Montana State Hospital.

Montana's Forgotten Suicides

PJ Reed, editor. 

Staff Shortages at Montana State Hospital. "Feds find state hospital put patients at risk, almost terminated agreement." 

(ORIGINALLY PUBLISHED MAY 31, 2017)

(As always, we the author's of this material are fully aware that only some of the staff at Montana State Hospital are crappy at what they do. And that, in fact, there are many good people at MSH who are willing to do their best. It is our intent to serve not only the interests of MSH' patient community, but those of the good staff at MSH, as well. For we know all too well that these good staff struggle to do their best as a direct consequence of the Rat Bastards most responsible for issues at stake. Thank you to all staff who have the sense of conscience necessary when it comes to working in state mental health care facilities. Without you, the patient community would be lost. )        

"Feds find state hospital put patients at risk, almost terminated agreement."
                      By Holly Michels. Lee Newspapers. January 28, 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.

"CMS is on your case for good reason." As stated to Montana State Hospital charge nurse Deeana Dugdale, May 05, 2017.

Her verbatim response to this author: "No they're not. That's all a bunch of lies, and you know it."

Background: Following a series of formal inspections conducted in fall, 2017, by the federal agency, Centers for Medicaid and Medicare Services (CMS), which licenses the operation of Montana's sole long term public mental health care facility, Montana State Hospital (MSH), that agency issued a "Notice of Immediate Jeopardy" in accompaniment with a related "Notice of Termination of Contract." Notice(s) of Jeopardy in this nature of situation only arises due to identified substandard conditions and care practices, putting the patients at risk of grave harm (as clarified in the above news byte); while Termination(s) of Contract relates to the fact that such facilities have failed to meaningfully respond to earlier direction by the involved federal agency, in this case CMS. In this specific case, CMS identified no less then one hundred and eleven such violations, which the administrators of MSH failed to correct upon prior federal advisories,  leading in turn to the above described notices. 

Of note, that this pattern of dereliction(s) of duty- in direct relation to the public trust- is all but identical to the history of Arizona State Hospital (ASH), which circa 2010-2015, which was also subject to CMS generated federal oversight (wherein the issue of staff shortages arose) , and which also subsequently failed to meet the requirements issued following CMS said based investigations. As it therein applies, ASH was operating in gross violation of state and federal law, leading in time to firing of no less then seven individuals directly associated with the operation ASH in that time frame. 

And I can attest to having alerted two Montana senators about the issue of staff shortages in fall, 2016. Ron Lehi (Hamilton) and Debbie Barret (Dillon), specifically speaking, followed  up on the information that I shared with them, as per my rights as a consumer and American citizen, and as such led to the state of probation that this particular facility is still under today (November, 2017). And for which I was retaliated against, just as I was in Arizona.

It's that bad.

Montana State Hospital at this very time (November, 2017).

Not to focus too much upon nurse Deena Dugdale's utter disconnection with reality, it is nonetheless worth noting that the cover-up of wrongdoing is often far worse then the wrongdoing itself. In this context, no one such bit of evidence stands more strongly then patterns of abject denial when state operated mental hospitals are identified as being in crisis due to irrefutable evidence produced by formal investigations.

And as usual, denials in this context come out of the mouths of persons in relative authority specific to their given positions- and therein directly associated involvement in such issues- be it nurse managers, mid-level facility managers, licensed physicians; as well as Hospital administrators and their given superiors in state managed health departments, including department employed lawyers, and on that list can go. 

These are the people interested in only one thing- maintaining status quo as it applies to the selfish interests- and willing to declare behind closed doors:

To hell with the needs and rights of the consumer/patient clientele we are obligated to serve. 

All that matters is us and our selfish interests.

When it comes to state hospitals, that is, and other like state operated facilities and agencies bearing the responsibility of caring for vulnerable persons who have no other choice but to rely on such entities, be it at-risk children, the elderly, or the mentally ill. Patent denial, in absolute defiance of the production of such evidence, wherein persons 100% aware of the fact that serious problems exist nonetheless adhere to the same behavior they are so accustomed to. Therein identifying themselves as the ones most responsible for it all. Whether due to ignorance or outright stupidity, these patterns of denial prove that such people are representative of the overall history of such state hospitals, which so often attract society's most malicious individuals. 

Monsters. Predators. Miscreants. As seen in Arizona circa 2011-2014 (ongoing), Washington state circa 2012-2014 (ongoing), Pennsylvania circa 2014-2017 (ongoing), and now Montana (definitely ongoing).

As the theme has so long stood:  

        WE COULD NOT MAKE THIS SHIT UP IF WE HAD TO

PLAIN FACT: On the basis of dozens upon dozens of documented violations of federal policy standards, on January 27, 2017, Montana State Hospital's operational contract with the United States Department of Health and Human Services (US DPHHS) and the facility's associated license to operate was effectively terminated, giving the facility less then fifteen  business days to comprehensively organize a meaningful plan in order to avoid full termination of said contract.

Notice of this termination of contract was published in the legal records section of each and every Montana newspaper.

At this time, May 31, 2017, Montana State Hospital (MSH) is still functioning under federal sanction because the ones directly associated with the operation of the place are incapable of remedying the issues most at stake.  This includes failing to meet measures imposed by US DPHHS as a direct consequence of violations that Hospital administrators knowingly allowed to occur prior to the related federal inspection.

One of the central issues identified in this context relates to MSH's ongoing (May 31, 2017) direct care staff shortages, namely, technician and nursing staff; shortages in staff that pose grave risk of harm to patients. As well as to the same staff who have to deal with these shortages, direct care staff as described above, versus any of those staff responsible for these shortages, namely Hospital administrators and the undercharges.

With these administrators in mind, let it be clear as well, that the concerns of the federal agency in this matter include the absence of required governance that such Hospitals must provide if they are going to be allowed to function.

No element of these details is of surprise to those of us on the staff of  The Arizona State Hospital and Patient Abuse, for indeed we have witnessed such malfeasance before. 

Literally. In detail.

The following article was published in our directly associated activist blog, away back in April 2013. As such, the issue at stake in Arizona's sole long term public mental health care facility (ASH) at that time did in time lead to the ultimate consequences that the administrators at ASH faced in spring 2015, as detailed in a wide range of public media sources, including this blog source.  

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

PJ Reed The Arizona State Hospital and Patient Abuse.

DATELINE APRIL 13, 2013.

Staff Shortages at Arizona State Hospital. Wherein the ongoing crisis at The Arizona State Hospital specific to shortages in behavioral health technician staff has grossly unjust impacts on the ASH patient community. 

Hi PJ

Here is the latest from SA… Due to the lack of staffing patients are being confined to day rooms for crowd control….  They are also shutting down mall privileges because of lack of staff.  They are telling the patients that it is only going to get worse. (April 09, 2013).

NUTSHELL: Generally speaking, the patients at The Arizona State Hospital are afforded a range of privileges designed to optimize their overall state of mental and physical health and well-being. These privileges include access to various recreational and therapeutic actives and related in-hospital resources, the bulk of which are provided at different locations throughout the hospital. Such resources include a gymnasium, library, exercise room, art therapy room(s), and so on; while on the Civil side of the hospital (where approximately half of the ASH patients reside), there is an open area referred to as "The Patient Mall", which is comprised of a roughly 1/4 mile long piece of concrete lined on each side by seating areas and other like amenities intended to provide patients with a reasonably comfortably environment not confined within the walls of specific treatment units. These various privileges and related amenities are central to extensive funding that the citizens of Arizona have provided on behalf of ASH's patients over the past 15-20 years, and as illustrated in the 2004 newspaper article that I posted two days ago (see "Teaser", Mon. 04/08/13), even the federal government has emphasized the importance of granting ASH patients clear opportunity(s) to participate in therapeutic and recreational opportunities away from the limited confines of unit "day rooms", where they have nothing more to do than watch t.v. or sleep in filthy overstuffed chairs that are thoroughly wiped down about once every decade while the more rambunctious individuals (staff included) carry on with nerve wracking episodic outbursts and other like mania.     

With respect for the revelations exposed in 1999-2000 by a Medicaid investigation at ASH, these are only a few of the specific details provided at that time:

Inspectors with the Centers for Medicare & Medicaid Services reviewed 12 patient cases during a May visit to the State Hospital, at 24th and Van Buren streets. They found a hospital where patients were plunked in front of televisions or allowed to wander instead of being engaged in treatment.

The review found:

Patients have cookie-cutter, incomplete or ineffective treatment plans. One patient who had been at the hospital four months told them he couldn’t remember any treatment other than “going to the library once,” “movies and popcorn” and “medicine.”

So long as the highest paid state employees in the Arizona Department of Health Services fail to do the right thing by directly addressing the graphic wrongdoing at ASH, things there are never going to change. As illustrated in recent news reports (see this blog: "RE: Security Cutbacks At The Arizona State Hospital" March 12, 2013), recent major changes to the basic management of The Arizona State Hospital have led to shockingly unreasonable staff shortages and related safety concerns, including but not limited to a number of patient escapes. 

These changes were implemented by ASH's current supervisor, Cory"crazycorycorner" Nelson, in order to establish what he and his superiors in the Arizona Department of Health Services (namely ADHS director Will Humble) have characterized as a "CULTURE OF CARE," and central to those changes, Nelson has laid off dozens of experienced ASH staff, including a thigh number of security staff. He has done while simultaneously ignoring increasing staff concerns that arose due to shocking incidents of violence that lest more than one staff person gravely injured, and in clear contradiction to promises that he made to staff during in the hiring process in summer, 2011. Now, over the past 12 weeks, there have been several highly publicized news reports that came about in response to reports generated by ASH staff specific to safety, and subsequent investigations of those reports exposed the issue of patient escapes; this, in turn, led to three specific interviews with Cory Nelson in which he patently denied the fact that these changes have had anything but positive results. In one case, for example, he flatly rejected the notion that reduced security staff contributed to a series of patient escapes (no less than 5 in 2012) on the 10 p.m. nightly news, which in the eyes of at least some viewers, greatly brought Nelson's character and capabilities as the man most responsible for managing ASH into question.  

Thanks as always to our sources. Consistent with these other reports, I am now receiving information about the direct impacts that these staff shortages are having on the patients at ASH. Specifically, one such recent report reads like this:

"Hi PJ

Here is the latest from S.A.C.… Due to the lack of staffing patients are being confined to day rooms for crowd control….  They are also shutting down mall privileges because of lack of staff.  They are telling the patients that it is only going to get worse." 

As usual, in this specific case, we are again seeing how the ineptitude of ASH's administrators is landing squarely on the heads of the Hospital's seriously mentally ill and disabled client-patients. Cory Nelson and Will Humble have absolute direct responsibility with respect for these matters at this time, along with various other executive staff at both ASH and in ADHS/Behavioral Health Services. But it is also critical to note that the primary care providers at ASH are also involved in these issues, for they are the ones most directly responsible for each and every ASH patients' welfare, and this direct responsibility flows straight to ASH's chief medical officer, Dr. Laxman P. Patel. All of these individuals are currently complicit in allowing for the patients at ASH to be denied the general resources available at ASH, and this is wrong. Not unusual, mind you, just wrong, wrong, wrong, and 100% consistent with the standard practices at ASH, as illustrated to date by this blog, and as increasingly reflected by prime time news reporting.  

I am not going to send to much time on this today. But you can be sure that there are other developments from my end in the works, even as I write. The administrators and senior clinicians at The Arizona State Hospital are willfully engaging in substandard medical-mental health care and practice, and they are getting away with! For now. For there are a number of people today looking directly at these matters, and I am increasingly confident that it is only a matter of time before these rat bastards are held accountable to the full extent of applicable state and federal law.   

PLEASE SEE: RESOURCES IDEAS: MARCH 13, 2013 I recently posted a new listing of resources and contact information specific to the affairs of The Arizona State Hospital, and I strongly encourage anybody of like mind to do whatever you feel comfortable with in terms of defending the dignity and rights of the patient community at ASH. The administrators and clinicians at ASH are maintaining that operation at a dismally substandard level of medical care and practice, and they are getting away with lock-stock-and barrel. Patient abuse is highly illegal and when it comes the care needs of the highly vulnerable, seriously mentally disabled patients at ASH, it is sickening to the core. Let's work together and see that this matter is resolved today. I welcome any and all contacts- INCLUDING ASH STAFF, AND I ASSURE YOU THAT YOUR IDENTITY WILL NOT BE PUT AT RISK- and want to extend my sincere thanks to those of you who I have come to know thus far through my writings, and I really appreciate your willingness to consider my concerns in this context.  

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

IN CLOSING.

TO THE ADMINISTRATORS OF MONTANA STATE HOSPITAL, MAY, 2017, AND EACH AND EVERY OTHER MSH STAFF PERSON INVOLVED IN THIS STILL EMERGING PUBLIC HEALTH CARE SCANDAL.

THIS PROCESS IS ONLY BEGINNING. 

YOU LIKELY HAVE LITTLE TO NO IDEA WITH THAT MEANS, BUT YOU MIGHT WANT TO CONSIDER THE FACT THAT CMS HAS YET TO BACK OFF. 

BUT YOU DO KNOW WHO YOU ARE. OR NOT, IF YOUR OWN SENSE OF CONSCIENCE IS SO LACKING THAT NOTHING WILL CONVINCE OF WHAT IT MEANS TO DO THE RIGHT THING IN THIS CONTEXT.

OR NOT, BECAUSE WE KNOW WHO YOU ARE. EVEN IF YOU DON'T.

YET.

CONSIDER YOURSELVES SO ADVISED. YOUR TIME HAS COME, THE JIG IS UP.

AND THE BALL IS NOW IN OUR COURT.  

paoloreed@gmail.com   

First Person Testimony provided to this BLOG in November, 2016. 

Family Produced Testimonial(s). About Joel Rudd. Dr. Steven Dingle. And so on.

Just so it's clear: 
Chris Blackman is a dear friend.

The following was posted as a comment to one of my more recent articles about Arizona State Hospital, which due to ongoing unwillingness of state health care officials to meaningfully bring persons most responsible for the well known scandal at ASH to legitimate accountability.

Including and perhaps foremost with the fundamental topic of civil and human rights as they arise in law and policy, ASH's long time legal counsel, Joel "Angel of Darkness-the Mortician" Rudd.

But including as well a number of centrally involved ASH psychiatrists, namely long time Chief Medical Officer Dr. Steven Dingle, who was and is still 100% failing to abide by his obligation to ensure that the flow of medical-mental health care at ASH meets contemporary standards.

AnonymousNovember 3, 2016 at 6:49 PM

my son was in ASH with you and I agree with 

everything

corey nelson should have been placed there as a 

patient 

along with joel rudd

they falsified labs and treatment

and joel rudd helped in violating his rights and 

mine as 

guardian, where was the office of human rights in 

all this?

they took me to court to get me removed as 

guardian so they 

could let him out of ash

joel rudd was involved with all of the whole dirty 

bunch

the minute I started asking questions, they booted 

him out

dr dingle is now in charge of ash and he knew it was 

all going 

on at the time and did nothing, and neither did joel 

rudd

thank god for the reporter dave biscibing news15 he 

brought 

down the dirty bunch including , judge barbara 

spencer, joel rudd, corey nelson and donna 

noriegra. 

now the prison system has become the new DBH.

I agree, as well, to everything stated in the above.

And yes, thanks to David Biscobing, who in fact came to the staff of this Blog in early 2013 with the specific request to collaborate in investigating the issues that we had been reporting since before PJ Reed even left ASH in February, 2012. The question stills stands however:

Why didn't anyone look at the evidence we had produced before ABC Ch15's investigation, which in its early stages only served- and this is huge, their interest that is, so "only" is not fair- to confirm all data produced in this blog, which by early 2013 incolded close to three hundred and fifty full articles (as of today, February, 2017, this Blog contains four hundred and fifty six full articles).

Therein the meat of what we have been trying to make since day one:

The seriously mentally ill, including the founding author of this Blog, are continually ignored in terms of being recognized as equally rightful members of American society and culture. No one reason more underlies why ASH was allowed to directly contribute to years of substandard medical care, which as we all know by now, contributed as well to any number of preventable deaths (no less then three in the period 2010-2014), and as importantly, virtually untraceable forms of patient abuse that can only be reported in fact by ASH patients in themselves.

Until the voices of persons hospitalized in facilities such as ASH are listened, versus simply heard, the ongoing discriminations and associated subpar conditions in long term public mental health care facilities is going to continue. This is plain as it gets.

And as I have said many times before, even as a person affected by mental illness, I could not make this shit up if I had to. It takes persons of utterly depraved character to fashion this nature of criminal conduct. 

That's precisely what we are talking about.

paoloreed@gmail.com

Colby C. Wang, Rat Bastard. AKA Colby "Now fired!" Wang.

Dateline: December, 2016.
RE: Montana State Hospital, Warm Springs, MT.

Montana State Hospital.
Montana's Forgotten Suicides. 

This, the new blog, soon to come, blogspot.com.

This still to be formally founded blog project will take a concerted look at the plain fact that for decades, the state of Montana has either been one of if not the one state with the highest rate of suicide rate in the nation. A very distubing status that Montana yet again achieved in 2015: Numero Uno. This fact in itself has attracted more then a reasonable degree of attention from Montana media, but not in such a manner that there has ever been serious consideration for the causations underlying this specific history. It is one thing to highlight variously emergent resources available to the public when it comes to suicide, as in Hotline numbers and governor sponsored contact information in the context, but another thing altogether to take on the task of exploring just why in the hell Montana citizens kill themselves then citizens of any other state.
Even when some of the state's primary media resources were provided with jump start material to go after this story, they backed off like a pack of sneering hyenas.

Afraid, most likely, of shaking up the status quo hereabouts; journalism gone bad. 

In this regard, we the staff of PJ Reed The Arizona State Hospital and Patient Abuse will again do whatever it takes to delve into the matter as it still stands, with particular regard for recently exposed and still emerging corruption in the state of Montana's overall public health care system, and the associated fact that funding specific to mental health services lags far behind services in other areas of health care. 

And as personified in well known Montana traditon, the relationship that the pull your up by your own bootstraps mentality of traditional Montana cultural mentality plays in furthering indifference and neglect that undeniably contributes to this ongoing crisis as it still stands in 2016. We have our work to do, yes, but already we can see as bright as day that this is going to be one monster of a good story.

A story beginning with the sordid presence of one:
Colby C. Wang, M.D.
Or, more succinctly:
Colby "Now fired!" Wang

As it should be. And should have been. Because it was a good 18-19 months ago that this Rat Bastard was identified as who and what he is. In relation to which we the BLOG took good faith action is seeking to draw the attention of Wang's, employer, The Montana State Hospital. And, as usual in terms of how this always goes (quite frankly), because those individuals employed at said hospital and most in a position to remedy the matter blatantly refused to do the right thing. Thus permitting the harmful impacts of Wang's ineptitide and associated abuse of his entrusted authority to continue unabated until we the BLOG were forced to go through it all over again. All of it.

And while we are still researching to precise stick that broke the proverbial camel's back in this particular debacle, the plain fact is, that this doctor met his fate in direct relation to the filings we the BLOG submitted to Montana Department of Health and Human Services. That's right. Sometime in late October, 2016, Wang was fired. Thus earning this new writing projects first official nickname.

                              Colby "Now fired!" Wang

First encountered in early summer, 2015, yet another highly questionable licensed psychiatrist employed in one the nation's various state hospitals, The Montana State Hospital (MSH), Warm Springs, MT, this man accrued an investigative file no less then 2.5" thick and maintained by the good folks with Montana Disability Rights, a non-profit entity required by federal law to investigate reports of violations under state and federal law in the context of disabiity.  This record was complied during the entirety of his seventeen months of employ in Montana, beginning with his being hired by the Montana Department of Health and Human Services and appointed as a primary care physician at MSH, and his finally being fired in October, 2016. But only after the unwillingess of Hospital officials to do the right thing when they first had clear eveidence to the effect. Which is where we come in. We are still amassing out data base and associated evidential materials about the the particular Rat Bastard's now proven ineptitude, but to date there is no shortage of this stuff.

Because somebody had to do something. And nobody else would. 

Indeed, as in Arizona, we are today doing this on behalf of persons affected by serious mental illness across the board, in Montana and beyond, because- you guessed it- somebody has to. Sadly, but not suprisingly, over the last eighteen months we have sought to compel a number of Montana based mental health care advocacy resources to take a good hard look at this state's sole long term public mental health care facility. Only to find- again, just as we did in Arizona circa 2010 and on into 2015- that none of the state employed individuals best able to have addressed this Rat Bastard's misconduct refused to do so.

Putting it on us.

As famed author Clifford W. Beers put it in his seminal text, A Mind That Found Itself  (first publication 1905): 

"Point me to injustice, and allow me do the rest."

This article must remain short, for we are still setting up out new office, but it should serve to give fair warning to what comeing next in terms of PJ Reed The Arizona State Hospital and Patient Abuse's newest investigative project.

IN CLOSING: By the way, "Dr." Wang. You can run. But you can't hide. Welcome to the realm of guerrilla journalism, asshole.

See you in court. 

paoloreed@gmail.com

Last Article?

"Mental illness is not just a matter of health. It is a matter of humanity, in which we all have value." 
         Jason Deshaw. August 10. 2016

Even if I don't make it out of this, myself affected in my own right by serious mental illness, and the associated struggles that I personally deal with on a day to day basis, my work to date has always been about compelling others to "do the right thing." Has never in that sense been about me, this project, outside of my own trials and tribulations as a patient in Arizona's sole long term public mental health care facility, and the relationship that I have even todeay with the ones still hospitalized there (and any newcomers there, as well). One way or the other, again- even if I don't make it out of this- I will continue in whatever way I can to call on anyone of reasonable conscience to take a long moment and consider the need, the very real need, for American society in general to work its ass off in terms of diminishing the abject discrimination(s) that have historically futhered the presence of grossly unjust and substandard health care pratices so graphically illustrated by very recent history at The Arizona State Hospital. 

For in fact, I believe that I will will within 24 hours either pass to the other side, a transition that I very familiar with in terms of thinking and sentiment, or be returned to a state hospital or other like facility (and you are goddamn right it will not be the Arizona State Hospital) via legally mandated standards of care. 

I have, in fact, been re-hospitalized on no less then two occasions since my February, 2012, discharge from ASH. I have never determined whether my time at ASH has much of- or one hell of a lot of- direct relationship with my ongoing struggles with anxiety (which only arose after I become an ASH patient) and enhanced post traumatic stress disorder (where in the past my issues with PTSD were limited to the abuse I suffered as a child, I today have dreams far too often about the fear I dealt with when engaged in doing the right thing as an ASH patient, and the related retaliative efforts of ASH administrators and their counter parts in clinical services to shut me up, fear as a matter of plain fact of being murdered or otherwise brutally harmed). No matter, however. My life is mine to deal with, and just as I have always tried, I will to the best of my ability hold no unjusitifed vehemenence towards anyone not as evil as the ones running ASH.

Because they have long had it coming. To willfully engage in furthering the sickening mistreatment of persons highly at risk of abuse, negligence, and societally embedded discrimination is indeed a crime against humanity itself. This applies not only to the seriously mentally ill population currently residing coast to coast in America's public mental hostpitals, but also to at-risk children, and the elderly across the board.  

And today, as it appears that I may be on the road to more inpatient mental health treatment, this on the basis of good faith concerns of mental health professionals familiar with my state of mind and emotion at this time, I only wish that my work has in fact made a difference. 

Yes, many have to date assured me that my efforts have been central to thus far applied "reform" at ASH (for lack of a better word), but I know that there is far more to do, regardless of whatever I have brought to the table over the last four+ years. My idea of making a difference cannot be quantified in any capacity. So long as I know that I doing the right thing on a day in day out basis, I am doing something right. 

Much of this hardly matters to me at times like now, though, for I am in relative psychiatric crisis, as it stands with respect for diagnosis of major depressive disorder and associated suicidal ideation, so I therein have other things on my mind right now. I will as always roll with it to the best of my given strengths and ability. One way or the other, my spirit in the basic sense of symbolic representation of human interests will always remain. As it has with respect for other similarly dedicated human rights activists.  

  

And, in context, with direct respect for the fact that I have spent at least some time in mental hospitals other then ASH, I feel it is of note that to date, I have not been compelled to become a voice of dissent in relation to such facilities. ASH is almost but not quite unique, a particuarly monstorous example of human society's most graphics shortfalls when it comes to public health care across the board. Deeply disturbing depravity that forced me in no uncertain terms to initiate and follow through with my decision to bring scandal to light, as a requisite means to see that the issues most at stake are addressed and abolished once and for all. And while I may have done okay, all of us can as well, and likely do far more... If that is, one has what it takes. 

I wish- not so much hope- but wish that my work will continue. As in, that I come out of this in better condition that I am today, as I write this. 

Big thanks, as always, and one way or the other, to each and every person associated with the effort to bring Arizona's sole long term public mental hospital up to par with established medical standards. You are down to the last of remarakble character and beauty.

And you know who you are.

paoloreed@gmail.com