with my assertion that patient/client safety and support are central to why the state legislature enacted this specific law.

       That said, please note the specific language of the third circumstance outlined above, whereby  applicable policy requires that the Division conduct investigations of reports about conditions that are alleged to be dangerous, illegal, or inhumane. During my 13 months of treatment  at The Arizona State Hospital, I was- from day one- lied to, physically and verbally abused, psychologically abused, coerced, and threatened; and my constitutionally protected rights to due process and equal protection, as well as my fundamental rights to dignity, safe habitation, and basic consumer protection, were all systematically abused or otherwise abridged on a daily basis by all levels of staff. The flow of abuse in this context was evident at the level of the lowest ranking technicians or nurses, on up through the primary attending physicians and the office of chief medical officer, to the highest ranking ASH administrators; with most of the direct physical and verbal abuse occurring in instances involving nursing or technician staff (because these staff persons spend the most time with patients in a 24/7 context), while the higher ranking staff persons engaged in denying effected patients meaningful protection against such abuse by covering up abuse and/or otherwise condoning its presence through administrative manipulation of the facts and the related flow of information.

       I recognized the misconduct for what it was from the get-go, and I openly expressed my immediate  concerns about these things as soon I could to about any member of staff willing to listen, but most specifically, in terms of serious concerns about abuse, directly to my primary attending physician (who, early on in my time at ASH was Dr. Laxman Patel), and to the patient advocate at ASH, Sonya Serda. But before long, I learned the hard way that patient complaints are typically rejected or otherwise suppressed by both Sonya Serda, and by the primary attending doctors such as Patel, as well as by ASH administrators such as the recently censured Chief Operating Officer at ASH, Donna Noriega. These suppressions and outright rejections of my complaints were systematic, and seemingly occurred as a matter of standard practice, with little or no regard whatsoever for the merits of the complaints; which in turn led me to begin following up my initial concerns about the issues with formally drafted submissions of well detailed reports of patient abuse. Time and time again I did this, sending copies of the grievance documents to each and every individual, office, or agency assigned with the responsibility of supporting client-patient rights and enforcing clearly established protections against patient abuse.

        But even this did no good. Instead, even after I followed all of the suggested avenues for meaningful resolution by very carefully and very civilly drafting numerous grievance documents which I submitted as per all applicable standards of law and policy,  I still found myself repeatedly subject to clearly unlawful manipulations or utter rejections of my fundamental concerns, by ADHS staff and other like agency representatives at all literally all levels. At the time, I also recognized this form of misconduct for what it was, but as an emotionally vulnerable adult subjected to this shit day in and day out in a hospital setting, I found it very, very overwhelming to have to accept, for it was frightening to an unspeakable degree; and as a recently discharged patient at ASH, I can and do attest to the severe emotional and psychological trauma that comes with being subjected to not only direct physical and verbal abuse on a daily basis, but to systematic administrative abuse of authority and related negligence, as well.

      Ultimately, following 13 months of ongoing staff misconduct and related patient abuse, as well as over eight months of facility (ASH) and agency (ADHS/BHS) administrative abuse, negligence, and outright rejection of the reports that I submitted specific to this misconduct, as well as directly related clinical and administrative abuse of authority, I came to the conclusion that ASH, as an operation, glaringly reflects widespread substandard health care CONDITIONS, which do- and as detailed in far more than one well documented report- pose definite danger, illegality, and inhumane acts at all levels of staff interaction with me as a patient-client.

       I then (February 09, 2012) very clearly reported my deep concerns and well rounded allegations about the general CONDITIONS at ASH, as well as the related systematic abuse and negligence throughout the affiliated agencies (which all belie a directly related and critically mismanaged state of conditions in that context) to Arizona Department of Health Services Division Chief, Margery Ault, as follows below:

        

      The concerns that I expressed in my February 09, 2012, letter to ADHS Division Chief, Margery Ault, very clearly refer to "the procedural histories" of four of my most serious grievance reports, and as I also stated in the letter, I know that these procedural histories are irrefutably representative of very clear endemic and critically substandard administrative CONDITIONS at The Arizona State Hospital, and beyond, in the directly affiliated state agencies. Yet at this point in time (May 28, 2012), well over 90 days since I sent the above letter to Margery Ault, I have not heard a thing. Therein, a graphic example of the vast disconnect between the experiences of Ash patients and the administrative officials assigned with enforcing the patients protections against abuse. The simple fact that Margery Ault's complicity in rejecting my request for investigation of substandard conditions at ASH is a blatant violation of  ACC provision R9-21-402 in all senses (see above), but in order to even more clearly show how this disconnect directly detriments the rights and protections of patient-clients of ADHS, I will also point out the final sentence of the provision, which emphasizes that:

      All investigations according to R9-21-402 shall be carried out in a PROMPT and EQUITABLE manner and with due regard for the DIGNITY and RIGHTS OF ALL PERSONS INVOLVED.  R9-21-402 through R9-21-410 do not obviate the need for systematically reporting, and appropriate, accidents and injuries involving clients.

       This situation, as it stands today, is 100% consistent with my overall experiences in terms of patient abuse at The Arizona State Hospital, and as a whole, it graphically reflects very clear complicity of ASH' parent agency at the state level, which is the Arizona Department of Health Services/Behavioral Health Services. But as I have reasonably revealed in the above materials, the ADHS Office of Grievance and Appeals, which is maintained under the direct authority of Margery Ault (to whom I sent the above letter), is also willfully participating in ongoing systematic violations of all applicable law and policy, which in no uncertain terms, is abuse of administrative authority, in and of itself. For after being lied to, and physically and verbally abused, coerced, and threatened, and so on, my deepest sense of dignity in relation to these events was pissed on in paradoxical coincidence with the incidents themselves; and with direct reference to the many, many months that I have been waiting for meaningful response from the ADHS Office of Grievances and Appeals, any sense of dignity that I may have had when I first sought assistance from that office (up to one full year ago) was diminished due to the very real fact that the responsible parties in this context have been anything but prompt in terms of meeting their assigned obligations; and it is furthermore clear that the only reason these agencies are getting away with ignoring (and therein abusing) their explicit responsibilities at this time is due to the fact that they- the representative staff in ADHS- do, without a doubt, have radically disproportionate power over the flow of this entire process, which flies in the face of equitability, no matter how you look at it.

       By the time I discharged from The Arizona State Hospital in late February, 2012, I had come to realize the fact that not only were the conditions at the Hospital out of control, but that the crisis also extended to the Arizona Department of Health Services, including the department's Office of Grievance and Appeals. Knowing as I do today that none of these publicly funded entities are managing their duties to the public, it is clear to me that the overall situation has escalated beyond the authority of  any/all affiliated state agencies, if for no other reason than the obvious conflicts of interest. But the very lives of the patients at ASH are still at risk, for I know that the patient abuse there is ongoing even as I write each day, and that is what I am most concerned about today. So despite the hardship of this process, and the related emotional and cognitive stress that comes with it, I will continue to dedicate myself to addressing these matters in entirety. All I can do is hope that I will be supported by as many resources as possible, because the power dynamic is vastly disproportionate, and it gets even worse as my concerns work their way up through the applicable channels of authority.

     
IN CLOSING: At the May 17, 2012, review in the Arizona Office of Administrative Hearings (OAH) of my allegations concerning the ASH staff person, Elaine Traylor, who physically attacked me and injured my rib cage on July 07, 2011, assistant Arizona Attorney General Joel Rudd declared that I "suffered no tangible harm" as a consequence of the proven time line violations that ASH and ADHS investigators are most definitely guilty of in terms of investiture agongating that very disturbing event. Here again, the vast disconnect between the one's assigned with serving the administrative needs of Ash pateints and the very real experiences of the patients themselves. Joel "the mortician" Rudd's statements to the effect I was not  detrimented (harmed) by the undeniable fear that comes with being subject to ongoing physical and verbal abuse, and the subsequently attendant anxiety that came with feeling/realizing that the abuse was not going to be addressed by the authorities that I as a citizen rely upon for protection in this context, are entirely consistent with my understanding of how deeply misaligned the public behavioral health system in Arizona is; and in my still yet to be scheduled future OAH hearings, I fully expect to be challenged by similar denials of the realities of the patient experience(s) at ASH.
     
This is the state of affairs as it stands today, and it really sucks, and that is all I can say about it. Please contact me if you can be of any assistance to this cause. Patient abuse at The Arizona State Hospital (or anywhere else) is fundamentally criminal, inhumane, and 100% beyond the commonly accepted standards of our times and of our nation.  Write simple letters or make phone calls if you can. I need your help.  The patients at The Arizona State Hospital are being subjected to ongoing abuse and grossly substandard medical-mental health care and practice, and the doctors and administrators at ASH and at the state are getting away with it.  Please become involved, and do what you can today to see that these matters are rigorously investigated, addressed, and meaningfully brought to an end. 

paoloreed@gmail.com



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