By Mike Rezendes
The Boston Globe
The agency that accredits hospitals, prompted by what it called “patient safety concerns,” conducted a surprise inspection of troubled Bridgewater State Hospital late last month and gave the facility 45 days to respond to the findings or risk losing accreditation.
The Joint Commission did not release details of what it described as “a preliminary report” from the May 30 inspection. But Marylou Sudders, a former Massachusetts Department of Mental Health commissioner, said the agency does not “send their surveyors out unless there are serious allegations or concerns.”
Darren Duarte, spokesman for the Department of Correction, acknowledged the surprise inspection, which comes after a series of articles in the Globe highlighting a patient death and widespread use of restraints.
“We are currently engaged with the Joint Commission following their visit last month, including the number of steps we are taking to ensure patients at Bridgewater State Hospital receive appropriate care,” he said in a prepared statement.
Despite its name, Bridgewater is a medium-security prison housing about 280 men involved with the criminal justice system who are diagnosed as mentally ill. The Joint Commission has granted the facility accreditation as a behavioral health care provider, not as a hospital.
Accreditation by the Joint Commission, a nonprofit that accredits about 20,500 health care entities in the United States, is widely viewed as essential to the credibility of hospitals and other health care institutions, said Sudders, noting that some states license hospitals without further review if they have obtained Joint Commission approval.
“It’s the gold standard,” said Sudders, now an associate professor at Boston College Graduate School of Social Work. “It’s not a minimal standard. It’s a higher standard.”
The Joint Commission did not specifically identify its concerns in its public statements, but the Globe has reported that Bridgewater clinicians and prison guards have routinely used seclusion and restraints to control patients diagnosed as severely mentally ill, often in violation of state law, regulations, and Bridgewater’s own policies.
In February, the Globe reported on the circumstances surrounding the 2009 death of Joshua K. Messier , a Bridgewater mental health patient who died as guards were strapping his wrists and ankles to a small bed. After Messier’s death, the Globe found, Bridgewater’s use of seclusion and restraints climbed 27 percent through the end of 2013, even as other forensic hospitals dramatically reduced their reliance on those measures.
The Joint Commission’s standards say that seclusion and restraints “pose an inherent risk to the physical safety and psychological well being of the individual served” and should be used “only in an emergency where there is an imminent risk of an individual served physically harming herself or himself or others.”
Video evidence and pretrial testimony in a lawsuit filed by Messier’s family show that Messier was calm in the minutes before he was placed in restraints, and that his body was limp as seven guards crowded into his cell applied the restraints. The state medical examiner ruled Messier’s death a homicide, though the district attorney chose not to prosecute.
State Representative Kay Khan a Newton Democrat who is a longtime advocate for improving management at Bridgewater, said the Joint Commission’s findings should lead to greater scrutiny of the facility and the creation of a working group of lawmakers to study management of the facility and recommend changes.
“There’s a tremendous need for improvement,” Khan said. “Sometimes when things like this happen it’s an opportunity to take a look at what’s happening and consider other programs around the country to see what’s working elsewhere.”
Roderick MacLeish Jr., an attorney who has filed a class-action lawsuit on behalf of patients at Bridgewater who are not serving criminal sentences, said he welcomed the Joint Commission’s visit.
“My clients welcome further review of Bridgewater by the Joint Commission or any other organization — particularly with respect to the use of seclusion and restraints,” he said, adding that the commission should also review why Bridgewater is housing developmentally disabled patients and other severely ill patients.
“Bridgewater is no place for autistic, mentally retarded, or chronically mentally ill patients not convicted of crimes,” MacLeish said.
An official at the Executive Office of Public Safety and Security, which oversees the state prison system, recently told the Globe that Bridgewater officials have cut their use of restraints by 98 percent this year, and their use of seclusion by more than 60 percent.
“While the Joint Commission has not issued its final report yet, we have shared with them our significant reduction in the use of seclusion and restraint over the past six months and our commitment to eliminating the use of seclusion and restraint in all but the most exceptional circumstances going forward,” Duarte said Monday.
Bridgewater officials spent years striving for Joint Commission accreditation, finally winning the organization’s seal of approval as a behavioral health care provider in 2003.
“We needed to make a lot of changes, training changes, staff changes, beefing up rehabilitation services,” said then-Bridgewater superintendent Kenneth Nelson. “It took time.”
The Joint Commission awarded the accreditation, which it has renewed every three years, based on an understanding that Bridgewater would reduce its use of seclusion and restraints.
At the time, Joint Commission surveyors noted that patients were sometimes placed in isolation or strapped to their beds because they refused to take medication or had a “history of self-abuse.” Mentally ill inmates, the surveyors said, should be secluded or restrained only if they were in danger of hurting themselves, other patients or inmates, or staff.
But a recent Globe analysis of seclusion and restraint data provided by Bridgewater officials showed that little had changed with regard to the use of seclusion and restraints since 2003. In fact, clinicians and guards at the facility increased their reliance on those tactics by 16 percent from 2004 through the end of 2013, the Globe found.
And records produced by MacLeish as part of the class-action suit show that his clients have been secluded and restrained for extended periods of time for minor transgressions of prison protocol that do not constitute the safety emergency required under state law.
After the Joint Commission receives and evaluates a response from the Department of Correction, it may take a variety of actions, ranging from accreditation to outright denial of accreditation, which would severely damage Bridgewater’s reputation.