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Saint Elizabeths Hospital Settlement
Summary by
DC Department of Mental Health
May 10, 2007




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Summary of the Settlement between the District of Columbia and the Department of Justice

Treatment will be individualized and supported by a multidisciplinary team that works together to develop an integrated plan that is modified as needed based upon the individual patientís response. The goal of treatment will be placement of the patient in the least restrictive environment.

  • Treatment at Saint Elizabeths will strengthen and support an individualís rehabilitation and recovery.
  • Patients will be encouraged to participate in treatment goals and treatment options.
  • Treatment will be individualized, based upon the patientís presenting symptoms and history to meet the needs of each patientís goals.
  • Treatment will be provided by interdisciplinary teams that work together to address the individualís needs so that he or she can be released to the community.
  • Each patient will have a treatment plan that is updated as needed based upon the patientís response to treatment, but at least every sixty days and which specifically identifies the therapeutic means by which the treatment goals are addressed, monitored, reported and documented.
  • Each patient will receive assessments by the clinical team which includes psychiatrists, social workers, nurses, psychologists, pharmacists, and rehabilitation specialists on a regular and as needed basis, and treatment will reflect these assessments.

Patients will be treated with respect and will be free from abuse and neglect.

  • Seclusion, restraint or involuntary psychotropic medications will be used only when the patient poses an imminent risk of injury to self or others and only after less intrusive alternatives have been considered and determined to be inappropriate.
  • Staff will be trained specifically in the use of seclusion, restraint and involuntary medication.
  • Patients are informed every thirty minutes of the behavioral criteria for release from the intervention.
  • The use of special interventions will be of limited duration.

There will be highly qualified staff in a sufficient number to implement this agreement.

  • Additional psychiatrists, nurses, psychologists, social workers, pharmacists and other staff will be hired to ensure an adequate work force and to provide proper supervision of patients. Specifically, the Hospital will ensure each psychiatrist on an acute care ward is not responsible for more than 12 patients, and for no more than 24 on a long term care ward.
  • There will be on going training for all staff on all areas of treatment including but not limited to best practices in diagnosing and development of individualized assessments, development of behavioral interventions, the use of interdisciplinary teams and development of integrated treatment plans.
  • Quality assurance measures will be in place for monitoring clinical practices including behavioral treatment interventions.
  • Staff will be trained on incident reporting.

Patients will receive treatment in a safe and humane environment.

  • Saint Elizabeths will improve its infection control program.
  • The Hospital will have the capacity to regularly review the units and areas of the Hospital to which patients have access for safety.
  • The Hospital shall update its fire safety and evacuation plan.
  • The Hospital shall identify and remove all hazardous and unsanitary conditions in living units and kitchen areas.

Saint Elizabeths Hospital will have a quality improvement program that provides for effective monitoring, reporting, and corrective action.

  • Within four months, the Hospital will submit corrective action plans concerning integrated treatment planning, mental health assessments, incident management, and restraints, seclusion, and emergency involuntary medication. The plans shall have specific steps to be taken with timelines and shall identify the person responsible for implementing the action steps and the quality assurance mechanism to evaluate the status of implementation.
  • The Hospital shall implement a comprehensive incident management program that identifies incidents to be reported, that is responsive to incidents or allegations of abuse or neglect so that the individuals involved are protected and that reviews incidents and develops appropriate corrective and preventative actions addressing the problems identified.
  • The Hospital shall have a system that tracks and trends incidents and the results of actions taken.

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