Of Patient Safety (Or Lack Thereof), Administrative Negligence, and the Preventable Death of Yet Another Patient-Consumer.
IN MEMORY OF APRIL MOTT, CHRIS BLACKMAN, MARY ADAMS, BARABARA WEST, DONALD FAY PRATHER.
PAOLO JACK REED.
"PD: Patient kills another patient over loud music at Arizona State Hospital." Catherine Meija. Arizona Family, April 23, 2019.
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| Dr. Cara Christ. |
It has been far too recent, and far too often that ASH patient-consumers have died preventable death due to the abject lack of skill, character, and inability of the administrative officers at the Arizona State Hospital to maintain reasonably a safe environment there. And yet here it is, again, April, 2019.
Circa the period 2011-2016, no less then the following did in fact die in direct relation to these failings: April Mott, Chris Blackman, Mary Adams, Barbara West. And as disturbing as this weeks murder of patient Donald Fay Prather is, in itself, is the fact that Arizona State Hospital has one of the most disturbing records in the nation at this time, specifically in a context of preventable deaths of individuals forced by the court to rely on the ones running the damned place. No one state mental hospital shares this degree of preventable death statistics, and while it is the practice of state employed health care officials to patently deny- in Pavlovian knee jerk- any suggestion that these deaths were the fault of the state, there are records to the effect that each of these four persons did, in fact, suffer preventable deaths.
And it need be noted that, only when it comes to death, be it that of actual patients or anyone else impacted in this sense (April Mott, e.g., who had no history in relation to ASH, outside of the consequences of administrative malfeasance there), are we the public made aware of arguably questionable issues at there. "What happens at ASH stays at ASH." Which is to say, day to day abuse of patients does potentially occur there without anyone outside of ASH staff and/or patients knowing about it. I saw it and experienced in it firsthand- day in, day out for the entirety of my thirteen months hospitalized at ASH. Psychological abuse, physical abuse, administrative abuse (of power), and on the list goes. As a matter of standard practice.
FACT: Shortly after being appointed as the Director of Arizona's Department of Health Services (ADHS), in a July, 2015, email sent to this blog publications website (paoloreed@gmail.com), in reference to the the care practices and conditions at that point in time, Dr. Cara Christ stated "Things at ASH are much better now." Christ's reference in this context related to the deeply scandalous misconduct of various ASH staff members immediately previous to her appointment, much of which was exposed circa 2012-2015 in this blog, as well as Phoenix area news media. Corruption and ineptitude extending from the level of direct care staff (technicians, nurses) and on up through the offices of ASH's senior psychiatric staff and directly into the executive offices, and well into the ADHS construct as well. I attest to this. Period.
Choosing to claim, as she did, that things at ASH were in any way better then they were prior to her authority without providing so much as a shard of evidence to that effect, Christ willfully fell into the same pattern of disseminating abjectly inaccurate propaganda that her predecessor Will Humble sought to rely on circa 2010-2015, blatantly as means to avoid oversight, accountability at ASH. Preserving the status quo in the Hospital's overall employee pool, in other words, and to hell with the harms that ASH patients are subject to in context.
I feel for damn good reason that there has been little to any improvement in the treatment of the ASH patient community in Christ's four+ years as the top ranking official in Arizona's public health care system. And I far from alone in this belief. The fact is that, at no point in time has Christ provided any evidence to the effect that things at ASH are much better today then they were circa 2010-2015, in blatant contradiction to her statements in that correspondence. For since that time, summer 2015, a range of equally wrongful misconduct at ASH has come to light, including with respect for the refusal of ASH's current CEO, Dr. Aaron Bowen, to release public records specific to incident reports, which are required to include incidents of patient on patient violence.
As per the very real record, Bowen's misconduct in this context occurred in violation of state and federal law and policy. But has Cara Christ taken any steps to formally address this specific issue?
Hell no, she hasn't. Go figure.
Very akin to the willingness of one of the world's most horrific tyrants, North Korean president Kim Jong-Un, to deny any awareness of details specific to the recent death of Otto Frederick Wambier, I contend that there is no possible way that Christ is unaware of such misconduct. It is, in fact, only one of her varied formal responsibilities to be fully cognizant of the quality of care at ASH and the behavior of all ASH staff, all of whom- including Bowen- work under her authority.
May seem a stretch, sure. Jong-Un, Christ. But is it, really? I think not.
As only one bright line example of the ongoing corruption that Christ has failed to reasonably acknowledge, we need only look to a October, 2017, stabbing at ASH. Wherein one patient known for be extremely violent was not being reasonable monitored and as such allowed to roam with no staff oversight, which did lead to the patient stabbing of another patient as he lay in his bed. This singular incident is of crucial importance with respect for the public's right to information about ASH, very much in terms of patient safety.
However, in the official ADHS/ASH 2017 Annual Report, Bowen and company- who I contend acted in complicity with persons such as Cara Christ as means to avoid accountability and oversight- failed to include the occurrence of this violence and near fatality. This was and still is an utter breach of the public trust by which Bowen and Christ are employed. (See in this publication, July 09, 2018: "The Arizona State Hospital's ANNUAL REPORT. 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.")
The patient who was nearly killed in that stabbing has since been represented by an attorney named Josh Mozell, who on December 03, 2018, stated the following:
Circa the period 2011-2016, no less then the following did in fact die in direct relation to these failings: April Mott, Chris Blackman, Mary Adams, Barbara West. And as disturbing as this weeks murder of patient Donald Fay Prather is, in itself, is the fact that Arizona State Hospital has one of the most disturbing records in the nation at this time, specifically in a context of preventable deaths of individuals forced by the court to rely on the ones running the damned place. No one state mental hospital shares this degree of preventable death statistics, and while it is the practice of state employed health care officials to patently deny- in Pavlovian knee jerk- any suggestion that these deaths were the fault of the state, there are records to the effect that each of these four persons did, in fact, suffer preventable deaths.
And it need be noted that, only when it comes to death, be it that of actual patients or anyone else impacted in this sense (April Mott, e.g., who had no history in relation to ASH, outside of the consequences of administrative malfeasance there), are we the public made aware of arguably questionable issues at there. "What happens at ASH stays at ASH." Which is to say, day to day abuse of patients does potentially occur there without anyone outside of ASH staff and/or patients knowing about it. I saw it and experienced in it firsthand- day in, day out for the entirety of my thirteen months hospitalized at ASH. Psychological abuse, physical abuse, administrative abuse (of power), and on the list goes. As a matter of standard practice.
Center of Psychiatric Excellence My Ass.
Choosing to claim, as she did, that things at ASH were in any way better then they were prior to her authority without providing so much as a shard of evidence to that effect, Christ willfully fell into the same pattern of disseminating abjectly inaccurate propaganda that her predecessor Will Humble sought to rely on circa 2010-2015, blatantly as means to avoid oversight, accountability at ASH. Preserving the status quo in the Hospital's overall employee pool, in other words, and to hell with the harms that ASH patients are subject to in context.
I feel for damn good reason that there has been little to any improvement in the treatment of the ASH patient community in Christ's four+ years as the top ranking official in Arizona's public health care system. And I far from alone in this belief. The fact is that, at no point in time has Christ provided any evidence to the effect that things at ASH are much better today then they were circa 2010-2015, in blatant contradiction to her statements in that correspondence. For since that time, summer 2015, a range of equally wrongful misconduct at ASH has come to light, including with respect for the refusal of ASH's current CEO, Dr. Aaron Bowen, to release public records specific to incident reports, which are required to include incidents of patient on patient violence.
As per the very real record, Bowen's misconduct in this context occurred in violation of state and federal law and policy. But has Cara Christ taken any steps to formally address this specific issue?
Hell no, she hasn't. Go figure.
Very akin to the willingness of one of the world's most horrific tyrants, North Korean president Kim Jong-Un, to deny any awareness of details specific to the recent death of Otto Frederick Wambier, I contend that there is no possible way that Christ is unaware of such misconduct. It is, in fact, only one of her varied formal responsibilities to be fully cognizant of the quality of care at ASH and the behavior of all ASH staff, all of whom- including Bowen- work under her authority.
May seem a stretch, sure. Jong-Un, Christ. But is it, really? I think not.
As only one bright line example of the ongoing corruption that Christ has failed to reasonably acknowledge, we need only look to a October, 2017, stabbing at ASH. Wherein one patient known for be extremely violent was not being reasonable monitored and as such allowed to roam with no staff oversight, which did lead to the patient stabbing of another patient as he lay in his bed. This singular incident is of crucial importance with respect for the public's right to information about ASH, very much in terms of patient safety.
However, in the official ADHS/ASH 2017 Annual Report, Bowen and company- who I contend acted in complicity with persons such as Cara Christ as means to avoid accountability and oversight- failed to include the occurrence of this violence and near fatality. This was and still is an utter breach of the public trust by which Bowen and Christ are employed. (See in this publication, July 09, 2018: "The Arizona State Hospital's ANNUAL REPORT. 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.")
The patient who was nearly killed in that stabbing has since been represented by an attorney named Josh Mozell, who on December 03, 2018, stated the following:
"The place is not better. Things have not changed.
And for our clients, it's becoming more dangerous."
Again, in July, 2015 (and we have it in our records), Dr. Cara Christ did send an email to this blog stating that "Things at ASH are much better now." How glaring can it possibly be? How tweaked a misunderstanding about a health care facility that Christ is responsible for? And just how does this negligence impact the ASH patient community?
"PD: Patient kills another patient over loud music at Arizona State Hospital." (Catherine Mejia. Arizona Family. April 23, 2019.)
And as we see today, April, 2019, with concern over yet another preventable death at ASH, the ones most responsible for current shortfalls at ASH are continually engaging in attempts to water down the significance of such incidents. This was depicted in the following response of ADHS about this event:
"The Arizona Department of Health Services notified the Phoenix Police Department about an incident involving two individuals at the Arizona Community Protection and Treatment Center (ACPTC) and is cooperating with authorities as they conduct the criminal investigation. The ACPTC provides treatment and housing for individuals who have committed a sexually violent offense, completed their mandatory sentence with the Arizona Department of Corrections, and are deemed unsafe to return to the community based on their status as a sexually violent person with a high likelihood to reoffend. These individuals are court ordered to our facility through a petition process by the county prosecutor."
Any such formal statement by ADHS also falls under Christ's authority. But as we wee, no aspect of this statement refers to the plain fact that an eighty three year old ASH patient named Donald Fay Prather died in this event. No offering of just how and why so violent an incident was even possible, in a hospital setting, for crying out loud. Christ's statement has so deep a void in terms of critical information about Prather's death that it turns the stomach, and contains no useful information at all to those of us who are concerned about the occurrence of such a tragedy. As in, just who is this man, Robert Wayne Fleming (the alleged murderer)? Where were staff members at the time of this assault, and how long did it take for staff to intervene?(Presuming they did intervene in the first place.) And on this list of inquiry can go.
No details whatsoever about the conditions and care practices at ASH that most necessarily have bearing on this tragedy, and so many others in recent years at Arizona's sole long term public mental health care facility. All of it, standard practice. Which does have undeniable relation to ASH's far longer history as a substandard health care facility.
I am of learned opinion that the victim in this case, at his given age, very likely has little if any remaining family directly involved in his affairs. And that it is the hope of Bowen, Christ, and all the other Rat Bastards involved with direct association to the ASH operation, that Prather's killing will go with relative lack of public concern. And it is true, as well, that this may turn out to be the case; this, the ongoing lack of public sentiment about just what goes on in places such as ASH.
We should all be ashamed. Bottom line.
