Times Record/Roane County Reporter
New mental health trends lead to changes at Spencer
July 13, 1989
New mental health trends lead to changes at Spencer
With the recent closure of Spencer State Hospital, an important chapter in the history of Roane County came to a end. This three- part series examines that history, and this week focuses on the events which eventually led to the hospital's closure.
The changing role of mental health services which began in the 1960's arrived in West Virginia a few years later. The concept of deinstitutionalization, allowing patients to live in the community rather than in a hospital, was combined with efforts to provide state hospital patients with real treatment rather than simple custodial care. The state's inability, or unwillingness, to fund adequate treatment, along with the growing disfavor in which large mental institutions came to be held, began nearly 20 years before Spencer Hospital was finally closed last month.
In 1971, David Ogilbee, formerly a therapist with the Alcoholic Treatment Unit established at Spencer State Hospital in 1964, told the Parkersburg News conditions at the hospital were "the worst I've seen anywhere that I have ever worked." The hospital aides, once the strength of the hospital's program, were being "worked to death" caring for a patient population of 820. Patients, he said, were treated as "untouchables" and compelled to perform menial tasks while staff members were kept busy doing personal jobs for administrators, on whom he blamed the institution's woes. Ogilbee also spoke of two patients who had recently been scalded to death.
In a 1974 interview with the same paper, Robert Daniell, superintendent of Spencer State Hospital from 1969 to 1979, responded to allegations that the state's mental institutions were "warehousing" patients. Daniell admitted Spencer's function had, with the new drug therapy developed in the late 1950's, become custodial rather than therapeutic. He also cited a lack of trained professionals to work with patients as a major obstacle to providing significant treatment. Daniell said the institution had come a long way since 1969, when only the men's wards were furnished with hot water, which they required for shaving, while women patients had to make do with cold.
If the needs of some patients were not being completely met, several small-scale treatment programs were implemented at Spencer State Hospital during the period of Daniell's administration. Among them were programs designed to bring about deinstitutionalization of patients, which would become the key issue in deciding the fate of the hospital.
The national trend toward deinstitutionalization of certain types of patients began in the late 1960's. West Virginia began to implement this policy under the direction of Dr. Mildred Bateman, who became commissioner of the W. Va. Department of Mental Health in 1962. She left in 1977 to accept a position at Marshall University. Recapping her career during an interview with the Charleston Gazette in 1977, Bateman said that in her 15 years with the Department of Mental Health, patient population in the state mental institutions had been reduced from 5,400 in 1969 to 2,380 in 1977. This was made possible, she said, by the increased use of tranquillizing drugs, emphasis on community mental health centers and a supportive policy by administration to keep patients out of large institutions.
At Spencer State Hospital the move toward deinstitutionalization was advanced on two fronts. The first of these, begun under Bateman's administration, was a rehabilitative effort geared toward training some patients to live in group homes. One of the early programs, called the Remotivation Unit, was established in 1975. At that time about one-third of the patients in the state's mental hospitals were labeled "chronics," meaning they had been institutionalized most of their lives. Long periods of institutionalization, it was observed, eliminated most self- initiated activity among this group and for many years it was assumed they could not be helped. The Remotivation Unit was designed to teach these "chronics" the skills they needed to live in group homes, such as basic personal care housekeeping. They were allowed to work in the sheltered workshop and paid minimum wage for their labor so they would learn about money and banking.
A second effort, Project Community Bound, was established in 1978. Its goal was the deinstitutionalization of the mentally retarded residents. It was believed they could also learn the skills necessary to live in in the community.
The second program to reduce patient population, transferring elderly patients from state-operated to private facilities in order to take advantage of federal money available for their care, would be implemented in 1979 under Bateman's successor Dr. George Pickett.
Even as the programs offered at the hospital were altered, so was the appearance of the structure. Removal of the structure's slate roof with its charming cupolas and other ornaments, began around 1959. In 1973 the stately 4-story administration building was knocked down and a modern administration and food service complex built in its place at a cost of $1.2 million, changing forever the face of the familiar landmark. Another landmark, the tall smokestack, was also torn down. A new fence around the hospital grounds was constructed in the early 1970's due to increasing complaints from citizens and law enforcement officials regarding patients walking away from the hospital, which now contained a new and dangerous type of resident.
Although an early report issued by state officials indicated the hospital was not equipped to handle the "criminally insane," at some time during the years a practice began of sending persons accused of crimes to Spencer for psychiatric evaluations to determine if they were competent to stand trial. Many of them also walked away from the hospital. By 1976 the situation had become so severe the Legislature started to look for a way to have pre-trial evaluations performed at a prison or other secure facility. Eventually it was determined that evaluations would be conducted in the maximum security wing at Weston State Hospital. But in fact, criminals were still being sent to Spencer three years later. According to Superitendent Robert Daniell, 28 accused criminals had been sent to Spencer for pre-trial evaluations during 1979.
Other psychiatric patients, admitted to the hospital after committing acts of violence, were judged "levelled off" by the hospital's care providers and released. Some of them committed other crimes following their release. In August 1978 a former Spencer State Hospital patient returned to Kanawha County following his release and killed a long-time friend during an argument. At the time of the murder the man was living in the dilapidated Holley Hotel in Charleston. His place of residence hints at what would later be discovered about inadequate community placements.
These incidents may have acted to impede the return of patients in rehabilitation programs to the community. Their relocation was blocked by widespread refusal of housing, as many citizens made no differentiation between these patients and their more violent counterparts, many of whom were also being released.
In 1978 investigation into the death of a patient would focus state- wide attention on conditions at the hospital. Although the facts revealed would place a great deal of the blame on policies generated at the state level. Dr. Pickett, newly appointed head of the now combined departments of Health and Mental Health, would begin to move to close the hospital.
Maude Sloan was admitted to Spencer State Hospital on March 6 and died on April 10 at Roane General Hospital. While it was eventually determined that cardiac arrest caused her death, it was also learned that the 76-year-old woman was diabetic and had been without her medication during the time she was a patient at the hospital. Routine lab tests that would have revealed Sloan's condition were ordered at the time of her admission, but were never completed.
Pickett, after only six months on the job, was called on to account for the tragedy. Seeking a scapegoat, he found it in the person of a 70-year-old foreign physician responsible for Sloan's care, who was given the option of resigning or being dismissed.
On June 23 Pickett told the Charleston Gazette he blamed "poor administration, lack of lab facilities, and a doctor uncomfortable with the English language" for Sloan's death. Appealing before a legislative committee, he said that the treatment Sloan had received was typical of West Virginia's institutions. Some of the physicians practicing in those institutions, he said, did not know how to do blood tests and the terms of their employment were close to indentured servitude. At the time of Sloan's death two-thirds of the physicians practicing in the state's hospitals were only temporarily licensed, pending passing an examination for certification to practice medicine in this country. Their average salary was $22,000 a year. Pickelt said he was trying to get these salaries raised and initiate a program to encourage trained professionals to relocate to West Virginia.
Regarding administrators, Pickett said he had already replaced six who had no background in hospital administration. "A series of people have run a mediocre system," he said in the Parkersburg News.
After three weeks of silence, Spencer administrator Bob Daniell also spoke to the News. He had been ordered by Pickelt, he said, to close the state hospital's lab when the head technician retired about a week prior to Sloan's admission. An official with the state hygenic lab in Charleston had reported that Spencer's lab was in poor shape and employed out-moded techniques, recommending that lab specimens be obtained by a technician from Roane General Hospital and sent to the central lab in Charleston for analysis. The state acted on his recommendations and ordered that no routine lab work be done at Spencer. Sloan's tests were among those not completed.
Daniell had protested the closing of the lab, saying it was necessary to handle the volume of admissions to the state hospital, still caring for nearly 1,200 patients. Most of these patients, he said, had no family physician because they couldn't afford one. As a result, over 90 percent of them had not had a recent physical exam, lab work or X-rays when they were admitted.
Employees of Spencer State Hospital had prepared a petition carrying 173 signatures to reinstate the doctor fired by Pickett. The document stated that he should not be blamed for refusing to insist on lab work that the state had ordered discontinued. Pickett eventually agreed to reinstate the physician in an administrative position.
Pickett also succeeded in getting the salary range for physicians practicing in state hospitals increased from $15,936-$56,652 to $22,428-$72,312. He also replaced Superintendent Daniell, who had no background in hospital administration, with Desmond Byrne, a recent graduate holding a Master's degree in that field.
After a few months at the helm, Byrne said the hospital still contained a number of patients who should be cared for in other settings. In June 1979 removal of elderly patients began. During the first year of Byrne's administration, the population of the hospital was reduced by 100 with patients being transferred to nursing or group homes.
In early 1980 Governor Rockefeller presented his new budget, under which a reduction in state employees would provide funds for a program of highway improvements.
Pickett said that some state hospital employees would be laid off and the patient population would be reduced by moving some patients from public to private care, a process already begun by Byrne at Spencer. In the case of the elderly, Pickett explained, the expense of their care would be greatly reduced if they were housed in Medicare/Medicaid certified facilities, as much of the cost would then be picked up by the federal government
The population in all state hospitals was declining, he said, and rather than have all the facilities operating below capacity, he planned to concentrate services at some institutions and layoffs at another. This would also accomplish the reduction in employees mandated by the governor. The layoffs, he said, would be concentrated at Spencer State Hospital. Sixty-five employees would be laid off and 100 patients would be transferred.
Byrne said his goal was to reduce the population of the hospital to 325 by July 1. The facility would, he said, move away from the custodial care provided in the past to a comprehensive treatment program for fewer patients. Removal of the elderly would also save money, he said, because the third floor where they were housed required repairs and could now be closed instead.
Two months later "an informant" told Spencer Newspapers that efforts to return patients to the community were not successful and many were being returned to the hospital. Arnold Mace, President of the local West Virginia Public Employees Association, expressed concern on behalf of the hospital's staff that moving these elderly patients might induce such severe trauma that it would lead to their death.
Events took a bizarre turn when a memo from the state health department's director of institutional services was intercepted and its contents released to the press. The memo stated that patients without family or "significant others" were to be moved without the "informed consent waiver" being signed. Pickett rushed to explain that this directive applied only to patients judged incompetent and unable to sign the consent form. Byrne described the order as "basically a way to get things done."
But many reacted with horror at the implicit principle of the order. Feelings intensified when circumstances surrounding the transfer of patients were revealed. One of the patients, a 67-year-old man, was transferred to Andrew Rowan Nursing Home in Monroe County. In a few days he was returned to Spencer. Then he was transferred to Huntington. He died there. The stress induced by the impending move caused another patient to have a seizure. Yet another set her hair on fire in fear of her transfer.
The June 26, 1980 edition of the Times Record carried an editorial which spoke of "frightened old people herded like cattle from the only home they have ever known...It is no doubt very dollar efficient for the elderly at Spencer to die, thereby saving the state the expense of feeding and caring for them."
The following month Pickett finally stated openly that within the next five years Spencer State Hospital would either have to rebuild or convert to another type of facility as part of a plan to replace the existing 12 state institutions with more modern treatment facilities over a 20-year period. During the 1980's debate centered around what type or care Spencer State Hospital would provide.
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