Article Figures & Data
Figures
- Figure 1.
Method of analysis of DOJ Findings Letters sent to state hospitals from 2003 through 2009.
Tables
Date Findings Letter Source Group I 12/8/2009 Georgia state psychiatric hospitals 8/24/2009 Ancora Psychiatric Hospital, Hammonton, NJ 1/30/2009 Kings County Hospital Center, Brooklyn, NY* 1/15/2009 Northwest Georgia Regional Hospital, Rome, GA* 5/30/2008 Georgia Regional Hospital, Atlanta, GA* 1/9/2008 Oregon State Hospital, Portland, OR* 8/6/2007 Connecticut Valley Hospital, Middletown, CT* Group II 5/30/2006 St. Elizabeth's Hospital, Washington, DC 5/2/2006 Patton State Hospital, San Bernardino, CA 5/2/2006 Atascadero State Hospital, Atascadero, CA 7/5/2005 Vermont State Hospital, Waterbury, VT 6/27/2005 Napa State Hospital, Napa, CA 3/17/2004 North Carolina mental health facilities 2/19/2004 Metropolitan State Hospital, Norwalk, CA 5/13/2003 Metropolitan State Hospital, Norwalk, CA Group III All Findings Letters ↵* Findings letters used to create the core set of TOIs.
Identified Leading Text of Interest (TOI) As Shown Essentially the Same Duplicates Within Essentially the Same Group Similar Language Similar Concept _____ shall ensure that their patients receive accurate, complete, and timely assessments and diagnoses, consistent with generally accepted professional standards, and that these assessments and diagnoses drive treatment interventions. More particularly, the _____ shall: 4 9 1 set of 3
1 set of 2Review and revise, as appropriate, psychiatric assessments of all patients, providing clinically justified current diagnoses for each patient, and removing all diagnoses that cannot be clinically justified. Modify treatment and medication regimens, as appropriate, considering factors such as the patient's response to treatment, significant developments in the patient's condition, and changing patient needs. 4 6 1 set of 3 1 The _____ shall develop and implement an integrated treatment planning process consistent with generally accepted professional standards. More particularly, the _____ shall: 4 8 1 set of 4
1 set of 21 Develop and implement policies and procedures regarding the development of individualized treatment plans consistent with generally accepted professional standards of care. 4 7 1 set of 3
1 set of 2Provide adequate and appropriate psychiatric and other mental health services, including adequate psychological services and behavioral management, in accordance with generally accepted professional standards. 3 3 1 set of 3 4
2 duplicates3
2 duplicatesEnsure that all psychotropic medications are: prescribed in therapeutic amounts;
tailored to each patient's individual symptoms;
monitored for efficacy against clearly-identified target variables and time frames;
modified based on clinical rationales; and
properly documented.
5 4 1 set of 3 1 1 Within the limitations of the court-imposed confinement and public safety, the State should pursue actively the appropriate discharge of patients and ensure that they are provided services in the most integrated, appropriate setting that is consistent with patients' needs. More particularly, _____ should: 4 8 1 set of 3
1 set of 22 Provide its patients with a safe and humane environment and protect them from harm. At a minimum, 7 5 2 sets of 2 _____ should ensure that seclusion and restraints are used in accordance with generally accepted professional standards. Absent exigent circumstances—i.e., when a patient poses an imminent risk of injury to himself or a third-party—any device or procedure that restricts, limits or directs a person's freedom of movement (including, but not limited to, chemical restraints, mechanical restraints, physical/manual restraints, or timeout procedures) should be used only after other less restrictive alternatives have been assessed and exhausted. More particularly, _____ should: 4 3 3 (2 were duplicates) Ensure that restraints: are used only when persons pose an immediate threat to themselves or others and after a hierarchy of less restrictive measures has been exhausted;
are not used in the absence of, or as an alternative to, active treatment, as punishment, or for the convenience of staff;
are not used as part of a behavioral intervention;
are terminated as soon as the person is no longer an imminent danger to himself or others; and
are used in a reliably documented manner.
3 6 2 sets of 2 1 3 (2 were duplicates) _____ shall provide medical and nursing services to its patients consistent with generally accepted professional standards. Such services should result in patients of the _____ receiving the individualized services, supports, and therapeutic interventions, consistent with their treatment plans. More particularly, the _____shall: 3 5 1 set of 2 2 (2 were duplicates) Establish an effective infection control program to prevent the spread of infections or communicable diseases. More specifically, the _____ shall: actively collect data with regard to infections and communicable diseases
analyze these data for trends;
initiate inquiries regarding problematic trends;
initiate necessary corrective action;
monitor to ensure that appropriate remedies are achieved;
integrate this information into the quality assurance review of the _____; and
ensure that nursing staff implement the infection control program.
3 4 2 sets of 2 1 2 TOI, text of interest; the number indicates the number of findings letters in which the TOI was identified; as shown, the text was written exactly the same as the identified TOI; essentially the same, ≥50% overlap; similar language, <50% overlap; similar concept, paraphrased TOI; the duplicates are TOIs that were written exactly the same within a specific category (e.g., one set of two: within the specified category, two TOIs were written exactly the same in two separate findings letters; one set of three: within the specified category, three TOIs were written exactly the same in three separate findings letters.
Identified Text of Interest State Psychiatric Hospitals, Georgia (12/08/09) Ancora Psychiatric Hospital, Winslow, NJ (8/24/09) Kings County Hospital, NY (1/30/09) NW Georgia Regional Hospital-Rome (1/5/09) George Regional Hospital-Atlanta (5/30/08) _____ shall ensure that their patients receive accurate, complete, and timely assessments and diagnoses, consistent with generally accepted professional standards, and that these assessments and diagnoses drive treatment interventions. More particularly, _____ shall: As shown, page 40, C.1. n/a As shown, page 43, B.1. As shown, page 55, B.1. As shown, page 51, B.1. Review and revise, as appropriate, psychiatric assessments of all patients, providing clinically justified current diagnoses for each patient, and removing all diagnoses that cannot be clinically justified. Modify treatment and medication regimens, as appropriate, considering factors such as the patient's response to treatment, significant developments in the patient's condition, and changing patient needs. As shown, page 41, C.1.g. n/a As shown, page 44, B.1.g. As shown, page 56, B.1.g. As shown, page 52, B.1.g. The _____ shall develop and implement an integrated treatment planning process consistent with generally accepted professional standards. More particularly, the _____ shall: As shown, page 41, C.2. Similar Language, page 37, E.3. As shown, page 45, B.2. As shown, page 56, B.2. As shown, pages 52 & 53, B.2. Develop and implement policies and procedures regarding the development of individualized treatment plans consistent with generally accepted professional standards of care. Essentially the same I, page 41, C.2.a. n/a As shown, page 45, B.2.a. As shown, page 56, B.2.a. As shown, page 53, B.2.a. _____ shall ensure that their patients receive accurate, complete, and timely assessments and diagnoses, consistent with generally accepted professional standards, and that these assessments and diagnoses drive treatment interventions. More particularly, _____ shall: Essentially the same I, page 36, B.1. Essentially the same I, page 48, B.2.a. Essentially the same I, page 51, C.2.a. Essentially the same II, page 12, IX.B. Essentially the same II, page 9, VIII.B. Review and revise, as appropriate, psychiatric assessments of all patients, providing clinically justified current diagnoses for each patient, and removing all diagnoses that cannot be clinically justified. Modify treatment and medication regimens, as appropriate, considering factors such as the patient's response to treatment, significant developments in the patient's condition, and changing patient needs. Essentially the same I, page 37, B.1.g. Essentially the same I, page 49, B.2.a.vi. Essentially the same II, page 52, C.2.a.vi. n/a n/a The _____ shall develop and implement an integrated treatment planning process consistent with generally accepted professional standards. More particularly, the _____ shall: Essentially the same I, page 38, B.2. Essentially the same I, page 47, B.1. Essentially the same I, page 49, C.1. Essentially the same II, page 12, IX.A. Essentially the same II, page 9, VIII.A. Develop and implement policies and procedures regarding the development of individualized treatment plans consistent with generally accepted professional standards of care. As shown, page 38, B.2.a. Essentially the same III, page 47, B.1.a. _____ shall ensure that their patients receive accurate, complete, and timely assessments and diagnoses, consistent with generally accepted professional standards, and that these assessments and diagnoses drive treatment interventions. More particularly, _____ shall: Essentially the same III, page 27, B.2.a. Essentially the same IV, page 20, A.1.b. n/a n/a Essentially the same V, page 45, B. Review and revise, as appropriate, psychiatric assessments of all patients, providing clinically justified current diagnoses for each patient, and removing all diagnoses that cannot be clinically justified. Modify treatment and medication regimens, as appropriate, considering factors such as the patient's response to treatment, significant developments in the patient's condition, and changing patient needs. Essentially the same I, page 28, B.2.a.6. Essentially the same III, page 22, B.3.b. n/a Similar Language I, page 41, A.4. Essentially the same IV, page 45, B.1.b. The _____ shall develop and implement an integrated treatment planning process consistent with generally accepted professional standards. More particularly, the _____ shall: Essentially the same I, page 26, B.1. Essentially the same III, page 19, A.1.a. n/a n/a Essentially the same IV, page 44, A. Develop and implement policies and procedures regarding the development of individualized treatment plans consistent with generally accepted professional standards of care. Essentially the same II, page 26, B.1.A. Essentially the same II, page 20, A.1.a.1. n/a Essentially the same II, page 41, A.5. Essentially the same I, page 44, A.1. Identified Text of Interest State Psychiatric Hospitals, Georgia (12/08/09) Ancora Psychiatric Hospital, Winslow, NJ (8/24/09) Kings County Hospital, NY (1/30/09) NW Georgia Regional Hospital-Rome (1/5/09) George Regional Hospital-Atlanta (5/30/08) Provide adequate and appropriate psychiatric and other mental health services, including adequate psychological services and behavioral management, in accordance with generally accepted professional standards. As shown, page 42, C.2.f. Similar Concept I, page 36, E.1. Essentially the same I, page 46, B.2.f. As shown, page 57, B.2.f. As shown, page 54, B.2.f. Ensure that all psychotropic medications are: prescribed in therapeutic amounts;
tailored to each patient's individual symptoms;
monitored for efficacy against clearly-identified target variables and time frames;
modified based on clinical rationales; and
properly documented.
Essentially the same I, page 44, C.2.o. n/a As shown, page 48, B.3.c. Essentially the same I, page 59, B.2.o. Essentially the same I, page 55, B.2.o. Within the limitations of the court-imposed confinement and public safety, the State should pursue actively the appropriate discharge of patients and ensure that they are provided services in the most integrated, appropriate setting that is consistent with patients' needs. More particularly, _____ should: n/a Similar Concept I, page 32, A.1. Essentially the same, page 55, F. Essentially the same II, page 65, F. Essentially the same II, page 61, F. Provide adequate and appropriate psychiatric and other mental health services, including adequate psychological services and behavioral management, in accordance with generally accepted professional standards. Essentially the same I, page 38, B.2.g. n/a Similar Concept II, page 59, C.2.d. Similar Language I, page 12, IX. C. & D. Similar Language I, page 10, VII. C. & D. Ensure that all psychotropic medications are: prescribed in therapeutic amounts;
tailored to each patient's individual symptoms;
monitored for efficacy against clearly-identified target variables and time frames;
modified based on clinical rationales; and
properly documented.
As shown, page 40, B.3.d. As shown, page 51, B.2.c.iv. As shown, page 56, C.2.c.iv. n/a n/a Within the limitations of the court-imposed confinement and public safety, the State should pursue actively the appropriate discharge of patients and ensure that they are provided services in the most integrated, appropriate setting that is consistent with patients' needs. More particularly, _____ should: Essentially the same III, page 45, E. As shown, page 55, C. As shown, page 63, G. Essentially the same IV, page 13, IX.J. Essentially the same IV, page 11, VIII.J. Provide adequate and appropriate psychiatric and other mental health services, including adequate psychological services and behavioral management, in accordance with generally accepted professional standards. Similar Concept II, page 33, B.2.d. Similar Language II, page 21, B.3. Essentially the same I, page 26, A.1.a. n/a Similar Language III, page 49, D.1, & page 51, D.2. Ensure that all psychotropic medications are: prescribed in therapeutic amounts;
tailored to each patient's individual symptoms;
monitored for efficacy against clearly-identified target variables and time frames;
modified based on clinical rationales; and
properly documented.
As shown, page 30, B.2.c.4. n/a Similar Concept I, page 28, A.3.a. Similar Language I, page 42, A. 11. Essentially the same II, page 49, D.1.c. Within the limitations of the court-imposed confinement and public safety, the State should pursue actively the appropriate discharge of patients and ensure that they are provided services in the most integrated, appropriate setting that is consistent with patients' needs. As shown, page 34, C. Essentially the same IV, page 22, D.1. Similar Concept II, page 31, F.1. Essentially the same V, page 49, I. As shown, page 48, C. Identified Text of Interest State Psychiatric Hospitals, Georgia (12/08/09) Ancora Psychiatric Hospital, Winslow, NJ (8/24/09) Kings County Hospital, NY (1/30/09) NW Georgia Regional Hospital-Rome (1/5/09) George Regional Hospital-Atlanta (5/30/08) _____ should provide its patients with a safe and humane environment and protect them from harm. At a minimum, _____ should: Essentially the same I, page 37, B. n/a As shown, page 41, A. Essentially the same II, page 53, A. Essentially the same II, page 49, A. Ensure that seclusion and restraints are used in accordance with generally accepted professional standards. Absent exigent circumstances —i.e., when a patient poses an imminent risk of injury to himself or a third-party—any device or procedure that restricts, limits or directs a person's freedom of movement (including, but not limited to, chemical restraints, mechanical restraints, physical/manual restraints, or timeout procedures) should be used only after other less restrictive alternatives have been assessed and exhausted. More particularly, _____ should: n/a n/a Essentially the same I, page 50, C.2. Essentially the same II, page 60, C. n/a Ensure that restraints: are used only when persons pose an immediate threat to themselves or others and after a hierarchy of less restrictive measures has been exhausted;
are not used in the absence of, or as an alternative to, active treatment, as punishment, or for the convenience of staff;
are not used as part of a behavioral intervention;
are terminated as soon as the person is no longer an imminent danger to himself or others; and
are used in a reliably documented manner.
Essentially the same I, page 45, D.4. Similar Concept, page 36, D.1. As shown, page 50, C.3. As shown, page 60, C.2. As shown, pages 56 & 57, C.2. _____ should provide its patients with a safe and humane environment and protect them from harm. At a minimum, _____ should: As shown, page 34, A. As shown, page 45, A.3. As shown, page 44, A.1. Essentially the same III, page 13, IX.K. Essentially the same III, page 11, VIII.K. Ensure that seclusion and restraints are used in accordance with generally accepted professional standards. Absent exigent circumstances—i.e., when a patient poses an imminent risk of injury to himself or a third-party—any device or procedure that restricts, limits or directs a person's freedom of movement (including, but not limited to, chemical restraints, mechanical restraints, physical/manual restraints, or timeout procedures) should be used only after other less restrictive alternatives have been assessed and exhausted. More particularly, _____ should: As shown, page 42, C. As shown, page 43, A.2. As shown, page 47, B. Similar Concept I, page 12, IX.E. Similar Concept I, page 10, VIII.E. Ensure that restraints: are used only when persons pose an immediate threat to themselves or others and after a hierarchy of less restrictive measures has been exhausted;
are not used in the absence of, or as an alternative to, active treatment, as punishment, or for the convenience of staff;
are not used as part of a behavioral intervention;
are terminated as soon as the person is no longer an imminent danger to himself or others; and
are used in a reliably documented manner.
Essentially the same I, page 42, C.4. Essentially the same II, page 44, A.2.a. Essentially the same III, page 47, B.1. n/a n/a _____ should provide its patients with a safe and humane environment and protect them from harm. At a minimum, _____ should: As shown, page 23, A.1. n/a n/a As shown, page 51, K. As shown, page 61, G. _____ should ensure that seclusion and restraints are used in accordance with generally accepted professional standards. Absent exigent circumstances— i.e., when a patient poses an imminent risk of injury to himself or a third-party—any device or procedure that restricts, limits or directs a person's freedom of movement (including, but not limited to, chemical restraints, mechanical restraints, physical/manual restraints, or timeout procedures) should be used only after other less restrictive alternatives have been assessed and exhausted. More particularly, _____ should: As shown, page 24, A.2. Similar Concept II, page 20, A.2.a. Essentially the same III, page 29, B. n/a n/a Ensure that restraints: are used only when persons pose an immediate threat to themselves or others and after a hierarchy of less restrictive measures has been exhausted;
are not used in the absence of, or as an alternative to, active treatment, as punishment, or for the convenience of staff;
are not used as part of a behavioral intervention;
are terminated as soon as the person is no longer an imminent danger to himself or others; and
are used in a reliably documented manner.
Essentially the same II, page 24, A.2.a. Similar Language I, page 20, A.2.b. Similar Concept I, page 30, B.2. Similar Concept II, page 46, C.18. Essentially the same IV, page 59, F.1. Identified Text of Interest State Psychiatric Hospitals, Georgia (12/08/09) Ancora Psychiatric Hospital, Winslow, NJ (8/24/09) Kings County Hospital, NY (1/30/09) NW Georgia Regional Hospital-Rome (1/5/09) George Regional Hospital-Atlanta (5/30/08) _____ shall provide medical and nursing services to its patients consistent with generally accepted professional standards. Such services should result in patients of the _____ receiving individualized services, supports, and therapeutic interventions, consistent with their treatment plans. More particularly, the _____ shall: As shown, page 46, E. n/a Essentially the same I, page 52, D. As shown, page 62, D. As shown, page 58, D. Establish an effective infection control program to prevent the spread of infections or communicable diseases. More specifically, the _____ shall: actively collect data with regard to infections and communicable diseases;
analyzed these data for trends;
initiate inquiries regarding problematic trends;
initiate necessary corrective action;
monitor to ensure that appropriate remedies are achieved;
integrate this information into the quality assurance review of the _____; and
ensure that nursing staff implement the infection control program.
As shown, page 48, E.11. n/a Similar Concept I, page 53, D.8. As shown, page 63, D.11. As shown, page 60, D.11. _____ shall provide medical and nursing services to its patients consistent with generally accepted professional standards. Such services should result in patients of the _____ receiving individualized services, supports, and therapeutic interventions, consistent with their treatment plans. More particularly, the _____ shall: Essentially the same II, page 44, D. n/a Essentially the same III, page 60, D. Similar Concept I, page 13, IX.H. Similar Concept I, page 10, VIII.H. Establish an effective infection control program to prevent the spread of infections or communicable diseases. More specifically, the _____ shall: actively collect data with regard to infections and communicable diseases;
analyzed these data for trends;
initiate inquiries regarding problematic trends;
initiate necessary corrective action;
monitor to ensure that appropriate remedies are achieved;
integrate this information into the quality assurance review of the _____; and
ensure that nursing staff implement the infection control program.
Essentially the same I, page 45, D.9. n/a Essentially the same I, page 62, D.9. n/a n/a _____ shall provide medical and nursing services to its patients consistent with generally accepted professional standards. Such services should result in patients of the _____ receiving individualized services, supports, and therapeutic interventions, consistent with their treatment plans. More particularly, the _____ shall: n/a Essentially the same IV, page 21, B.2. n/a n/a Essentially the same IV, page 52, D.3. Establish an effective infection control program to prevent the spread of infections or communicable diseases. More specifically, the _____ shall: actively collect data with regard to infections and communicable diseases;
analyzed these data for trends;
initiate inquiries regarding problematic trends;
initiate necessary corrective action;
monitor to ensure that appropriate remedies are achieved;
integrate this information into the quality assurance review of the _____; and
ensure that nursing staff implement the infection control program.
n/a Similar concept II, page 22, B.5. Similar language I, page 31, D.1. Essentially the same II, page 48, F.2. Essentially the same II, page 55, D.6.b. Identified Text of Interest State Psychiatric Hospitals, Georgia (12/08/09) Ancora Psychiatric Hospital, Winslow, NJ (8/24/09) Kings County Hospital, NY (1/30/09) NW Georgia Regional Hospital-Rome (1/5/09) George Regional Hospital-Atlanta (5/30/08) Oregon State Hospital (1/9/08) Ensure that, before nursing staff work directly with patients, they have completed successfully competency-based training regarding mental health diagnoses, related symptoms, psychotropic medications, identification of side effects of psychotropic medications, monitoring of symptoms and target variables, and documenting and reporting of the patient's status. As shown, page 47, E.4. n/a Essentially the same I, page 53, D.4. As shown, page 62, D.4. As shown, page 59, D.4. Essentially the same I, page 44, D.2. Ensure that nursing staff accurately and routinely monitor, document, and report patients' symptoms and target variables in a manner that enables treatment teams to assess the patient's status and to modify, as appropriate, the treatment plan. As shown, page 47, E.5. Similar Concept, page 35, C.7. Essentially the same I, page 53, D.5. As shown, pages 62 & 63, D.5. As shown, page 59, D.5. Essentially the same I, page 44, D.3. Ensure that nursing staff actively participate in the treatment team process and provide feedback on patients' responses, or lack thereof, to medication and behavioral interventions. As shown, page 47, E.6. n/a As shown, page 53, D.6. As shown, page 63, D.6. As shown, page 59, D.6. As shown, page 44, D.4. Ensure that each patient's treatment plan identifies: the diagnoses, treatments, and interventions that nursing and other staff are to implement;
the related symptoms and target variables to be monitored by nursing and other unit staff; and
the frequency by which staff need to monitor such symptoms
As shown, page 48, E.10. n/a As shown, page 53, D.7. As shown, page 63, D.10. As shown, page 59, D.10. As shown, page 45, D.8. Ensure sufficient nursing staff to provide nursing care and services in accordance with generally accepted professional standards. As shown, page 47, E.3. n/a n/a As shown, page 62, D.3. As shown, page 58, D.3. As shown, page 44, D.1. Ensure that nursing staff are appropriately supervised to ensure that they administer, monitor, and record the administration of medications and any errors according to generally accepted professional standards. As shown, page 47, E.7. Similar Concept, page 35, C.3. n/a As shown, page 63, D.7. As shown, page 59, D.7. Similar Concept, page 44, D.5. Ensure that, prior to assuming their duties and on a regular basis thereafter, all staff responsible for the administration of medication have completed successfully competency-based training on the completion of the Medication Administration Record. As shown, page 47, E.8. n/a n/a As shown, page 63, D.8. As shown, page 59, D.8. As shown, page 44, D.6. Ensure that all failures to properly sign the Medication Administration Record and/or the Narcotics Log are treated as medication errors, and that appropriate follow-up occurs to prevent reoccurrence of such errors. As shown, page 47, E.9. n/a n/a As shown, page 63, D.9. As shown, page 59, D.9. Essentially the same, page 44, D.7. ↵* Text of interest in the Nursing Section was observed in only 6 of the 15 Findings Letters.
