The Role of Hospital Executives In Furthering Historical Failures To Do The Right Thing. Wherein, the fundamental findings and merits of congressionally enacted efforts to preserve and protect the rights of Americans across the board, are routinely exploited rather then abided by in order to maintain status quo in our nations state managed mental hospitals.

 "Numerous state psychiatric hospitals have recently been exposed for violations and/or deficiencies in patient care and safety, including several that have come under U.S. Department of Justice (DOJ) investigation. The reports show that these facilities are not safe, sanitary or rehabilitative places." (S. Wagner, Director of Litigation and Prosecution, The Citizens Commission on Human Rights. November 24, 2007)

From this publication, January 21, 2018: "In the year 1997-98 or thereabout, Arizona State Hospital was formally stripped of its license to operate due to the exposure of substandard care practices and conditions. Following reacquiring the trust of federal regulators in 2000, the Hospital again all but lost its license in 2004, again due to violations of law and policy. In 2013-14, following the (then) two year history of this blog publication, issues of serious concern to the welfare of ASH's patient community yet again led to significant federal intervention, wherein the Hospital's license was almost stripped- yet again. 

History does not have to repeat itself, must not repeat itself, and it is up to us, the people, to make this so. Are the current administrators of ASH up to the task? Does the current director of ADHS have the right stuff?

Only time will tell. But it's running out. Fast."

“If only they could grasp these factors, these highly entrusted public servants, and take good faith advantage of related information provided to them, and by utilizing the concerns of Hospital patients in order to make a difference; and when it comes to ASH, in fact, as one readily available means to deter repeated arisals of obviously recent history.” (See below.)

"You, Dr. Cara Christ , are 100% responsible for doing the right thing today. So do it, already."

Dr. Cara Christ.
Director, Arizona Dept. of Health Services
2015-the present. 

Since her appointment to the highest ranking position in Arizona’s public health care system in 2015, Arizona Department of Health Director Dr. Cara Christ has repeatedly stated that there have been “great improvements” in the state’s sole long term public mental health care facility, Arizona State Hospital (ASH). To date however, January 2018, Dr. Christ has never provided any evidence or information about just what these “improvements” at ASH are, in fact. This is of very real concern to the staff of this publication, given that Dr. Christ’s immediate predecessor (Will Humble ADHS Director 2009-2015) willfully relied upon producing a pattern of overt and untruthful propaganda that served to delay a subsequent process of critically needed oversight and accountability at ASH. Propaganda that defied the realities specific to the ASH operation, including but not limited to preventable patient deaths, the tragic murder of a young Phoenix woman, and a wide range of patient generated concerns expressed in grievance submissions; and as such, granted the former administrators of ASH further opportunity to continue operatinASH in a manner deeply harmful to the welfare of the Hospital’s patient community. These issues have been exemplified by the information provided in this blog since 2012, as well as in a number of scathing investigative findings of the staff of ABC Ch15 circa 2013-2015; (As reported previously in this publication, at least three preventable deaths occurred due to this fact). 

The following article was originally published sometime in the first twelve months of the life of this blog, PJ Reed The Arizona State Hospital Patient Abuse. We are republishing this information as one means to remind our readers of how dismally substandard the operation at ASH was circa 2010-2012, and in order to raise consideration as to whether in fact any legitimate improvements have in fact come about since Dr. Christ was granted directorship over Arizona’s public health care system. 

ASH Patient Medical Records: Wherein the issue of any patient at The Arizona State Hospital's desire to access and review their own personal ASH medical records is brought to the table in order to clarify a thing or two about yet one more aspect of ASH's substandard conditions. 

(Originally published April 06, 2013)

RULE: Hospital Information Portability and Protection Act, Title 45 United States Code [2006].

Section $164.524 Access of individuals to protected health information.

     

(1) Individuals request for access. The covered entity must permit an individual access to inspect or to obtain a copy of the protected health information about the individual that is designated in a record set.

NUTSHELL INTRODUCTION TO THE FOLLOWING: Patient' access to their own records may only be restricted if the records are psychotherapy notes, or notes/information that LIKELY poses a clear threat of harm to anyone, be it the patient themselves, others, and so on. That's it, no exceptions. 

Your records are YOURS, and in no other circumstances may ASH staff restrict such access, including but most importantly the Hospital’s administrators (who are to have full understanding of these standards of law, as per their obligations specific to the public trust). 

Should ASH staff or administrators deny said access for any reason at all, they must provide the client-patient with a clear explanation for such denials in writing. 

If ASH staff fail to meet these strict requirements, they are doing so in violation of the The Hospital Insurance Portability and Protection Act, which is an exclusive and paramount federal law, with direct applicability to health care policy as applicable to the function of any licensed medical provider. Period. 

I know from experience that ASH staff, including senior clinicians and administrators, will deny such access to any patients's records if the access poses any likelihood that staff wrongdoing will be exposed. ASH patient records as a whole contain a wide range of information about any patient's flow of treatment, and as such, often do offer the opportunity for patient or patient representative access to evidence in support of claims about staff misconduct, and for this reason, ASH administrators are more than reluctant to grant patients their lawfully rightful access to records for this very reason. Standard practice at ASH, in other words, and one more distinct aspect of how and why the senior clinical staff at ASH continually get away with providing their patients with grossly substandard care, in direct complicity with ASH administrators. 

The following outlines the underlying law specific to this reality, albeit in torturous legalese. 

GENERAL

 Word has come to me of late, that the administrators and senior clinicians at The Arizona State Hospital are engaged in ongoing denials of any ASH patient's fundamental right to access and review their own ASH medical records. This is an issue that I know for a fact contributes to  unabated criminality specific to the clinical practices at ASH, for any ASH patient's  records will include supplemental notes are taken by all levels/forms of ASH staff, such as the nurses, technicians, recreational staff, even the librarian, and as such, represent a diverse variety of data in the context of records, and none of which are psychotherapy notes. The fact is that, if many/most patients/patient representatives were made aware of the full records compiled by various ASH staff who are directly involved in any patient's treatment, the patient (etc.) would be provided a reasonable opportunity to review a range of details underlying how ASH staff in general interpret the patient's needs, behaviors, and related status specific to their given diagnosis, as well as in terms of the patient's overall flow of treatment. 

But the fact is, ASH senior clinical staff do not want most patients to see these records, because that would also provide ASH patients with a much clearer idea of just how deceitful and/or unethical their primary care physicians are. By controlling, manipulating, and distorting such information in association with allegations about patient misconduct, when, in fact, the issue of staff misconduct is at stake, it is a plain fact that such senior ranking staff unethically violate the provisions of state and federal law in order to condone staff misconduct and therein further abuses of patients.

This article is an overview of the current standards applicable to this specific topic, and I am hopeful that it will be of use to anyone seeking these specifics in relation to their own treatment at ASH, or there treatment of their loved ones, and so on.

FACT

I know how critical this issue is in terms of any patients ability to exercise their right(s) to report potentially unlawful issues that arise in specific relation their flow of treatment at ASH, because I was personally subjected to this specific violation of my rights and related protections on more than one occasion. As follows, details about one of my experiences in this context.

During the summer months of 2011, I sought nurses notes from the Palo Verde east unit specific to my own treatment and related behavioral characteristics as a patient on that unit.I made this request as per protocol, in good faith as always, by submitting the required formwork by which I was to be provided assess to those records, as per my rights under the provisions of HIPAA.

I was compelled to make this request because my assigned primary physician at the time, Pervaiz Ahkter, had previously alleged that nursing staff on the Palo Verde east unit had documented a range of (my own supposed) "misbehavior”. I knew that any such notes, should they actually exist, were patently untrue, this simply on the basis of knowing myself and having distinct awareness of my overall interactions with nursing staff. The fact is, a number of Palo Verde nurses were in their own right willing to violate ASH’s own rules, and to abuse the rights and ignore the care needs of ASH patients; but on no one occasion did I violate my required responsibilities as an ASH patient when defending my rights in this or any context.

Ahkter was "citing" such records in order to threaten my status and associated privileges as an ASH patient; specifically, he subjected me with the threat of restricting me to Palo Verde east, therein threatening my ability to attend all/any off-unit therapeutic resources, and a range of other like resources not available on ASH’s various treatment unit. I effectively called him on his allegations by requesting access to those records.

But, with no justification whatsoever, and without providing any written explanation, Dr. Akhter subsequently denied my request.

Important to note that I was only assigned as one of  Akhter’s patients after my falling out with ASH's current Chief medical Officer, Laxman P. Patel, who was my first assigned primary care physician at ASH, and whose earliest response to my reporting of staff misconduct was (verbatim), “What do you expect? This is the state hospital.” Said “falling out”, did thus occur in on the basis of Patel's disagreement with my ongoing willingness to report ASH staff misconduct whenever I was aware of its occurrence. Patel’s attitude was a shining example of patterns of abject negligence  and associated administrative ineptitude that did in time become standard practice in terms of how I was mistreated and abused over the entirety of my time as an ASH patient. (For more information, please see my April 4, 2013 article, Fundamental Fact #2)

It is also important to understand that, in all truth, I accrued no valid history of engaging in any form of actual "misbehavior" during the entirety of my time at ASH (this is true but for one or two very specific occasions, each of which occurred under very unusual circumstances, and wherein this misbehavior was insignificant in terms of ASH’s general rules). I was, conversely speaking, assaulted by other ASH patients on no less then two occasions, patients who were literally encouraged to do so by ASH staff who shared Patel’s disagreement with my willingness to report staff misconduct. 

Similarly, at no point whatsoever in my eight months of psychiatric treatment while in Tucson areas hospitals prior to being committed to ASH, did I engage in any form of misconduct, a fact that my care providers in those specific hospitals are more then willing to verify. It was only at ASH that allegations of this nature arose. Putting me, the client-consumer-patient in danger of being identified as a perpetrator, when I was in fact, the victim.

I attest that it is common practice at ASH for senior clinical staff, including the attending Chief Medical Officer, to mischaracterize any patients' behavior in order to unlawfully manipulate the patients' flow of treatment, in order to suppress information about staff misconduct, and to maintain the status quo by which ASH administrators get away with operation the Hospital in violation of law and policy.  All of this, a gross abuse of their given authority that flies in the face of the public trust, the Hippocratic Oath, and other like precepts of established medical standards.

In this particular case, Pervaiz Akhter, attempted to intimidate me in this fashion in clear retaliation for my willingness to report staff misconduct. His going about this was far from exclusive during my varied experiences at ASH; and in short time, I garnfered clear awareness of the extent to which even ASH’s CEO and chief medical officer will retaliate against patients such as I, on the basis of my right to report staff misconduct.

All ASH patients are disabled under federal law, and retaliation of any kind on the basis of any consumer-patient’s exercising of the right to oppose any medical provider’s practices is prohibited by the provisions and protections specific to the Americans with Disabilities Act (Title 42 United States Code [1990]).

As stated, I contend that Patel’s goal was to intimidate me into submission and to stop reporting staff misconduct; or else, to use the untruthful claim of these nurses notes in order to restrict my access to day to day activities at ASH, including therapeutic sessions, recreational activities, and so on.

In either case, Ahkter's intent clearly violated a host of patient rights and protections. But I have no idea if he even has the capacity to realize  this. For just like ASH's current Chief Medical Officer, Laxman P. Patel, who is a native of India and who received his formal medical training there,  Dr. Pervaiz Akhter also came to the United States from one of the most horrifically out of control regions of the world today, Pakistan, a nation known as anything but a bastion of human rights and democratic values specific to human interaction. This, the face of ASH today. It really is that bad.   

The standards applicable to any patient's right to access their own health care records is well established today, and are very clearly defined, as such, by state and federal law in every part of the United States. Thus, anytime ASH staff choose to deny such access, they must adhere to very strict provisions of these laws, lest they be held accountable as per equally defined penalties, which are most significantly spelled out by applicable federal law and policy. Specifically, the Hospital Insurance Portability and Protection Act (HIPPA) covers any American citizen's rights in this context, and it's primary purpose is to ensure that hospitals and health providers don't engage in unlawful management of any individual's given needs. The HIPPA document itself was congressionally enacted due the critical nature of this subject, and as such, very clearly supersedes the authority of involved health care providers; as such, if and when health care providers fail to adhere to HIPPA or act in violatio investigation. The reports show that these facilities are not safe, sanitary or rehabilitative places." (S. Wagner, Director of Litigation and Prosecution, The Citizens Commission on Human Rights. November 24, 2007)

From this publication, January 21, 2018: "In the year 1997-98 or thereabout, Arizona State Hospital was formally stripped of its license to operate due to the exposure of substandard care practices and conditions. Following reacquiring the trust of federal regulators in 2000, the Hospital again all but lost its license in 2004, again due to violations of law and policy. In 2013-14, following the (then) two year history of this blog publication, issues of serious concern to the welfare of ASH's patient community yet again led to significant federal intervention, wherein the Hospital's license was almost stripped- yet again. 

History does not have to repeat itself, must not repeat itself, and it is up to us, the people, to make this so. Are the current administrators of ASH up to the task? Does the current director of ADHS have the right stuff?

Only time will tell. But it's running out. Fast."

“If only they could grasp these factors, these highly entrusted public servants, and take good faith advantage of related information provided to them, and by utilizing the concerns of Hospital patients in order to make a difference; and when it comes to ASH, in fact, as one readily available means to deter repeated arisals of obviously recent history.” (See below.)

"You, Dr. Cara Christ , are 100% responsible for doing the right thing today. So do it, already."

Dr. Cara Christ.
Director, Arizona Dept. of Health Services
2015-the present. 

Since her appointment to the highest ranking position in Arizona’s public health care system in 2015, Arizona Department of Health Director Dr. Cara Christ has repeatedly stated that there have been “great improvements” in the state’s sole long term public mental health care facility, Arizona State Hospital (ASH). To date however, January 2018, Dr. Christ has never provided any evidence or information about just what these “improvements” at ASH are, in fact. This is of very real concern to the staff of this publication, given that Dr. Christ’s immediate predecessor (Will Humble ADHS Director 2009-2015) willfully relied upon producing a pattern of overt and untruthful propaganda that served to delay a subsequent process of critically needed oversight and accountability at ASH. Propaganda that defied the realities specific to the ASH operation, including but not limited to preventable patient deaths, the tragic murder of a young Phoenix woman, and a wide range of patient generated concerns expressed in grievance submissions; and as such, granted the former administrators of ASH further opportunity to continue operatinASH in a manner deeply harmful to the welfare of the Hospital’s patient community. These issues have been exemplified by the information provided in this blog since 2012, as well as in a number of scathing investigative findings of the staff of ABC Ch15 circa 2013-2015; (As reported previously in this publication, at least three preventable deaths occurred due to this fact). 

The following article was originally published sometime in the first twelve months of the life of this blog, PJ Reed The Arizona State Hospital Patient Abuse. We are republishing this information as one means to remind our readers of how dismally substandard the operation at ASH was circa 2010-2012, and in order to raise consideration as to whether in fact any legitimate improvements have in fact come about since Dr. Christ was granted directorship over Arizona’s public health care system. 

ASH Patient Medical Records: Wherein the issue of any patient at The Arizona State Hospital's desire to access and review their own personal ASH medical records is brought to the table in order to clarify a thing or two about yet one more aspect of ASH's substandard conditions. 

(Originally published April 06, 2013)

RULE: Hospital Information Portability and Protection Act, Title 45 United States Code [2006].

Section $164.524 Access of individuals to protected health information.

     

(1) Individuals request for access. The covered entity must permit an individual access to inspect or to obtain a copy of the protected health information about the individual that is designated in a record set.

NUTSHELL INTRODUCTION TO THE FOLLOWING: Patient' access to their own records may only be restricted if the records are psychotherapy notes, or notes/information that LIKELY poses a clear threat of harm to anyone, be it the patient themselves, others, and so on. That's it, no exceptions. 

Your records are YOURS, and in no other circumstances may ASH staff restrict such access, including but most importantly the Hospital’s administrators (who are to have full understanding of these standards of law, as per their obligations specific to the public trust). 

Should ASH staff or administrators deny said access for any reason at all, they must provide the client-patient with a clear explanation for such denials in writing. 

If ASH staff fail to meet these strict requirements, they are doing so in violation of the The Hospital Insurance Portability and Protection Act, which is an exclusive and paramount federal law, with direct applicability to health care policy as applicable to the function of any licensed medical provider. Period. 

I know from experience that ASH staff, including senior clinicians and administrators, will deny such access to any patients's records if the access poses any likelihood that staff wrongdoing will be exposed. ASH patient records as a whole contain a wide range of information about any patient's flow of treatment, and as such, often do offer the opportunity for patient or patient representative access to evidence in support of claims about staff misconduct, and for this reason, ASH administrators are more than reluctant to grant patients their lawfully rightful access to records for this very reason. Standard practice at ASH, in other words, and one more distinct aspect of how and why the senior clinical staff at ASH continually get away with providing their patients with grossly substandard care, in direct complicity with ASH administrators. 

The following outlines the underlying law specific to this reality, albeit in torturous legalese. 

GENERAL

 Word has come to me of late, that the administrators and senior clinicians at The Arizona State Hospital are engaged in ongoing denials of any ASH patient's fundamental right to access and review their own ASH medical records. This is an issue that I know for a fact contributes to  unabated criminality specific to the clinical practices at ASH, for any ASH patient's  records will include supplemental notes are taken by all levels/forms of ASH staff, such as the nurses, technicians, recreational staff, even the librarian, and as such, represent a diverse variety of data in the context of records, and none of which are psychotherapy notes. The fact is that, if many/most patients/patient representatives were made aware of the full records compiled by various ASH staff who are directly involved in any patient's treatment, the patient (etc.) would be provided a reasonable opportunity to review a range of details underlying how ASH staff in general interpret the patient's needs, behaviors, and related status specific to their given diagnosis, as well as in terms of the patient's overall flow of treatment. 

But the fact is, ASH senior clinical staff do not want most patients to see these records, because that would also provide ASH patients with a much clearer idea of just how deceitful and/or unethical their primary care physicians are. By controlling, manipulating, and distorting such information in association with allegations about patient misconduct, when, in fact, the issue of staff misconduct is at stake, it is a plain fact that such senior ranking staff unethically violate the provisions of state and federal law in order to condone staff misconduct and therein further abuses of patients.

This article is an overview of the current standards applicable to this specific topic, and I am hopeful that it will be of use to anyone seeking these specifics in relation to their own treatment at ASH, or there treatment of their loved ones, and so on.

FACT

I know how critical this issue is in terms of any patients ability to exercise their right(s) to report potentially unlawful issues that arise in specific relation their flow of treatment at ASH, because I was personally subjected to this specific violation of my rights and related protections on more than one occasion. As follows, details about one of my experiences in this context.

During the summer months of 2011, I sought nurses notes from the Palo Verde east unit specific to my own treatment and related behavioral characteristics as a patient on that unit.I made this request as per protocol, in good faith as always, by submitting the required formwork by which I was to be provided assess to those records, as per my rights under the provisions of HIPAA.

I was compelled to make this request because my assigned primary physician at the time, Pervaiz Ahkter, had previously alleged that nursing staff on the Palo Verde east unit had documented a range of (my own supposed) "misbehavior”. I knew that any such notes, should they actually exist, were patently untrue, this simply on the basis of knowing myself and having distinct awareness of my overall interactions with nursing staff. The fact is, a number of Palo Verde nurses were in their own right willing to violate ASH’s own rules, and to abuse the rights and ignore the care needs of ASH patients; but on no one occasion did I violate my required responsibilities as an ASH patient when defending my rights in this or any context.

Ahkter was "citing" such records in order to threaten my status and associated privileges as an ASH patient; specifically, he subjected me with the threat of restricting me to Palo Verde east, therein threatening my ability to attend all/any off-unit therapeutic resources, and a range of other like resources not available on ASH’s various treatment unit. I effectively called him on his allegations by requesting access to those records.

But, with no justification whatsoever, and without providing any written explanation, Dr. Akhter subsequently denied my request.

Important to note that I was only assigned as one of  Akhter’s patients after my falling out with ASH's current Chief medical Officer, Laxman P. Patel, who was my first assigned primary care physician at ASH, and whose earliest response to my reporting of staff misconduct was (verbatim), “What do you expect? This is the state hospital.” Said “falling out”, did thus occur in on the basis of Patel's disagreement with my ongoing willingness to report ASH staff misconduct whenever I was aware of its occurrence. Patel’s attitude was a shining example of patterns of abject negligence  and associated administrative ineptitude that did in time become standard practice in terms of how I was mistreated and abused over the entirety of my time as an ASH patient. (For more information, please see my April 4, 2013 article, Fundamental Fact #2)

It is also important to understand that, in all truth, I accrued no valid history of engaging in any form of actual "misbehavior" during the entirety of my time at ASH (this is true but for one or two very specific occasions, each of which occurred under very unusual circumstances, and wherein this misbehavior was insignificant in terms of ASH’s general rules). I was, conversely speaking, assaulted by other ASH patients on no less then two occasions, patients who were literally encouraged to do so by ASH staff who shared Patel’s disagreement with my willingness to report staff misconduct. 

Similarly, at no point whatsoever in my eight months of psychiatric treatment while in Tucson areas hospitals prior to being committed to ASH, did I engage in any form of misconduct, a fact that my care providers in those specific hospitals are more then willing to verify. It was only at ASH that allegations of this nature arose. Putting me, the client-consumer-patient in danger of being identified as a perpetrator, when I was in fact, the victim.

I attest that it is common practice at ASH for senior clinical staff, including the attending Chief Medical Officer, to mischaracterize any patients' behavior in order to unlawfully manipulate the patients' flow of treatment, in order to suppress information about staff misconduct, and to maintain the status quo by which ASH administrators get away with operation the Hospital in violation of law and policy.  All of this, a gross abuse of their given authority that flies in the face of the public trust, the Hippocratic Oath, and other like precepts of established medical standards.

In this particular case, Pervaiz Akhter, attempted to intimidate me in this fashion in clear retaliation for my willingness to report staff misconduct. His going about this was far from exclusive during my varied experiences at ASH; and in short time, I garnfered clear awareness of the extent to which even ASH’s CEO and chief medical officer will retaliate against patients such as I, on the basis of my right to report staff misconduct.

All ASH patients are disabled under federal law, and retaliation of any kind on the basis of any consumer-patient’s exercising of the right to oppose any medical provider’s practices is prohibited by the provisions and protections specific to the Americans with Disabilities Act (Title 42 United States Code [1990]).

As stated, I contend that Patel’s goal was to intimidate me into submission and to stop reporting staff misconduct; or else, to use the untruthful claim of these nurses notes in order to restrict my access to day to day activities at ASH, including therapeutic sessions, recreational activities, and so on.

In either case, Ahkter's intent clearly violated a host of patient rights and protections. But I have no idea if he even has the capacity to realize  this. For just like ASH's current Chief Medical Officer, Laxman P. Patel, who is a native of India and who received his formal medical training there,  Dr. Pervaiz Akhter also came to the United States from one of the most horrifically out of control regions of the world today, Pakistan, a nation known as anything but a bastion of human rights and democratic values specific to human interaction. This, the face of ASH today. It really is that bad.   

The standards applicable to any patient's right to access their own health care records is well established today, and are very clearly defined, as such, by state and federal law in every part of the United States. Thus, anytime ASH staff choose to deny such access, they must adhere to very strict provisions of these laws, lest they be held accountable as per equally defined penalties, which are most significantly spelled out by applicable federal law and policy. Specifically, the Hospital Insurance Portability and Protection Act (HIPPA) covers any American citizen's rights in this context, and it's primary purpose is to ensure that hospitals and health providers don't engage in unlawful management of any individual's given needs. The HIPPA document itself was congressionally enacted due the critical nature of this subject, and as such, very clearly supersedes the authority of involved health care providers; as such, if and when health care providers fail to adhere to HIPPA or act in violation of the privileges and protections created to individuals receiving medical service, there are very serious consequences which are to be implemented by state and federal oversight. I attest to the fact that ASH's senior clinical staff, as well as ASH's administrators, unlawfully manipulate the presence of the HIPPA document as a matter of challenging patient requests to access their own ASH medical records, taking grossly unfair advantage, in effect, of most any patients' inability to refer to HIPPA, and related lack of awarenesses to their rights context. 

The HIPPA document is anything but short and to the point, and no person unfamiliar/uncomfortable with legal terminology found therein is going to have an easy time finding their way through the thing. This is partially true in the case of persons disabled by debilitating forms of mental illness. The one's running ASH flagrantly exploit this fundamental dynamic to the fullest extent possible, in graphic defiance of HIPPA itself, in sickening contradiction to the very purpose of HIPPA, and 100% out of line with established codes of decency in this specific context. The following is a statement that I recently submitted to one specific media outlet that I am currently working with, and is designed to give the investigative staff of that source an idea of the legal dynamics underlying this matter.

 As such, the following is fairly technical and not entirely well done (I comfortably admit to this possibility), but I hope that it is in some way useful to any person's interest in this matter as it stands today. 

NUTSHELL TO THE FOLLOWING: Patient access to their own records may only be restricted if the records are psychotherapy notes, or notes/information that LIKELY poses a clear threat of harm to anyone, be it the patient themselves, others, and so on. That's it, no exceptions. Your records are YOURS, and in no other circumstances may ASH staff restrict said access. The following outlines this, albeit in torturous legalese. 

I'VE UTILIZED A VERY BASIC APPROACH TO STRUCTURING THIS DOCUMENT, REFERRED TO AS THE "IRAC" METHOD, WHICH RELIES UPON NOTHING MORE COMPLEX THAN: ISSUE-RULE-ANALYSIS-CONCLUSION, AS FOLLOWS.

                   - IDENTIFY THE ISSUE AT STAKE.
                   - APPLY THE APPLICABLE RULE OF LAW.

                   - ANALYZE THIS APPLICABILITY

                   - CONCLUDE THE RESULT OF THIS ANALYZATION. 

ISSUE: Do patients have a right to access their own personal medical records from hospital staff, and if so, what are the terms of such access, including circumstances whereby hospital staff can lawfully restrict such access? In principle, one’s own medical records are a form of personal property, known in law as protected health information; as such, hospital patients and medical clients are generally granted full access to their personal protected health information and related treatment records, except for in a very narrow area of conditional exceptions (discussed below). This is fundamental to contemporary health care practice, and only would a corrupted body of medical profession and practice seek to deny such records from any individual receiving treatment therein. Thus, there is an established rule of law specific to this principle. 

RULE: Hospital Insurance Portability and Protection Act, 2006) CFR Title 45; subtitle $164.524 Access to protected health information.

(a) Standard: Access to protected health information.

(1) Right of access. Individuals request for access. 

    The covered entity must permit an individual access to inspect or to 
    obtain a copy of the protected health information about the individual 
    that is designated in a record set. Except as otherwise provided in 
    paragraph (a)(2) or (a)(3) of this section, an individual has a right of 
    access to inspect and obtain a copy of protected health information 
    about the individual in a designated record set, for as long as the 
    protected information is maintained in the designated record set, 
    except for:

   (i) Psychotherapy notes: (Psychotherapy notes means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, nurses’ observations and notes, symptoms, prognosis, and progress to date.) 

   (ii) Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.

(2) Unreviewable grounds for denial. A covered entity may deny an individual access to without providing the individual an opportunity for review, in 

      the following circumstances.

(i) The protected health information is excepted from the right of access by paragraph (a)(1) of this section.

(ii) A covered entity that is a correctional facility or a covered health care provider acting under the direction of the correctional facility may deny, in whole or in part, an inmate’s request to obtain a copy of protected health information, if obtaining such copy would jeopardize the health, safety, security, custody, or rehabilitation of the individual or of other inmates, or the safety of any officer, employee, or other person at the correctional facility or responsible for the transporting of the inmate..

(iii) An individuals access to protected health information created or obtained by a covered health care provider in the course of research that  includes treatment may be temporarily suspended for as long as the research is in progress, provided that the individual has agreed to the denial of access when consenting to participate in the research that includes treatment, and the covered health care provider has informed the individual  that the right of access will be reinstated upon completion of the research.

(iv) An individual’s access to protected health information that is contained in records that are subject to the Privacy Act, 5 USC 552a, may be denied, if the denial of access under the Privacy Act would meet the requirements of that law.

(v) An individual’s access may be denied if the protected health information was obtained from someone other than a health care provider  health under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.

  

(3) Reviewable grounds for denial.

    

(i) In cases where access is likely to endanger the life or physical safety of the individual or another person;

(ii) In cases where access is likely to cause substantial harm to such other person(s)

(iv) In cases where someone other than the individual has requested access and such access is determined to likely pose substantial harm to the individual or another person.

(4) Review of  a denial of access. If access is denied on a ground permitted (above) the individual has a right to have the denial reviewed by a licensed health care professional designated by the covered entity and who did not participate in the original denial.

   

(b) Implementation specifications: Requests for access and timely action.

______________________

My summary i-v: None of the above terms "(2)" apply at ASH outside of psychotherapy notes (which strictly apply as I have already defined above, with no exceptions), but do apply as follows, to: (ii) correctional facilities (ASH is not a correctional facility); (iii) research facilities ("" "" "" "" "" ""); (iv) Privacy Act 5 USC 552a (not applicable to hospital patients in public facilities); (v) outside information not compiled by the entity (not applicable to in-hospital records).

ANALYSIS: Individuals do in fact posses the implicit right to access all/any health care records specific to their treatment in entities covered by the terms of HIPPA. There are very limited exceptions to this right, and specific to ASH, the nature of psychotherapy notes very well may arise, depending on the specific circumstances (the nature of which is described above, limited to formal counseling sessions, etc.). 

Nurses' notes and other like compiled health care information does not fall under the specific exceptions provided by HIPPA. It is also of note that anytime a health care provider chooses to deny any individuals access to protected health care information, they must provide the individual with written explanation/justification for such a denial (this is also laid out in HIPPA, but I did not include such details at this time as a matter of expedience.) Likewise, at ASH, there may be cases where an individuals access to their own health care records might pose danger to their own safety or the safety of others, but as described above in the HIPPA document itself, denials on this basis must adhere to strict consideration wherein it's determined that the access will likely pose such danger in this context. 

CONCLUSION: I attest to the fact that my request to access nurses's notes was reasonably based upon my need and simple desire to review information specific to my behavior at ASH, information by which I could reasonably obtain an understanding of what I could do in order to correct my behavior should my behavior in fact be inappropriate, as per established rules and policy. I was well familiar with ASH’s general rules from day one of time there, and I did ask Laxman Patel to detail whatever my alleged misbehavior was in (his claim about) these nurses notes, but he refused to provide me with any firm idea of just what misbehavior I had supposedly engaged in. Had there been any legitimate trust to his claim, there was nothing stopping him from providing me with that information. I recognized this for what it was, and as I said. 

The information in question- nurses’ notes- had nothing at all to do with accrued psychotherapy notes, and posed no form of danger whatsoever, either to myself or anybody else, had I been provided with that information. This, 100% based on my known behavioral characteristics and the absolute absence in my personal history of any nature of violent behavior under any circumstances (including when I was assaulted by other patients at ASH).

Thus and herein, neither Akhter nor any other member of staff at ASH- including and particularly ASH administrators-  had any right or justification to deny me access to my protected health care information in question in this case. I contend that this action was a patent violation of my rights under HIPAA, and that by alleging this, Akhter was willfully engaging in a form of retaliation on the basis of my known reporting of staff misconduct, which is a violation of my protections and rights under the ADA.

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The plain fact of the matter is that I was aware of my right to access these records, and I went so far as to share my awareness of this fact with Akhter at that very time when he cited nurses notes in direct relation to my alleged misbehavior (as I have already described). Akhter responded by stating: "I  am not going to provide you with those notes because I do not want you to nitpick about the conduct of staff”, which represented an overt reference to how Laxman Patel had previously, insultingly characterized my legitimate and good faith reports about staff misconduct and associated abuses of patient rights.  This was Akhter’s sole justification for this denial, and I was never provided with any form of written explanation, despite my express request for such.  As such, I can again clarify with certainty that the denial of my right to access these records by my primary doctor at ASH (Ahkter) was in clear violation of HIPPA.

In spite of the fact that immediately filed a grievance report to the ASH patient advocate, Sonya Serda, there was no lawfully required response to the concerns included in that document; and later, when I shared the details of this issue with representatives of the ADHS Office of Greivances and Appeals, they too rejected the merits of my concerns, and as such, engaged in furthering the violations specific to this matter as it stood at the time. I of course have all records of the history of this process as it played out in 2011, while I was at ASH. Whether this pattern of denials stems from ignorance, or outright and willful abuses of authority and associated negligence, I cannot say today. One way or the other, it is all- all of it- textbook ineptitude, at best, and has no place in the operation of a facility such as ASH.

All standard practice. This is how it goes at ASH. And we should expect it as such, right? After all, this is the state hospital. 

IN CLOSING: I have already stated my knowledge specific to the willingness of senior clinical staff at The Arizona State Hospital to unlawfully manipulate the Hospital Insurance Portability and Protection Act as a matter of challenging patient requests to access their own ASH medical records, taking grossly unfair advantage, in effect, of most any patients' inability to refer to HIPPA, and related lack of awarenesses to their rights context. It is also critical to realize that the administrators at ASH similarly distort the intent and application of HIPPA in order to engage in gross violations of the public trust. 

These distortions of federal law and policy extend into the realm of ASH administrators who willfully hide behind HIPAA in order to deny the greater public any awareness of administrative abuses of authority in such state managed facilities. This issue was clearly illustrated by ASH supervisor Cory "crazycorycorner" Nelson's repeated denials of his direct involvement in the tragic murder of April Mott in late August, 2011; denials that Nelson made in relation to various media inquiries specific to why ASH allegedly could not publicize escaped ASH patient Jesus Rincon Murietta's presence in the greater Phoenix metropolitan area, this in spite of the fact that Murietta had very clear and recent history of graphically violent behavior, including the very manner in which he escaped ASH. (For more information, please see yesterday’s (January 21, 2018) article in this publication, entitled “The Role Of Hospital Chief Executive Officers In Perpetuating Wrongdoing.”; and/or “Cory Nelson’s Ongoing Lies.” April 10, 2013)

As such, Nelson is hiding behind the HIPPA document in order to cloak the factual causes underlying Ms. Mott's untimely death, and I contend that his conduct in this case is prosecutable under federal law. At a minimum, it is just as atrociously in contradiction to the intent and design of HIPPA as one might possibly come upon in today's societal affairs, to the degree that an innocent young woman was tragically murdered. Goes without saying, that this is unacceptable in all senses.    

There is no reason for any of you, my readers, to hold back on doing whatever you can to defend the rights of Arizona's most seriously mentally ill citizens. The patient abuse in the The Arizona State Hospital is ongoing, and the complicity of the Hospitals' highest ranking administrators and senior clinicians has yet to be meaningfully addressed. ASH is the sole long term public mental health facility to the state of Arizona, and it is operating at a level of substandard mental-medical care and practice, and they are getting away away with it, lock-stock-and barrel. This is unacceptable. Patient abuse is sickening to the conscience of any reasonable moral human being, and the abuse of Arizona's most vulnerable adults at ASH needs to stop. PLEASE SEE MY "RESOURCE IDEAS" ARTICLE AND DETERMINE HOW YOU CAN BEST DEFEND THE RIGHTS AND CARE NEEDS OF THE PATIENTS AT ASH.

DATELINE 2018: Again the issue of having individuals in positions of entrusted authority at Arizona State Hospital with as much if not more experience in the prison system then in actual hospitals has come into the light. As much as CEO Aaron Bowen may not like it, ASH is a hospital, in fact, not a corrections facility. The patients at ASH are consumer-clients of the Arizona Department of Health Services, and not inmates. And on this basis, laws come onto play that are not specific to prisoners (or merely the Eighth Amendment of the U.S. Bill of Rights), but rather to disabled Americans who happen to be hospitalized in covered entity facilities such as ASH. All ASH patients possess the full rights provided to them via the United States Constitution, and are protected by the tenets of the Bill of Rights. These bright line aspects of patient rights are seemingly unapparent to Bowen, obstesibly due to is ignorance which I contend has to do with his background in corrections. For now, that is.

It’s anything but a surprise.  Cory Nelson also came out of the corrections industry, for example. (And look where it got him.)  

If Bowen and Cara Christ could only grasp the fact that ASH patients possess more vested interest then anybody else in the quality of care there; and that the patients, as such, are the chief stakeholders when considerations of the operation of ASH arise. This fact underlies why a former patient such as myself can play so significant a role in shedding light on the actual realities in these facilities. It is not so much that I’ve a legal background, or that I am a good writer, per se’. And is not due to the claim by some state mental health professionals in recent months that I am not, in fact, so affected and disabled in my own right; for I am so affected, but nonetheless possess attributes and strengths that have allowed me to make a difference in relation to these issues. 

I am not unique, either. There are countless individuals in American today who are capable of doing amazing things, despite (?) being affected by serious mental illness. By discriminating against me even in this way, by characterizing my behavior and struggles as anything less then truthful, all these Rat Bastards are really doing, is trying to further the historically recognized social pitfalls that persons such as I face, even this day in age. Stigma, most specifically, wherein many people today still feel that no person capable of markedly good work could be mentally ill; and conversely, that no person committed to a place like ASH could ever possess the character necessary to stand up against the disproportionate forms of power so commonly exhibited and exploited by state managed mental hospital employees. 

Pervais Akhter is a case in point, having stated to me in 2011, not long after taking my care over from from Patel: “Who do you think you are? You are just another patient here.”

If only they could grasp these factors, these highly entrusted public servants, and take good faith advantage of related information, by utilizing the concerns of Hospital patients in order to make a difference; and when it comes to ASH, in fact, in order to deter repeated arisals of obviously recent history. What they could do, oh what they could do, to help throw a stick in the spokes of continued abuses of vulnerable persons. To help diminish  stigma, and to raise public awareness about how much potential for good many if not most mentally ill people possess. To embrace, in other words, the roles of hospital patients in these circumstances, versus to oppose those roles. And so on. 

But they apparently cannot, seemingly do not want to; and would rather, it only follows, let the proverbial shit hit the fan yet again. 

Herein, my dedication to fighting these issues is, rather, the result of experiencing overt and abject representations of egregious abuses of human rights, exhibitions of depraved mistreatment of vulnerable adults; and it is my given sense of civic duty. In every single grievance document that I’ve ever produced and submitted to Hospital staff, I have asked for nothing more then reasonable response and related attention to possible issues of valid concern; as such, only asking such staff to do their jobs (for crying out loud). And I have pointedly asked persons such as Bowen and Christ to merely “do the right thing” in virtually every article I’ve written about these matters, believing and in fact knowing as I do that all it takes is exercise of humane action. In graphic defiance of my civil approaches to communicating with these people, I have only encountered text book exhibitions of rejection and unconcealed resentment. 

I cannot stand by and allow for this shit to happen. Bottom line. They have always ample opportunity to make a difference(s) in their own right. The failure to do so is on them, and their reputations are theirs’ to preserve, or not. I really care less at this point. 

On the past Thursday, January 18, 2018, meeting of the ASH Human Rights Committee, an attorney presented the provisions of the Hospital Information Portability and Protection Act (HIPAA), and provided a range of details specific to how any patient’s medical records shall be managed by medical providers such as Arizona State Hospital. In part, and in direct response to one community members inquiry in context, the attorney clarified the fact that any such medical provider, defined in HIPAA as a covered entity (which ASH is), shall provide protected health information to any patient seeking that information. And as I included in the above 2013 article, the exceptions by which ASH can deny such requests are very limited to psycho-therapy notes, or in circumstances where clear and present risk of harm may arise. 

Retaliation at ASH, and in other state managed mental hospitals, is prevalent even this day in age. I have witnessed and been subjected to it more then once, in more then one state managed hospital facility. In all such cases, those actions arose in direct relation to my good faith willingness and associated right to report any form of violations of law and policy that I recognize as posing harm to the wellbeing of myself and my patient-peers in such facilities. One Dr. Colby Wang, a since-fired member of the psychiatric staff in Montana’s state hospital, tried to pull that shit on me not too terribly long ago. He did so with the complicity of Hospital administrators; and in fact, that of a licensed attorney named Craig Fitch who works on-site at that facility, declaring himself “the patient’s lawyer” while also engaging in the same sort of deceitful misconduct that ASH’s former legal counsel did, Joel Rudd. 

I have also observed time an again the willful effort of facility administrators and their counterparts in health departments to unlawfully exploit the presence of HIPAA. This occurred as recently as the December meeting of the ASH Human Rights Committee, when CEO Dr. Aaron Bowen sought to berate committee members in relation to the HIPAA document. This exploitation of HIPAA is irrefutably based on the wish of such entrusted health care officials to maintain the status quo by which substandard care practices and conditions are allowed to exist in state managed mental hospitals.  But as we know with ASH in mind, there have been no less then five direct federal interventions brought about due to identified violations of state and federal law in the last twenty years, interventions including decertification and delicensure, and the firings of a number of individuals directly associated with the operation of ASH in that time frame. 

Not coincidentally, Montana State Hospital has been under federal sanction for over twelve full months at this time. Go figure. As these features to my experiences and advocacy prove, there is no just cause to believe that any of my allegations in this context are in any way untrue. They never have been found as untrue, have been repeatedly confirmed as fact via the role of federal investigators in addressing these matters, and by other media sources outside of this publication who have contributed to related exposures, some of whom I still collaborate with today.

More later.  

paoloreed@gmail.com