RE: Dr. Cara Christ. Dr. Aaron Bowen. Deceivers of Truth.

                                                       "Things are much better now."
                                                      Dr. Cara Christ
                                                    Current Director
                                                 Arizona Department
                                                  of Health Services,
                                                      2015-present.

"This is the state hospital. What do you expect?"

Dr. Laxman Patel

Late January, 2011.

INTRODUCTION: One patient is stabbed by another patient with so violent a known history that he should have been closely monitored at all times. All aspects of this incident are part of the documented record on the date it occurs. Subsequently, ASH administrators in direct complicity with ADHS officials omit that record from an annual report about the conditions, care practices, and general operation of ASH. 

As stated in yesterday's article "The Arizona State Hospital's ANNUAL REPORT FISCAL YEAR 2017. Of Ongoing Mistruths in the Official Record and Complicity Between Hospital Administrators and State Employed Officials In Furthering Corruption In Arizona's Public Health Care System.", we now have emerging documented evidence to the effect that the administrators of Arizona State Hospital (ASH) are engaging in shrouding the truth specific to patient safety (or lack thereof) and associated record keeping in terms of patient on patient violence. And they are doing so in complicity with the director of the state's public health care agency.

As per law and policy, this 2017 report was produced by the Director of Arizona Department of Health Services (ADHS), Dr. Cara Christ, in direct cooperation with the Chief Executive Officer at ASH, Dr. Aaron Bowen.

THE FULL 2017 ASH FISCAL REPORT IS PUBLIC RECORD. YOU CAN FIND IT AT:

www.azhds.gov/documents/director/agency-reports/ash/2017-ash-annual-report.pdf

PAGE EIGHTEEN AND THE SECTION "PATIENT ON PATIENT ASSAULTS" IS WHERE ONE CAN VIEW THE FACT THAT THE OCTOBER 03, 2017, STABBING OF AN ASH PATIENT WAS OMITTED FROM THE REPORT ITSELF. 

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FACT: 

On October 03, 2017, patient A.W. at Arizona State Hospital (ASH) was viciously stabbed six times by another patient. The aggressor in this matter has a known record of very violent behavior, enough so that he was to be closely observed at all points in time when not in seclusion. In recent history, formal petitions had been filed to ensure that this individual was even more closely monitored. But despite these varied facts, this individual had opportunity to not only acquire a weapon, but also to viciously attack one of his patient-peers, nearly killing him.

Had patient A.W. died, in fact, this would stack up to just one more preventable death caused in part by the ineptitude and criminally negligent misconduct of some ASH staff, who are "guided" by the authority of ASH administrators, including but not limited to long time Chief Medical Officer Dr. Steven Dingle and Chief Executive Officer Dr. Aaron Bowen.

Incidents of this magnitude occur due to insufficiencies specific to available staff, which in itself is one form of administrative-medical negligence. Such shortages in staff put both patients and staff alike at grave risk of possible harm. Some staff, that is, as in only those who work in direct proximity to patients, namely staff technicians and nurses. While Hospital administrators spend there time in off-limit office areas that patients have no access to. As such, administrators and their immediate counterparts- psychiatric staff- bear little to none of the risk that lower ranking staff have to contend with on a day-in day-out, 24/7 basis. This is the core reason for why staff shortages in these facilities are the norm, the simple fact that the issue poses risk to all but the ones most responsible for ensuring that staff meet the required numbers, as per federal law. Abject disregard for the safety of patients and direct care staff.

And as much as many folks today still believe that mental hospitals are inherently dangerous, akin to corrections facilities (prisons and jails), I contend that in contemporary terms, in direct relation to the simple fact that we are talking about hospitals, it is highly irresponsible for state employed officials to further the myth that mentally ill persons across the board are inherently dangerous. Likewise, such hospitals require a sufficient number of security staff and other like resources that can maintain reasonable safety with reference to patients known to be dangerous to others. 

It is ridiculous, as well, for anyone to claim that it's reasonable to expect that state mental managed health facilities inherently have abusive staff, as Dr. Laxman Patel put it to me early on in my time as an ASH patient (2011-12): "This is the state hospital. What do you expect?", when I chose to report to him the fact that some staff were regularly engaged in verbally and psychologically abusing certain members of my patient-peers (more vulnerable to abuse type patients). 

FACT:

As also discussed yesterday, the 2017 Annual Fiscal Report specific to the operation of has a section (found on page 18 of that report) required to provide factual data specific to patient on patient assaults. This data is critical to the Hospital's ability to provide a reasonably safe environment, by specifically identifying all such incidents regardless of the severity of these assaults. In the sub-section October 2017, that period of time when the attempt to murder patient A.W. occurred (I feel that when someone opts to stab you six times, chances are good it is their intent is to kill you), Bowen and Christ willfully chose to omit this incident from the record. In criminal law and procedure, such lying by omission is lying, bottom line. The staff of PJ Reed The Arizona State Hospital and Patient Abuse would welcome either these people to challenge this standard of law, but as per history of ASH and ADHS, we know that they won't.

What we also know is that directly due to the willingness of these highly entrusted state employees to manipulate or otherwise alter the facts that are to be included in this Fiscal Report, any number of other aspects of the data contained in the Report may well be flawed, And what we also know from the still recent history of ASH, such administrators and officials engage in this nature of mis-truthing as an unlawful means to avoid due oversight and accountability.

More specifically speaking, circa 2013-14, former ASH CEO Cory Nelson allegedly destroyed some proportion of ASH's  public  records (this allegation was made by one of his staff when interviewed during a federal investigation of ASH), records that had been lawfully requested for review by the Phoenix area ABC news affiliate, KNVX Ch15. What's even more disturbing is that ADHS's then Director, Will Humble subsequently promoted Nelson to a higher position in the ADHS construct. I recall this period of time well, and feeling that it was although Nelson was rewarded for his known lack of character.

Cory Nelson
Former since-fired
Deputy Director, Arizona Department
of Behavioral Health Services.

Cory Nelson, of course, was summarily fired in early 2015, along with his previous underling at ASH, Donna Noriega, a ADHS staff attorney, Jeff Bloomberg, and a handful of other entrusted state employees working at ASH and for ADHS. While Humble hastily resigned his position in the weeks immediately preceding these firings.

Still today, this is how it goes at ADHS, and at ASH, as well. Patent lying and willful deception designed to maintain the sub-standard conditions and care practices at ASH. These patterns exist as well in the ADHS Office of Grievances and Appeals (OGA), which is required to ethically manage the process of investigation specific to patient generated reports about the issues needing attention at ASH. 

I attest to the fact that in terms of grievance filings that I provided this office, staff at OGA routinely failed to abide by a range of terms included in Arizona's administrative law; time line requirements, for example, which are designed to provide consumers of ADHS various services (including the patient-consumers at ASH) timely response(s) to such reports. This practice was obviously oriented towards the hope that ASH patients such as I would let these reports go, on the basis of overtly inept bureaucratic misconduct.

This failure of state employed health department officials to acknowledge the significance of patient generated grievances is another form of administrative-medical negligence, and has direct relation to the cover up of the attack on patient A.W. No matter how critical the nature of such grievances are, Hospital administrators and their supervisory staff in the Department regularly participate in suppressing all elements of the issues most at stake, including patient safety, criminal abuses of patients by staff, medical ineptitude displayed by ASH psychiatrists, and on the list can go. And no matter how serious the nature of certain incidents of violence are, these same state employees willfully do whatever they have to in order to keep such incidents secreted away and out of the public eye.

It's that bad. I could not make it up- any of it- even if I had to.

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IN CLOSING: I have been interviewed by more then one interested party in recent days, persons with some nature of vested interest in addressing the ongoing substandard conditions and care practices at ASH. This is far from the first time, and I have always been happy to do so. I do so in the interest of the patient community at ASH, at least some of whom are personal friends from my time there. 

If only Cara Christ was capable of sharing this dynamic in her given attitude about the patient community at ASH. When she took over the helm of ADHS in spring 2015, I immediately contacted her, and encouraged her to keep a close eye on the realities at ASH. Several months later, after she had appointed Dr. Aaron Bowen as CEO at ASH, Christ contacted me, and stated in an email "Things at ASH are much better now." At the time I was willing to believe her, and I was willing to stand in support of her presence in context. A position I maintained for many months, as a matter of good faith respect. 

The Author, 2012.

I know better now. It's 2012 all over again. For it is readily apparent the Christ is taking the same risks that her predecessor took circa 2014, with no regard for the implications as they apply to the welfare of ASH patients. And it is too late for her and her brood of incompetents to presume I will not do whatever I have to see that they are all held accountable. I have contacts in the federal government from back in the proverbial day when I first took on the issue of seeing that ASH patients be provided reasonably optimal care and treatment. I am still in touch with David Biscobing, and at least one newer contact in Arizona media. And I am as well prepared as I have even been in terms of doing good work in my own right, in context. We warned them....

MORE LATER. AS ALWAYS.

paoloreed@gmail.com

The Arizona State Hospital's ANNUAL REPORT FISCAL YEAR 2017. Of Ongoing Mistruths in the Official Record and Complicity Between Hospital Adminsistrators and State Employed Officials In Furthering Corruption In Arizona's Public Health Care System.

All to the direct detriment of patients at Arizona State Hospital. 

Dr. Cara Christ
Current Director
Arizona Department
of Health Services.

INTRODUCTION: 100% consistent with the corruption identified circa 2013-2015, we now have emerging documented evidence to the effect that the administrators of Arizona State Hospital (ASH) are engaging in shrouding the truth specific to patient safety (or lack thereof) and associated record keeping in terms of patient on patient violence. Such violence most often occurs in state managed mental hospitals due to staff shortages, wherein individuals known to be violent have opportunity to attack and gravely harm non-violent patients; while the goal of administrators in issuing untruthful information in context has everything to do with avoiding due oversight and accountability. This form of corruption in medical terms amounts to patent negligence and outright operational malpractice.

As with all such matters, the 2017 ASH Annual Fiscal Report is required to provide factual information specific to a wide range of operational conditions and related care practices at ASH. Included as such, this information is required to provide data about patient on patient assaults. But as shown in the following, ASH administrators, in patent complicity with state employed health department officials (including the departments [ADHS] current director, Dr. Cara Christ), are willfully engaged in omitting factual data about otherwise documented patient on patient violence, in violation of law and policy.

It should be noted at the outset that ASH receives overall direction from the Chief Executive Officer, Dr. Aaron Bowen, who reports to the Director of ADHS, Dr. Cara Christ. On this basis, there should be no disconnect between Bowen's knowledge base about the internal affairs at ASH and the awareness of those affairs of Christ. But just as former since-fled ADHS Director Will Humble chose to praise the overtly corrupt ASH administrators circa 2013-2015- namely since-fired ASH CEO Donna Noriega and then Deputy Director of the state's Department of Behavioral Health Services, Cory Nelson, right up until their proverbial deaths as employees of ADHS- we are today witnessing the same degree of complicity, administrative negligence, and utter denial of corruption at ASH in relation to Christ's role at the helm of ADHS.

The ASH CEO, meanwhile, directs the various "leaders" of ASH, who comprise the Executive Management Team (EMT). The Executive Management Team oversees hospital operations, establishes administrative policies and procedures and directs ASH planning activities. Each one of these individuals are responsible for the care needs and treatment of ASH's patient community, and as such, are further required to provide factual, evidence based information specific to the general operation of ASH. 

This very necessarily includes all information reflected in ASH's 2017 Annual fiscal Report.

The members of EMT as follows: 

 Aaron Bowen, Psy.D., Chief Executive Officer 
 Steven Dingle, M.S, M.D., Chief Medical Officer 
 Michael Sheldon, M.P.A, Chief Operating Officer 
 Debra Taylor, M.S.N., R.N., Chief Nursing Officer 
 Lisa Wynn, B.S., Chief Quality Officer 
 Margaret McLaughlin, M.S., Chief Compliance Officer 
 Shanda Payne, L.M.S.W, ACPTC Director 
 Levada Coker, C.P.M., Human Resources Assistant Chief 
 William Bugbee, Chief Security Officer 
 Justin Lepley, C.P.M., M.B.A., Chief Financial Officer 
 Carol Hasper, B.S.B.A., P.M.P., Senior Project Manager/IT Services


And now, from the annual report itself, page 18 (eighteen):

Patient on Patient Assault, 
October, 2017: 0 (zero)

Shame, shame, shame. Lies, lies, lies. 

The plain fact is that, on October 03, 2017, patient A.W. was stabbed six times by patient R.M. This incident is obviously of critical nature. Patient A.W.'s very life was in grave condition following this attack, and only surgery that A.W. underwent later on the same day saved him.

Each and every Hospital employee listed above is fully aware of the truth in this matter, and as such, are overtly complicit in misleading the public in order to avoid due oversight and accountability in relation to just how and why this near tragedy occurred. Patient A.W. is deserving of the same level of safety that ASH staff possess. If it was a staff person who got stabbed, patient R.M. would be subject to criminal charges, and there is no way in hell that the record would be hidden. But due to A.W. being affected by mental illness, and reliant on the shortsighted and discriminative conduct of ASH doctors and administrators, this incident has been covered up. It's that simple, it is that plain.

For the administrators of ASH to lie about this matter is unconscionable to the Nth degree. Knowing as they do that one of the patient-consumers at ASH was nearly killed due to negligence and associated administrative incompetence, and to then lie about it in terms of this fiscal report, which is designed in part to provide the public- including patient families who have a reasonable expectation in terms of the care needs and safety of their kin- with clear awareness of the quality of care at ASH adds up to criminal misconduct.  

This also calls into question the overall data included in this report. Given the mentality "What happens at ASH stays at ASH", which is overwhelmingly evidenced yet again by this specific issue, there is no way for we the public to know just what is really going on there. I can attest via my experiences at ASH in 2011-12 that this precisely how Hospital administrators such as but not limited to Chief Medical Officer Dr. Steven Dingle want it to be. Ideally in their twisted minds so as to get away with abusing or otherwise violating the rights of the patient community as a whole.

Pending, thus, requests under the Public Information Act for all related Hospital records specific to violence, and other like issues that I fell safe in assuming these people are seeking to hide from the public. This has occurred at numerous points in time over the last few years. Notably, ASH and ADHS were sued on the basis of the Hospital's administrators refusal to release such records when Phoenix's ABC news affiliate, KVNX Ch15, sought to investigate this exact same nature of corruption. 

Be interesting to see if things go any differently today. They didn't get away with it then, and they won't at this time. I promise this.  

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Bottom Line. These people are furthering the long standing corruption at ASH, in defiance of the term "Psychiatric Excellence" and the assurance of  Dr. Cara Christ that ADHS and the Arizona State Hospital is committed to the following:

 ADHS' Vision: Health and Wellness for all Arizonans 
 Mission: To promote, protect, and improve the health and wellness of individuals and communities in Arizona. 

The Arizona State Hospital has the following Vision and Mission Statements:  Vision: Quality, Compassion, and Excellence in the Provision of Psychiatric Care. 
 Mission: Provide evidence-based, recovery-oriented, and trauma-informed care to the individuals receiving care at Arizona State Hospital in order to facilitate their successful transition to the least restrictive alternative possible. 

BULLSHIT!

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IN CLOSING: Take a close look at several of the liars who were involved in the known corruption at ASH prior to the last scandal there. These people are, in my mind, sociopathic in their willingness to put persons disabled by mental illness at grave risk of harm. It is in their eyes, in my opinion, the dark sided aspect of their criminal nature. Absolutely Machiavellian, after birth of Beezlebub, bottom feeding bureaucrats with no understanding of what it means to be ethical. 

Will Humble
Former ADHS Director
2009-2015

Cory Nelson
Former since-fired
ASH CEO,
Deputy Director
ADHS Behavioral
Health Services.
2012-2015

Donna Noriega
Former since-fired
ASH CEO.
2013-2015.

And I can not in sincerity believe that persons such as current ASH CEO Dr. Aaron Bowen, the Hospital's Chief of Security William Bugbee, or any other member of ASH's Executive Management Team are of better character then these former employees of ASH and ADHS. This issue is shocking, stomach turning, and most definitely deserving of federal oversight at the soonest possible time.  

Sucks. For the patients, who are deserving of optimum health care and treatment as consumers of ADHS so called services. 

And for the Rat Bastards who are deserving of going down just like each and every other such villain I have identified over the years in this blog publication. Whatever comes your way, you all have it coming.

And don't say we haven't warned you for the last three years. 

paoloreed@gmail.com  

Dr. Cara Christ. Please.... While you still can.

Dr. Cara Christ
Current Director
Arizona Dept. of Health Services
("current")

Out of basic respect, and in the interest of tact and diplomacy, I am willing to ask one more time for the director of Arizona's public health system (ADHS) to simply do the right thing. It is her job, her responsibility, and entirely consistent with ethics, so there should be no need for a citizen-consumer to make such a suggestion. And yet, there it is. That said, I will leave it to her to go about taking action while she still can. 

Before things go sideways. Based on a range of new information provided to the staff of PJ Reed The Arizona State Hospital and Patient Abuse, it looks as though a relative storm of attention is about to hit the operation of Arizona State Hospital (ASH). I am not making this up. I mean it. 

Since day one, from the time I filed my first grievance as a patient at ASH away back in spring 2011, my intent has been good faith, non-conflict based, and 100% out of concern for the welfare of the ASH patient community, as well as any staff there not involved in the crap that we all know has gotten ASH into serious trouble with the federal government no less then four times in the last couple of decades. 

Historically, this approach has made no difference whatsoever to the ones who repeatedly rejected the merits of my various grievance filings in my thirteen months as an ASH patient. Indeed, rather then take the safest route available to them with respect for not going down the wormhole, ASH administrators and their immediate supervisors etc. in ADHS chose to risk their jobs, face the possibility of criminal prosecution, litigation, and on that list goes. 

All to the direct detriment of the patient community, as a matter of standard practice.  

Not a whole lot more to say right now; I would hope my point is clear.

MORE LATER. AS ALWAYS. 

paoloreed@gmail.com   

Evidence to the effect of Montana State Hospital's inability to get their shit together. Just like Arizona State Hospital. Literally.

INTRODUCTION. In late 2013, and again in 2014, the Federal Centers for Medicare and Medicaid Services (CMS) completed several lengthy and in-depth investigations of the Arizona State Hospital (ASH), Phoenix, AZ. The subsequent CMS report(s) determined that ASH was operating in violation of a wide range of federally mandated regulations by which ASH is licensed to operate, including the facility's failure to maintain required patient to staff quotients (ratio). Consequently, CMS issued a "Notice of Jeopardy" wherein ASH's license to operate was at risk of being terminated. As per standard protocol, CMS granted the Hospital to get it's shit together within and allotted time period. At the conclusion of that time period, in early 2014 CMS determined that this had not occurred, leading to more direct federal oversight that did lead to the summary firing of no less then seven individuals directly directly associated with the operation of ASH, including the Hospital's CEO, the Department of Health/Behavioral Health Services' Deputy Director, one state employed attorney, and several lower ranking staff at ASH itself.   

In recent articles, the staff of PJ Reed The Arizona State Hospital and Patient Abuse and Montana State Hospital. Montana's Forgotten Suicides have described the fact that in fall 2016, CMS was notified that the Montana State Hospital (MSH) was failing to maintain required patient to staff quotients (ratio). Just like ASH in 2013-14. And just like ASH, MSH is still today failing to get its shit together. 

Below are several mainstream press articles specific to MSH history in context, circa January 2017 to the present. 

It should be noted that reporter Holly Nichols interviewed me at MSH in December, 2017, and again in late January, 2017, following which she published the first of a series of articles about these issues. While in 2013, an investigative reporter named David Biscobing of the Phoenix area ABC news affiliate, KNVX/Ch15, contacted me through this blog publication with a request to collaborate in order for him to initiate his own formal investigation of ASH. 

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State Psychiatric Hospital Changes Policies After Lockdown

Associated Press. May 31, 2018.

The Montana State Hospital has changed some policies and plans to increase staffing and improve training after a unit of the psychiatric hospital was locked down in November due to a lack of staffing and two patients were unnecessarily held in seclusion.

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Warm Springs Assaults blamed on chronic, 

pervasive staff shortages. 

HOLLY NICHOLS. Lee Newspapers. March 08, 2017

A recently recently released federal inspection details why the Montana State Hospital at Warm Springs, which is home to civilly and criminally committed patients with mental illness, was at risk of losing its federal certification for twelve days in January. Documents from the Federal Centers for Medicare and Medicaid, which certifies parts of the hospital, say "chronic, pervasive staff shortages" led to the attacks. 

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Feds find state hospital put patients at risk,
almost terminated agreement.

HOLLY NICHOLS. Lee Newspapers January 27, 2017.

HELENA – Montana State Hospital, the state’s publicly run psychiatric facility, was set to lose its federal agreement in February because of what’s called an “immediate jeopardy,” a situation where the hospital’s noncompliance with federal regulations was considered serious enough to risk death or serious injury to a resident.

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IN CLOSING: Collaboration between mainstream and independently produced media is an increasingly common feature to investigative journalism today. The advent of the internet, the emergence of blog formats (including blogspot.com), and the realization that independent investigations of issues critical to the public interest are useful to mainstream media outlets, are granting the public a much firmer understanding of exactly what goes on in shadowed corners that, for the most part, have historically been out of sight, out of mind. This most definitely applies to state managed mental hospitals such as ASH and MSH.

On countless occasions in the history of this publication, I have stated that it was never my intent to become a central source of information about the realities in state hospitals. This is still the case. When I showed up at MSH in spring, 2015, I had no predisposition to the effect that I would run into the same degree of shortsightedness that ASH is so well known for (and that's putting it nicely). Likewise, I had no desire to fall into the same level of dedication about the affairs of the MSH patient community that I was compelled to engage in on behalf of my former patient-peers at ASH.

But there you go, right? Different meadow, same cow pies. 

paoloreed@gmail.com

Of Current Thugs on Security Staff at The Arizona State Hospital.

James Roger Forney
Twice convicted
sexual child predator,
former ASH security guard,
now in prison.

DATELINE JULY 04, 2018:

William Bugbee, Randy Lewis. You are not above being criminally charged. You are common thugs, not legitimate law enforcement officers, and in my book, dirt. Dirt. Little different from Forney, other  then still getting away with your shit.

Fair warning. Once, and once only. 

paoloreed@gmail.com

How It's Done II. RE: Bringing about oversight and accountability when state managed mental hospitals are being mismanaged and in violation of licensure, federal and state law and policy.

THE LETTER

RECAP OF THE JULY 02, 2018 ARTICLE: 

As discussed, when I was hospitalized at the Montana State Hospital (MSH) in late spring, 2015, I filed several good faith grievances about a rogue staff psychiatrist named Dr. Colby Wang, on the basis of his abusive use of language, his threat to keep me hospitalized there at his leisure regardless of my state of health, and other such features to his behavior and conduct.

Upon being readmitted to MSH for the 2nd time in late August, 2016, Wang willfully, directly and personally interfered with my admission in direct response to the grievances that I had filed in 2015, which I deduced  to be retaliative in nature. Retaliation of any kind is patently forbidden by my protections specific to the Americans With Disabilities Act. I thus filed a grievance about the issue immediately after this act was imposed upon me. 

In subsequent weeks, MSH administrators refused to acknowledge my grievance as having any merit. This refusal was shared by the Hospital's own in-house "patient's lawyer", Craig Fitch.

(Colby Wang was summarily fired in early October, 2016)

I thus took it upon myself to take close note of any issues occurring at MSH that I felt to be wrongful, unlawful, or otherwise harmful to the wellbeing of the MSH patient community; and went so far, in fact, as to give Fitch fair warning as to this intent.

In October, 2016, during my second month of being readmitted to MSH, it became readily apparent to me that the Hospital was experiencing graphic staff shortages, an issue that I knew to be in violation of the federal standards that all such state mental hospitals are required to adhere to, and which I also knew posed grave risk of harm to patients and staff alike.

I initially suggested to my patient-peers on the MSH Resident Advisory Committee (RAC) that we as a group submit a report of this issue to the governor of Montana. During the RAC meeting where I brought this up, an administrative staff person wrongfully interfered (RAC is supposed to function with no direct intrusion of MSH staff) with this suggeston and insisted that we take the issue to the Hospital CEO, Jay Pottenger.

Jay Pottenger

Chief Executive Officer
Montana State Hospital
2016-present.

At a subsequent RAC meeting, Pottenger refused to acknowledge the significance of this issue, effectively declaring that the matter was out of his control.

I was thus compelled to send a personal reporting of the matter to Montana Senators Ron Lehi (R-Hamilton) and Debbie Barrett (R-Dillon). I did so in a handwritten two page letter, shown below. 

In late November, 2016, not long before my pending discharge, the federal Centers for Medicare and Medicaid Services (CMS)- which licenses the operation of MSH- initiated a drawn out formal investigation of all aspects of the MSH operation. This investigation culminated in a final report that identified over one hundred eleven (111) violations of the standards by which MSH is licensed.

After giving MSH administrators a period of time to correct these concerns, CMS was forced to issue a Notice of Jeopardy on the basis of these concerns not being addressed. (This is precisely what happened at the Arizona State Hospital.)

As stated, I am not able right now to enlarge the images above, but will be able to in short order. For now, suffice it to say that this letter included all details specific to the process by which I was compelled to draft it, as well the significance of the issue of staff shortages, which I knew not only were occurring in violation of federal standards, but which also poses grave risk of harm to staff and patients alike. Low ranking staff, that is, and not the fat-cat bureaucrats like Jay Pottenger, who traditionally are so disconnected to the realities of what really goes on in these places, that they hardy really give a damn when information of this sort is provided to them.

But they do this at their own risk. As proven by the most recent trouble that Arizona State Hospital experienced (emphasis here on most recent, because it sure as hell isn't the first time), and by the ongoing developments at Montana State Hospital, which is even today- more then eighteen months after they were sanctioned by the federal government- yet to be resolved.

So be it.

IN CLOSING: There is no just cause for any administrative member of state managed mental hospitals to ignore well intentioned efforts of patients who express concern about their experiences. But just as with my time at the Arizona State Hospital, where none of my good faith, well drafted as per protocol grievances found any degree of resolution, these patterns of abject negligence occur away up in Montana, too. And very likely, throughout the nation. This is wrong, wrong, wrong. 

It is clear to me by now, as a man affected and disabled by serious mental illness who has accrued three full years in more then one state managed mental hospital, that the sole reason for why this occurs has to do with my status as a man affected and disabled by serious mental illness. Were such issues to be raised in a non-mental health care facility, private, county, whatever, there is no way in hell that hospital administrators would risk ignoring such matters, on the basis of liability, if nothing else. 

But in state managed hospitals, where a pervasive attitude of "What happens in (Vegas) stays in (Vegas)" exists as a matter of standard practice, such issues are swept under the rug, with no regard for the rights or care needs of the involved patient, etc. Virtually all individuals hospitalized in these places are disabled under state and federal law. It follows, thus, that this is patent discrimination on the basis of disability, and nothing less. 

Even in this day in age, it is that bad. I attest to it, and have only one choice:  To continue reporting it all in my writing and reporting in this blog, and elsewhere. I and my staff refuse to relent until reform oriented towards addressing these issues meets our satisfaction, most specifically in a context of getting state managed mental hospitals out of the habit of defying medical standards once and for all. 

MORE LATER. AS ALWAYS.

paoloreed@gmail.com

Random Notes.

I have been reviewing my various notes from the ASH era, where I spent thirteen hellish months, January 2011-February 2012. I spent a lot of my free time there (and at ASH, there is a lot of that) engaging in what my ASH therapist referred to as "Voluminous note taking" (which he entirely supported), leaving there with over thirty basic journals full of such notes, only a bit of which have actually been part of this blog. 

One loosely done daily note reads as follows, and is representative of the lengths that Cory Nelson and his goon squad- including CMO Dr. Steven Dingle so far as I am concerned-  were willing go to in the hope of thwarting my advocacy efforts at the time.

It relates how on December 05, 2011, as I sat alone, minding my own business at one of the outside "on the mall" tables, a scrawny little tech who I never knew the name of led this large Mexican man, I think his name is Carlos or something, right up to my table and sat his ass down not five feet from where I was sitting. 

This guy "Carlos" was a forensics patient with a very violent history including at ASH (he had supposedly broken more then one patient's jaw over his years there), very notorious to all patients with extensive experience there, who was only seen on the mall being escorted by at least two large male techs while restrained at both hand and foot level.

First thing I noticed was that Carlos had no restraints of any kind on. I shit you not. My initial words were, "Do you mind?" This scrawny ass tech just looked at me, no response whatsoever. So as quickly as I could, I gathered my things and moved way the hell way from them. 

I contend in all sincerity that in this specific case, they were willing to see that I be gravely injured in order to get their way, shut me up, maintain the status quo. Same idea as when I was wrongly, summarily transferred from the appropriate treatment unit at ASH for my care needs- which my referring doctor in Tucson had personally ensured I would be placed on based on my established behavioral characteristics and related diagnosis, depression zero violence- to one of the most violent. This occurred not only in defiance of basic medical ethics, but even the Hospital's own protocol. 

I was provided at the time with a letter rubber stamping this transfer that was signed by both Cory Nelson, and Steven Dingle. In a subsequent response to the grievance I filed in context, Nelson's verbatim words were (I have that document here on the table next to me as I write): "It is within the purview of the Chief Executive Officer to move patients from one unit to another at the discretion of the Chief Executive Officer." 

Therein: They run that Hospital more like a prison then a hospital, in fact. Rat Bastards the whole lot of them. Evil incarnate. 

And as our last full article relates, I was all but identically retaliated against by one Dr. Colby "Since fired!" Wang on the same basis- for exercising my right to disagree with his conduct, and for filing grievances in context- this at the Montana State Hospital, 2015, 2016. 

Could not make any of this shit up if I had to. (No reason to.)

paoloreed@gmail.com   

How it's done. RE: Bringing about oversight and accountability when state managed mental hospitals are being mismanaged and in violation of licensure, federal and state 

law and policy.

The following information is oriented towards showing how any citizen or consumer of state provided health care services specific to mental health care facilities can meaningfully take action to address issues of crucial importance. As stated above, this in terms of crucially needed oversight by the federal agency Centers of Medicare and Medicaid Services (CMS), which is effectively responsible for the licensing of these facilities. The plain fact is, virtually any state managed mental hospital is licensed to operate by this agency, on the basis of the consumer-clients there, the bulk of whom are needful of insurance coverage provided by CMS. This operational status requires that such facilities strictly abide by a wide range of federally established regulations directly overseen by CMS, which are in effect, a form of law and policy designed to ensure that persons affected and disabled by serious mental illness. 

I am compelled to state as well, that it doesn't require individuals or entities not affected by mental illness to take action as I have, be it via this blog, or via my recognizing and reporting issues about patient abuse and medical malpractice in state mental hospitals to the authorities. Point being that many individuals affected by serious mental illness are more then capable of engaging in all sorts of "normal" activities, including public interest advocacy. But I can attest to having been accused or otherwise mischaracterized more then once of not being affected by serious mental illness on the basis of my work as a mental health/illness advocate and activist in recent years. 

Accusations of this sort are 100% consistent with ongoing discrimination against persons affected by mental illness, wherein the ones behind this issue are still mired in the belief that we the mentally ill are inherently lacking in intelligence. Utter ignorance that for far too many years has been the root cause for holding us back from engaging in life to the fullest of our given ability(s). It is sickening, but certainly not unheard of, given the known history of abuses and discriminations against disabled persons across the board. But it patently untrue that this is the case. 

One immediate figure in defying this belief is Dr. Mark Vonnegut, son of Kurt Vonnegut. Mark is a licensed and practicing medical doctor (pediatrician) who is affected by schizophrenia, and has spent in-patient time more then once in mental health care facilities, including before and after his medical education at Harvard University and his subsequent licensure as a physician; he is also the author of "The Eden Express" (1975), and  "Just like someone without mental illness only more so: A memoir" (2010). Recommended reading, by the way, his relation to one of the world's most prolific writers- Kurt- is obvious. 

I'll add as well that throughout contemporary history, a range of persons affected by serious mental illness have been 100% behind mental health care reform on the basis of their ability to report on such issues. In my case, as a recognized advocate and activist, I will state as clearly as possible that my very real struggles with serious mental illness have not diminished my education in law, my sense of civic duty and ethos, or any other aspect of my given attributes and overall life experiences.

So far as mischaracterizations go, I'll mention a very shortsighted re-diagnosis of me in  fall, 2016, by one Dr. Richard Holt, after I had exposed Montana State Hospital's grossly unlawful operational status and related substandard care practices to the federal government (much more in this in the following text). I won't go into much detail about Holt today, but I will share that when we first sat down to meet, he was compelled to describe how he once spent time in Vienna, and "Walked the same roads and trails that Freud once did...." Outside of basic pompousness and insecurity, I at that time was asking myself why the hell this jerk twas telling me this, knowing as anyone might that it has nothing to do with his possible qualities as a psychiatrist, or actual relevance to my needs as his patient. Another outright bizarre aspect of his personality flows from him also spending at least some time in Great Britain, which has him speaking today in a slightly clipped British accent, and using the term "brilliant" so often that it almost made me gag. 

Could not make this shit up if I had to. These are the sorts of psychiatrists one may well run into in state managed mental hospitals. Freaks, nincompoops, incompetents... And on that list can go.  

But the fact is, Holt's bullshit in summarily re-diagnosing me was clearly based on a non-medical agenda that had nothing to do with my actual care needs as an individual affected by serious mental illness. Agenda specific to maintaining status quo across the board, rather, and just another means that such people believe will keep patients in their place. His agenda in context had to do with pre-maturely discharging me from MSH with no regard for my state of mind and emotion at the time; and as stated, occurred approximately one month after I had alerted the authorities about the substandard care practices and conditions at MSH, which did lead in short time to federal oversight and accountability.  

All of this said, we all know that the Arizona State Hospital (ASH) has repeatedly failed to live up to the responsibilities directly connected these regulations, most recently circa 2013-15, which did lead to CMS issuing a formal  Notice of Jeopardy, in a context of ASH being at high risk of being losing the licensure provided by CMS.

While in Montana, this precise same range of issues arose circa 2015-2017, wherein following me coming to realize that Montana State Hospital (MSH) was operating in violation of these regulations, I actively initiated direct contact and reporting to CMS in fall 2016 my concerns about this issue. Which did in January 2017 lead to CMS issuing yet another formal Notice of Jeopardy following a concerted investigation of the conditions and care practices at MSH. 

Again, it is the hope of the staff of "PJ Reed The Arizona State Hospital" that the following article can and will contribute to aiding anyone with concern about the conditions and care practices in state managed mental hospitals to take direct action on behalf of the patient communities in such facilities. I do personally encourage any person, including but not limited to hospitalized patients themselves, or patient families, and so on, to consider this information as a means to take action, so that can get these facilities up to speed with established law and policy.

Our Standard Disclaimer: I am well aware that in any state mental hospital there are many Good Staff who work to the fullest of their ability to meaningfully benefit the flow of treatment and general welfare of their clientele, the patients. Good Staff who are willing to do this in defiance of the intimidation if not outright retaliation that senior ranking staff and administrators rely upon  in the hope of maintaining status quo, regardless of how detrimental to patients and staff alike that status quo may be And I will say as loudly as possible in textural form: Thank you, thank you, thank you, Good Staff! You are truly jewels in the desert and mountains!             

-----------------------------

BACKGROUND, MONTANA STATE HOSPITAL, WARM SPRINGS, MT

“Dying is an art.

Like everything else,

I do it exceptionally well.

I do it so it feels like hell.

I do it so it feels real.

I guess you could say I have a call.”

Sylvia Plath.  "Ariel" (1965)

In late spring, 2015, following yet another lethal suicide attempt and seven days in an ICU as a consequence of the physical impacts of that attempt, I was committed as per law to the Montana State Hospital (MSH), located in Warm Springs, MT. It was my first commitment to a state hospital since ASH in 2011, and not something I expected, given that this suicide attempt was no less sincere (legitimate) then my earlier attempts throughout the years (I will likely get it right eventually). And while I did not take for granted that MSH would necessarily be much different then ASH, I also had no predisposition in terms of presuming things there would be as screwed up as the mismanagement of ASH, in fact.

However, I am happy to report that in many respects, MSH has a range of more optimal benefits then the full gamut of ASH's overall care practices and conditions. Most specifically, I was immediately struck by the fact that the vast majority of MSH's lower ranking staff- technicians, namely- were of very civil and outright kind nature, in contradiction to many of the technicians at ASH (Elaine Traylor comes to mind context);  which, it occurred to me before long, stems from the simple fact that MSH's overall staff (outside of psychiatric staff and administrators) is largely represented by individuals reared in Montana's smaller towns. 

MSH is located in a rather isolated and entirely rural area of the state, while ASH, in contrast, exists smack dab in the middle of Phoenix, which in my opinion, is a hot, dirty, and utterly challenging place to live if, in fact, one comes (as I do) from a small town. As such, Phoenix has many of the same socio-cultural stressors typically found in any other of America's bigger cities, including graphic economic disparities, street violence, and on that list can go; and not to mention Phoenix's surface of the sun temperatures for a good 8 months of any given year. Contributing, again in my opinion, to some proportion of really unhappy citizens living in Phoenix who may well not even have decent cooling in their homes, much less a swimming pool, possibly living in more dangerous areas of the city, due to the cost associated with such amenities (and it is well known that low ranking mental hospital workers- technicians most specifically- are underpaid to the nth degree.)

This at least, lends itself to MSH having a relatively better environment than ASH offers.  As said, MSH sits in a rural area of one the most beautiful states in the nation, with outstanding views of nearby mountain ranges, no fences, lots of trees, and even a stream small lake. On this basis alone, it only makes sense that the low ranking staff there- who live nearby in this same nature of environment- are markedly more friendly then many of the ones at ASH.

But in terms of deeper issues specific to patient care, it does  not much matter where and any such facility is actually located, be it (ASH) in Phoenix (the higher ranking staff there, nurses, doctors, and administrators do not have to contend with the general harshness of a Phoenix existence on the same level lower-underpaid staff), or be it in the idyllic countryside of western Montana MSH. The plain fact is that it is the one's directly responsible for the administrative operation of state hospitals are the ones behind why these places are well known as "snake pits" of patient abuse and arguably incompetent psychiatrists. 

As follows.

MONTANA STATE HOSPITAL, THE EXPERIENCE.

I spent close to eight full weeks at MSH after that 2015 admission. s stated, this was my first admission to a state hospital since ASH. My first assigned primary psychiatrist at MSH was, in fact, a visiting doctor named Dr. Robert Most, a private practitioner who had a habit of annually taking time away from his base in the Minneapolis area. He does, as such, actively practice in other settings, where as he put it, he can acquire meaningful experience designed to heighten his given quality as a practicing psychiatrist. This approach to psychiatry is outstanding, to say the least, and graphically differs from the attitude of most psychiatrists, particularly those found in state mental hospitals.

With this element of Dr. Most's approach to his work, suffice it to say that I found him to be of very reasonable character, and more then simply competent in terms of interacting with me (and I feel safe in presuming, his other patients). And on this basis, as stated above, has direct relation to his being a far better qualified psychiatrist then the standard full time staff in state hospitals. He does this by choice, in other words, while many if not most state hospital psychiatrists do it because they have to, as a direct result of their relative incompetence.

As such, Dr. Most was very capable of improving my basic state of mind of emotion, lifting my spirits as it were, merely on the basis of his "bedside manner" and professionalism in a context of medical practice. Helping me to recover in fairly short time, as in actually recover, from the depression that I was dealing with prior to my admission. I very well sensed this at the time, and still today offer my deep appreciation for this particular psychiatrist's ability to actually help me.

Thus, at the five or so week point of time after my admission to MSH, Dr.  Most and my broader treatment team began formally preparing for my discharge, a process that in itself generally takes a few a weeks to complete. I was in firm agreement with the status of my treatment, and was literally feeling so appreciative of this doctor's qualities that I felt very well prepared to reenter the public milieu. It was that simple.

Then the shit storm arose.

Now, I was aware that Dr. Most was essentially filling in for a regular staff psychiatrist who had taken time in order to have hip surgery, which is why and how the opportunity for him to temporarily practice at ASH arose.  At the six week point of time following my admission, he advised me that his time was about up at ASH, following which he returned to his practice in Minnesota. We parted on very good terms indeed. I was, again, on the verge of discharge, and quite frankly, quite happy in context.

I was subsequently introduced to the doctor who would be taking over my treatment, including as I saw it, the management of my pending discharge. As I saw it, I would likely no sooner meet this 2nd doctor then I would out the door and on my way home. However....

Enter Dr. Colby Wang.

I well recall my first meeting with Dr. Colby Wang. He asked me to call him "Colby", for example, which in itself led me to think this doctor was fairly nice fellow. I did not, as such, bear any immediate (as in, after that first meeting) concern about his personality or related skills as my primary attending psychiatrist. Or any concern whatsoever about my status as a very soon to be discharged patient.

But that changed very quickly.

In our second meeting, Wang's tone of voice and general demeanor took and entirely different shape. Point in fact: His opening statement to me in that 2nd meeting glaringly stands out today, and still hurts, in fact. As follows.

"I see that you come from a very fucked up family."

NOTE: It is in my medical records that my personal family history includes the presence of mental illness and substance abuse. My father Jackson Reed Pickens, a one time Triple A professional baseball player and Annapolis educated career Naval officer with an exemplary record of service that extends back into the 1940s, was also affected by depression and -like me- a relatively late onset of addiction to alcohol (hardly uncommon in military service); very sadly, my father died in 1971, very possibly of suicide. I also lost an older brother, Jackson Reed Pickens, Jr. in 1974 to complications of a drug overdose, which somewhat (but not entirely given the times) defies his history of public service and compassion for others. And as I have described in prior articles, I was at one time sexually abused by my older sister Sharon, when she was eighteen and when I was six years old or so, this would have been in 1967 or so. I also have have an older brother, Frederick Calhoun, Harvard educated and a former professional soccer player, who in time same to struggle with addiction that effectively deprived him of the ability to succeed in life by the time he was in his mid-20s. While my mother, following the death of first, her husband of over twenty years, and then of her first born son, did as a matter of plain fact develop a horrifically intense addiction to booze, which in itself has a whole hell of a lot to do with my psychological issues as they stand today.

As such, my entire immediate family posses both fantastic attributes and directly associated achievements. Achievements including extensive service to others. And so on.

I attribute the more troubling elements of my family history to a range of socio-cultural and familial dynamics that did over time detract not from my family's known attributes, but rather our basic ability to maintain emotional and psychological stability. These elements include cultural identity conflict (my father's heritage as an American Indian, something that I share with him and understand quite well via my MA in American Indian Studies), of war and international conflict (my dad's 30 year record of exemplary military service), of loss (the tragic and unexpected deaths of both my father and my oldest brother in a period of four years), and other such societal ills experienced by many American families. For a licensed psychiatrist to characterize this nature of familial dysfunction as "fucked up" is unconscionable. Bottom line. 

Therein (and outrageous obscenity aside), for a licensed psychiatrist to characterize any person's familial history as "fucked up" is patently unconscionable. Without so much as giving the two us reasonable opportunity to get to know another and develop a firm and trusting relationship, this son of a bitch felt it was proper to shame me by characterizing of my family in this way. It was then and there that I was graphically reminded of one my five (in 13 months!) assigned psychiatrists at ASH, Dr. Pervaiz Akhter ( "I cannot believe you are not a felon" ), known by many ASH patients back in the day as an insulting and arguably racist (Akhter was raised and educated in Pakistan) care provider with mannerisms that for the most part left me confused if not pissed off every time we met.

What can I say? I do not much like assholes.
(Who does?)

Wang subsequently chose in his boneheaded way to impose even more of his particularly nefarious bullshit onto me. It went like this in each of the next few meetings between me him, which did in all senses undermine the flow of recovery that I had benefitted from under the care of Dr. Most. But worst of all was the fact that, in absolute defiance of the fact that my discharge from MSH had been put well into motion before I even met Wang, he decided that my status in context was flawed, stating as a matter of plain fact that he would keep me at MSH "as long I want to."

Wang's willingness to ignore my actual state of mind and emotion in order to threaten me in this context left me at times sick to my stomach- literally-  with fear over the willfully abusive nature of yet another highly entrusted state employed physician. Worse even, then my experiences at ASH for the most part. I can can, this, attest to how terrifying it is to have a state employed authority of any kind abuse that authority as a means to intimidate or otherwise hammer you into submission. Submission has nothing to do with medical care- it is only those medical professionals who possess arguably sadomasochistic mindset(s) that engage in misconduct. And  in my experience, it is only in state managed mental hospitals that the threat of such miscreants exists. Bottom Line.

It was that bad. 

As per my rights as consumer of Montana's health care services, I did thus file a number of formal grievances about Wang's  ridiculously out of line misbehavior, including if not foremost his radical and unwarranted alteration to my status as a soon to be discharged MSH patient. No state employed mental hospital doctor has the right or authority to detain the client-consumers under their care beyond the stability of such patients. To do so is in defiance of the federal standards specific to state managed facilities, including the 8th Amendment of the US Bill of Rights prohibition against any individuals deserved freedom(s), and is a patent violation of international human rights, as well.

I made these facts clear on that specific grievance, and as a consequence, in part, I was discharged from MSH not as quickly as I should have been, but at least in a manner free of his threat to keep me there at his leisure.

It has been said that I write a "mean grievance", but I attest that I have never desired to frivolously do so; having to engage in such action is counter-therapeutic, a basic pain in the ass; and in this specific case, it was a matter of me literally fighting for my life. No fun. No fun at all.

In this context, while I did file grievances about Wang's  ridiculously atrocious misconduct, it need be said that beyond those actual grievances,  I sincerely did want to go any further into worrying about it all. I had already decided that I had had enough of that in Arizona, going tooth and nail after the existence of highly entrusted but patently corrupt state medical professionals and all of that. And I was so relieved to get the hell out of his grossly intimidating and disparaging power over my rights and care needs, in fact, that once I made it out the door of there in late June, 2015, I said to myself, "This is over."

I did, as such, only want to move on and away from Wang in  hope of remaining free of the emotional trauma that arose in relation to each and every such grievance I filed while a patient at ASH; emotional trauma arising due to the barebones fact that of each and every one those filings systematically rejected both at the Hospital and subsequently in Arizona's Office of Administrative Court, the emotive impact on me thus being that these people considered me less then human, and not deserving of the rights of persons not affected (as I am) by serious mental illness.

I thus chose to rely on MSH administrators to do their jobs in context. 

I should have known better.

Montana State Hospital, like any other such state managed health care facility, has a due obligation to meaningfully respond, as per law and policy,  to evidence or claims suggesting that their respective health care employees- from doctors to technicians and everyone in between- may be engaged in violating the civil and human rights of their given clientele (or otherwise breaking rules). This most definitely includes grievance complaints generated by consumers of state services across the board. But as I have described in the past, state managed mental hospitals are far less likely to be subjected to the oversight and related accountability that ant other like facility would experience, this on the basis of patients in state hospitals being affected by mental illness.

More on standards of care.

As most people know, there are a number of forms of serious mental illness. In this context, and like any other state hospital, MSH is also required to provide reasonably appropriate treatment units in a manner consistent with the primary diagnoses and related behavioral characteristics of each patient receiving treatment. This is spelled out in MSH own procedural standards as a matter of plain medical policy and practice, and does flow from directly related federal guidelines. While also representing just one element of mental health care reform- a rational and well intended deviation from the old days, when we would all be forced into one common zone, as though cattle. There are, as such, four specific designations to each of the four treatment units at MSH, which the Hospital is required to abide by on the basis of individual patient diagnoses and treatment needs.

In this context, some patients at MSH are treated on one specific unit that's designated to care for persons with known criminal conduct flowing from their given mental diagnosis. Such units are referred to as "forensics", while the patients are often referred to as the "criminally insane" (I hate that term, but it still in use).

While others, affected by chronic forms of serious mental illness that so disables them that they are needing of long term care, are treated on a unit that specific designation.

The third unit at MSH is specifically designated to care for mentally ill persons affected by acute psychosis, which may arise in relation to diagnoses such as schizophrenia and other like , and who may as such have arguably volatile behavioral characteristics (including but not limited violence). (It need be clarified that I've no psychiatric-medical history of psychosis whatsoever, or any other other form of potentially volatile diagnosis, including violent behavioral characteristics.)

And there is  a fourth unit that is designated for patients such as I, who may be affected by depression or other like emotional disorders as well as substance abuse, but nothing resembling acute psychosis.

2016 RETURN TO MONTANA STATE HOSPITAL

In September, 2016, I was again committed to MSH due my ongoing struggles with my specific diagnosis, major depressive disorder and associated traits, including but not limited to the risks associated with my given suicidal history in context. As stated above, MSH- like any other such public health care facility- is required by the federal agency that in part licenses the place to provide appropriately designated treatment units in manner consistent with any patient/consumer's specific diagnosis. As such, and as per my 2015 treatment at MSH, I knew for a fact in my case, as per my long established diagnosis of major depressive disorder, substance addiction (alcohol), and associated traits including PTSD, the formally designated treatment unit in my case is called Bravo Unit. This is a plain fact, and is designated as such in MSH' own operational policy forms.

During my formal admission in September, 2016, it was established that I would again treated on the appropriate unit (Bravo Unit) on the basis of my known diagnosis and specific treatment needs. But within minutes of me being assured of this, Wang personally called the admissions nurse and told her to redirect my placement from Bravo Unit and into one of the most violent treatment units at MSH (Alpha Unit). Alpha unit as a matter of plain fact is designated to treat persons affected by acute psychosis. 

I, on the flip side, have no history of psychosis whatsoever.

Wang's action in this matter amounts to patently unlawful retaliation. My right to be treated in the setting specific to my treatment needs was deeply violated on the basis of the hospital's unwillingness to abide by the federal law(s) that applies to MSH's license to operate.

I thus came to realize that much more fully that this state managed long term public mental health care facility was experiencing some of the same issues that ASH is so well known for. As a matter of documented fact, I was was subject to gross retaliation at ASH, in direct relation to my ability and willingness to report issues detrimental to the welfare of the ASH patient community, and very similarly removed from the appropriate ASH treatment and placed instead on one the most violent.

As stated, the first indication these issues at MSH initially arose in 2015, when Wang subjected me to ridiculously abusive mistreatment. Which I did report at that time in several grievances, as per my civil rights to speak out against issues that I know to be illegal or otherwise inappropriate. And as described already, I had to interest in going any further with those reports one I finally got the hell away Wang. I had enough of that in relation to ASH, and I did not want to go through the tedious and at times outright traumatic process by which my writing in this blog contributed to the shake up at ASH in 2015.

But in 2016, once I realized that MSH administrators were not going to address the issue of Wang's overt and undeniable retaliation against me, due to which I was forced to seek recovery on a unit populated by individuals primarily affected by acute psychosis, I made the decision to pay close attention to any form of wrongdoing or operational shortfalls at MSH, and to take on MSH as new focus of my advocacy and activism work. In very short time, I even went so far as to directly warn MSH's so called "patient's lawyer," Craig Fitch, of my intent to take these such issues to task.

I cannot easily make clear how harmful the impacts of being on Alpha unit were to me, but suffice to say for the moment that it was at times horrific. I've nothing against persons affected acute psychosis, but such individuals- often diagnosed with schizophrenia- are very hard to so much as communicate with (which is very non-therapeutic to persons such as I), much less feel safe around (given that such individuals are susceptible to breaks in reality and associated violent outbursts). My PTSD was triggered on countless occasions due to the often violent conditions on Alpha, and my inability to engage in meaningful conversations with the majority  of the Alpha unit patient community.

It was that bad. Again.

One very interesting development arose when Dr. Colby Wang was summarily fired in early October, 2016, approximately 4 weeks following my having reported his abject refusal to abide by law in a context of my protections under the Americans With Disabilities Act, which patently states disallows any form retaliation on a basis of any disabled person's reporting of issues about wrongdoing. I made that report through MSH own grievance format. And despite MSH refusing to admit that Wang was patently acting in violation of these protections, I know for a fact that he had stacked up a pile of complaints from other MSH patients, many of which wound in a file maintained by the organization Montana Disability Rights. And I do believe without a shadow of doubt that my grievance specific to retaliation did break the proverbial camel's back. (See: Montana's Forgotten Suicides. Montana State Hospital. "Colby C. Wang, Rat Bastard. AKA Colby Now Fired! Wang. PJ Reed, December 28, 2016)

As things played, in October, 2016, it was an MSH staff member who raised the fact to me, in person, that MSH was operating on a regular basis with graphic shortages in staff. This young man, a staff technician, actually went so far as to declare "I don't even think this is legal!" These shortages were pretty obvious to me, but it took the personal communication with this person to compel me to engage in addressing this  particular issue to the best of my ability. The fact is, he was correct in thinking that such shortages are in violation of law; and which (just like at ASH circa 2012-15) pose direct risk to patients and lower ranking direct care staff alike. (Note here, "lower ranking staff", and not at the level of the actual medical staff or the much less so in the administrative offices at MHS. This is how it always goes.)

Given my awareness that staff to patient ratios (quotients) in state managed hospitals are required to meet the standards of the federal government, namely Centers for Medicare and Medicaid Services, which in part licenses these places, I took this this staff persons concerns seriously.

Enter Montana State Hospital's Resident Advisory Council 

But, as at ASH back in the day, it was not my first desire to come down too hard on MSH administrators, as in by alerting federal authorities about this matter on the basis of it being a violation of federal standards, despite my knowing that this was my right as a citizen-consumer of services from Montana's public health system.

I chose instead to raise the issue in a weekly meeting of the MSH Resident Advisory Council (RAC), which I was at the time a voting member of. I suggested in that meeting that RAC write a letter to Montana's governor, Steve Bullock, in hope of raising needed awareness of this issue. A letter, simply designed to alert him that MSH was in need of attention. 

RAC is comprised solely of MSH patient-consumers, and as such, is designed by its mission statement to function as a body service and advocacy in the interest of the great MSH patient community. However, as a matter of policy, there are always at least one MSH staff member present- not as a voting member of RAC, but rather as chaperone of sorts. These persons are required to be present, but do not in fact have a right to interfere with the goings on of Council 

JAY POTTENGER, FAT-CAT BUREAUCRAT.

Jay Pottenger
Chief Executive Officer
Montana State Hospital
2016-present.

At that time, when I exercised my right  to ask my peers on RAC to vote on this suggestion, a attending Hospital employee named ------------- challenged the idea by stating that it would "be rude" to not take this issue to Jay Pottenger, the facility's fairly new CEO, first. 

I found this to be overtly inappropriate intrusion on the function of RAC, but members agreed with this approach, so I went along with it.  We were thus advised by ---------- that Pottenger would attend the next meeting at RAC in one weeks time.

Pottenger failed to attend his first scheduled presence at the next RAC meeting, which I found to a further affront on the work that RAC provides to MSH patient-consumers. But there nothing we could do. He subsequently showed up at the next one, and my peers on RAC directed me to clarify this concern in my own words. As such, I not only stated that this issue poses very real risk to both patients and staff alike, but went further as a matter of diplomacy to acknowledge that this was likely due to a lack in state funding, something out of his immediate control (and as such, not his fault). I closed my very brief statement by adding that it would also be my hope that an increase in needed funding would directly benefit the underpaid lower ranking staff, including staff technicians and nurses.

Pottenger's verbatim response?

"I am not permitted to challenge the governor's budget."

It was a unnerving as hell to hear this highly entrusted state employee ignore the most crucial issue at stake, safety, and justify it on the basis of his limitations as a state employee. Unnerving, but far from surprising to me. And 100% consistent with what it means to be a bureaucrat, in graphic defiance of his actual job as the administrator of public health care facility that is expected as per the public trust to ensure that MSH' disabled and highly at risk patient-consumers

After Pottenger took his leave, RAC members furthered discussed the matter, but the idea of a letter to the governor was basically pushed aside. I expressed at the time that I found this situation untenable, and emphasized the need for RAC to take action in a reasonably timely matter. I therein realized that my concern in this case was not being taken seriously enough in terms of feelings on the issue, which I made clear. I then stated that I would go ahead and draft a letter myself. I clarified that I was intent on exercising my sense of civic duty as a citizen-consumer of state services, and that I would not refer to my expressed concerns in the letter in the name of RAC itself.

I then drafted an Oct. 29, 2016, letter to Montana Senators Ron Ehli (R- Hamilton, MT) and Debbie Barrett (R- Dillon, MT), two elected state officials who I been advised had exhibited a vested interest in the state of Montana's public mental health care system. In that document I detailed my all elements of my understanding of the significance of shortages in staff at MSH, with an emphasis on patient and lower ranking staff safety, as well as the issue of law and policy in context.

I did not directly receive any response to my letter from either of these elected representatives, but in mid-November, shortly before my pending discharge, I did become aware of the fact that representatives from both the state as well as the federal offices of the federally managed Centers for Medicare and Medicaid Services (CMS) were engaging in some level of inspection of MSH's overall operation. And while I did not take for granted that this had direct relation to that letter, what came about next did.

In late December, 2016, and into early January, 2017, CMS issued investigative findings that identified one hundred eleven (111) specific violations of standards by which MSH is licensed to operate; and central to those findings was the fact that MSH was allowing for endemic shortages in staff.

And more disturbingly was the finding by CMS that the administrative staff at MSH were grossly out of touch with their required responsibilities.

As such, very much like what went on in Arizona, this specific example of yet another state mental hospital's failure to abide by established standards arose in part (arguably large part)  to the dismal ignorance of MSH's current Chief Executive Officer, Jay Pottenger, which was presented in pretty square terms by the final CMS report itself, following formal interviews and findings, personified in the following record:

"This meeting was requested by the (CMS) survey team to ensure that staff member A (Pottenger) had been made aware of this Immediate Jeopardy concern and to clarify any questions staff member A may have had.

Staff member A stated he was not aware of whom the governing body would be, but perhaps thought it might be himself.

Staff member had additional questions on how the governing body functioned as it pertained to the facility."

(United States Department of Health and Human Services. Centers for Medicare and Medicaid Services. OMB No. 0938-0391. January 01, 2017. Montana State Hospital. Provider/Supplier/CLIA Identification Number 274086. Page 15.)

Can you imagine going into a restaurant kitchen and asking an on-shift dishwasher what his title is, what work he's supposed to do, and what are the responsibilities that he is paid to perform? And having the guy respond: "Who's the dishwasher? Me? And while we're on it, what does a dishwasher do, anyway?"

This fat-cat goddamn bureaucrat Pottenger has over 30 years of hospital management experience in bureaucratic systems not limited to state agencies, and astoundingly, ridiculously(!) failed to understand his own freaking job title (!), job description (!), and his associated responsibilities in context when asked by the licensing agency by which he has a freaking job about these basic matters.


Utter buffoonery at the top of MSH' administrative authority, 100% like Cory Nelson-Donna Noriega.... and Bowen? Yet again and in stark form, another bright line example of the potential ignorance of persons accustomed to working in bureaucracies.

Shortly after this report, CMS issued a notice of "Immediate Jeopardy." This standard of notice is specific to the licensing of state managed health care facilities, the term "jeopardy" meaning, in fact, in jeopardy of being delicensed.

And the sad fact is that, despite the significance of CMS findings in fall 2016 and the related Notice of Jeopardy in January, 2017, MSH has yet to get their shit together. As recently as spring, 2018, for example, new findings that confirmed that the issue of staff shortages was yet to be resolved. But things are in motion, as they were circa 2013-2015 in connection to ASH. And I am content in knowing that I actively got this process going, knowing as I do the care needs and rights of the MSH patient community.

IN CLOSING: I intend to publish more detailed information about the issues that have led MSH into ongoing oversight by the federal government. I have numerous records that will in time be available for viewing in this blog publication. But in sum:

- I recognized the fact that I and my patient-peers were being deprived of the care needs specific to treatment at MSH, in violation of our rights.

- I initially sought in good faith to bring attention to these issues through MSH formal grievance procedure. Wherein I did file a grievance specific to the wrongdoing of Dr. Colby Wang. 

- Due to the subsequent fact that MSH administrators were intent on allowing for Wang's misconduct, I took it on to do whatever I could to see that MSH be brought up to speed with their lawful obligations.  


- This did include me directly contacting state elected officials about the issue of staff shortages that I knew to be in violation of federal regulations.

- And this contact did in short time lead to federal oversight and accountability on behalf of the care needs and rights of MSH patients. A process which as noted above in ongoing.

At ASH and in the context of the history of this blog publication, it was me as a patient identifying issues needing direct attention from Hospital staff, including doctors and administrators; and learning the hard way that these people were not ethically inclined to do their jobs; so I took it further, directly to state employed officials assigned the task of ensuring that ASH meet standards of law and policy, and only ran into brick walls; thus, I realized nobody was willing to the do the right thing, so I took it on myself, while still hospitalized at ASH, and subsequently via the founding of this blog. 

AGAIN: 

I saw a problem that I recognized as something that somebody had to do address (and sought staff to do something about it).

I then learned the hard way that nobody else was willing to do anything about it. 

So I did something about it myself.

This is what it takes. If even this. So doable, in fact, that even someone such as I, affected by serious mental illness, may well be capable of getting it done. One thing I have also learned the hard way is that state government agencies in themselves rarely respond to reports about state mental hospitals, and nor do many federal agencies, including Department of Health and Human Services and/or the Department of Enforcement. This has everything to do with ongoing societal disregard if not outright discrimination against the mentally ill. So don't waste too much time there. Instead, contact your state representatives as a citizen of your given state, clarify the issues that you are concerned about, and tactfully demand that they do something about it. 

You might just be amazed.

MORE LATER.

paoloreed@gmail.com