Uneasy Exits

Hasty discharges may put Manhattan Psychiatric Center patients at risk

To an outsider, Peter Fazio may have seemed a logical candidate for a discharge from the Manhattan Psychiatric Center to a community mental health center. Though he had been a patient at the Ward's Island facility since 1988, he seemed well-adjusted and even had a job working in the library.

But, underneath, Fazio was terrified of leaving the safe and familiar surroundings of the psychiatric hospital. In a 1997 treatment plan, doctors noted that Fazio grew agitated whenever discharge planning was discussed. "I will hurt myself," Fazio said. A hospital clinician, aware that Fazio's psychiatric history included several suicide attempts, underlined a note on his treatment plan: "Alert: He is a serious risk."

Even so, it became clear to Fazio by last summer that his release was imminent. Days after being escorted to interviews at community mental health facilities, Fazio took a razor to his throat, wrists, and stomach, and killed himself.

Manhattan Psychiatric Center: increasingly grim
Michael Sofronski
Manhattan Psychiatric Center: increasingly grim

Some staff members believe that Fazio's suicide was a direct consequence of a "discharge at all cost" mentality that has been forced on MPC by its bosses in the Pataki administration. An internal review of the incident stopped short of endorsing this view, but did determine that the "active discharge role of this hospital has not been adequately communicated." The hospital has already followed orders to release hundreds of patients. Some 200 more are expected to be discharged in the coming year. As a result, say clinical staffers at MPC, many patients are being released prematurely. And some could end up on the streets, where they may pose a risk to themselves and others.

Though psychiatric hospitals are being downsized all over the state, the cuts are most dramatic at MPC. The facility, which has traditionally treated patients referred for long-term care by Manhattan hospitals, had over 900 residents just three years ago. During the 10 months ending February 4, 1999, the number of inpatients at MPC fell from 653 to 485— almost a 25 percent drop. (Nearly a third of the patients discharged from the state's 18 adult psychiatric hospitals during this period were leaving MPC.) And the exodus isn't over yet: the New York State Office of Mental Health has urged MPC to further reduce its population— to a target of 250 people— by fiscal year 2000­01.

"MPC is and will continue to downsize its patient population and wards," MPC director Horace Belton wrote in February 1998, a few months before his retirement. "We have been mandated . . . to do so."

Downsizing itself is nothing new. For years, advocates have been arguing that the state should close many of its underutilized psychiatric hospitals and dedicate the savings to community mental health programs, which are generally believed to provide a better environment for most people with mental illnesses. To a great extent, this has already happened. In 1995, the year Pataki took office, the number of inpatients at state psychiatric hospitals was roughly 9000. Today, there are fewer than 5300 patients in the system. In two years, OMH estimates, there will be only 3700 to 4700 inpatients statewide.

With many of the upstate psychiatric hospitals already near bottom— several with barely a hundred residents— the state has put intense pressure on MPC to bring down its patient population. Last March, OMH sent a team down from Albany to help MPC figure out how it could reach its target census. In May, the hospital set aside 14 staff members to start the Office of Discharge Planning, a body responsible for doing "whatever needs doing to move approximately 350 patients to an appropriate discharge."

The result, according to interviews with half a dozen current and former clinical staff at the hospital, as well as patient advocates, has been a concerted push to discharge patients. "Teams were walking through the wards, pointing to patients and saying, 'He can be discharged,' " one hospital clinician who wished to remain anonymous told the Voice.

In one instance, according to a senior MPC official, the hospital's current director, Eileen Consilvio, asked about a patient, " 'Why is she still here? She's not getting better. We ought to discharge her.' The medical staff didn't agree." Not long afterward, the same patient attacked a doctor on one of the wards. Neither MPC nor Consilvio returned calls for comment, though Consilvio issued a denial through an OMH spokesperson, Roger Klingman.

In another case, all of the patients on one physician's ward were transferred to other wards after he refused to sign off on a discharge that was being pushed by hospital administrators.

OMH denies that it is forcing patients out before they are ready. "If there was any pressure at all, it was to do appropriate discharges," says OMH's Klingman. "It really hinges in each individual case on a physician's decision. Without that determination, the person is not going to be discharged."

Nevertheless, at least one senior medical official recently quit because he felt patient care was taking a backseat to cost cutting. "I felt I could not be effective and maintain patient standards," said the official, who took advantage of a retirement package in December, along with about 40 other staff members. "I felt I was beating my head against the wall with no results."

Critics of the discharge plan charge the Pataki administration isn't concerned with patient care, but simply wants to reduce staff and save money. They point out the governor's recent budget failed once again to propose any new money to expand community mental health facilities, even though state statistics show that there is an unmet need of approximately 14,000 beds.

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