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