After an investigation into a Bridgewater State Hospital patient's suicide, the Disability Law Center is calling for the facility to be placed into receivership and for state officials to develop a long-term plan that would transfer control of the hospital to the Department of Mental Health from the Department of Correction.
The center on Monday issued its report into the April 8 death of Leo Marino, a Lawrence man with a history of suicide attempts who killed himself by ingesting large quantities of toilet paper while in isolation at Bridgewater, according to the report.
The report describes Bridgewater State Hospital as "an institution being asked to do the impossible: to provide hospital level care in an understaffed, underfunded, antiquated facility that is not a hospital, but a prison charged with providing a therapeutic, healing milieu in an institution run by the Department of Corrections instead of the Department of Mental Health."
The Disability Law Center is authorized under federal law to investigate cases of neglect and abuse of people with disabilities or mental illness in Massachusetts. Upon his admission to Bridgewater, Marino was diagnosed with major depressive disorder with suicidal ideations, according to the report.
Its review is the second outside report this month recommending oversight of Bridgewater State Hospital be shifted away from the Department of Correction.
A policy brief issued by the Pioneer Institute on June 14 suggested involving the Department of Mental Health in a partnership at the hospital, giving its staff "influence over treatment operations, wider information sharing and cross accountability in the functions of Bridgewater State Hospital."
Bridgewater State Hospital serves as both "a Department of Correction institution as well as the Commonwealth's only strict security psychiatric hospital," according to its mission statement. The hospital is classified as one of DOC's eight medium-security facilities.
State law requires male patients to be sent to Bridgewater State Hospital if they are in risk of endangering themselves or others.
In preparing its report, the Disability Law Center reviewed documents including medical and correctional records and 238 hours of video footage of Marino's final days in an isolated treatment unit, and interviewed staff from DOC and the Massachusetts Partnership for Correctional Healthcare, which is contracted to provide medical and mental health services at Bridgewater State Hospital and in prisons.
The report cites failures in treatment, security and protocol leading up to Marino's death, including a lack of training and supervision for the workers designated to observe his behavior.
"This case is the perfect storm of everything that's wrong with treating patients with mental illness at a correctional facility," Disability Law Center executive director Christine Griffin said in a statement. "Correctional officers and the Massachusetts Partnership for Correctional Healthcare staff lack the ability to care for the patients who are sent there for treatment, not punishment. Until the Department of Mental Health has the sole responsibility for caring for Bridgewater State Hospital patients, nothing will change — and other patient deaths will certainly follow."
The law center recommends that Bridgewater patients be moved to existing Department of Mental Health facilities by the end of 2016. Its report calls on Gov. Charlie Baker to place the hospital into receivership under the Executive Office of Health and Human Services while the administration, operations, medical and mental health care, treatment and programming of the hospital are transferred to the Department of Mental Health.
The Disability Law Center says it issued similar recommendations to Gov. Deval Patrick in July 2014 following its first investigation into Bridgewater State Hospital.