Tag: Colorado Mental Health Institute at Pueblo

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News for Colorado

Planned Parenthood Shooter’s Complaint Of “Chemical Lobotomy” At State Psychiatric Institute Has A Basis In Fact

Admitted Planned Parenthood shooter Robert Lewis Dear, Jr. has complained during his court appearances about the “chemical lobotomy” he is receiving from the antipsychotic drugs being forcibly administered to him at the Colorado Mental Health Institute at Pueblo (CMHIP).

Harvard-trained psychiatrist Peter Breggin, M.D., shares this view of antipsychotic drugs.

Breggin, who has testified as an expert witness in court cases about the dangerous side effects of mind-altering psychotropic drugs, writes in his article, “Making Americans into Zombies”:

“The antipsychotic drugs like Risperdal, Zyprexa, Abilify, Geodon and Seroquel have their clinical impact by causing severe impairment of the frontal lobes [of the brain] – the highest mental centers.  They cause actual chemical lobotomies.”

The frontal lobe is the part of the brain used to control important cognitive functions, such as emotions, judgment, problem solving, memory, and language.   By impairing these mental functions, antipsychotic drugs can cause a person to become zombie-like – a chemically induced state similar to the result of a surgical lobotomy, in which nerves are cut in the frontal lobes, causing irreversible brain damage, as psychiatric “treatment.”

Dear has admitted to the November 2015 shooting rampage that left three people dead and nine wounded at the Planned Parenthood clinic in Colorado Springs.  But a judge ruled Dear was incompetent to proceed to trial and committed him to CMHIP to be restored to competency.

Based on the testimony of a CMHIP psychiatrist that drugging Dear with antipsychotic drugs was likely to improve the prospects for his return to competency, a judge approved the forced administration of three antipsychotic drugs: Zyprexa, Abilify and Haldol.  The Colorado Court of Appeals upheld that ruling on January 5.

In the world of drug-pushing psychiatry, severely impairing important cognitive functions of the brain with antipsychotic drugs is viewed as a means to making someone more rational.

Psychiatrist Breggin says :  “Antipsychotics are just lobotomizing drugs.”

WARNING:  Anyone wishing to discontinue or to change the dose of a psychiatric drug is cautioned to do so only under the supervision of a competent medical doctor because of potentially dangerous, even life-threatening mental and physical withdrawal symptoms.

If you or someone you know has been harmed by psychiatric drugs, we want to talk with you.  You can contact us by clicking here or by calling 303-789-5225.  All information will be kept in the strictest confidence.

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Colorado Mental Health Institute News for Colorado

State Psychiatric Facility in Pueblo Facing Loss of Medicare and Medicaid Funds Over Dangerously Deficient Practices

The Centers for Medicare and Medicaid Services (CMS) has given the Colorado Mental Health Institute at Pueblo (CMHIP) until June 28 to correct serious deficiencies in the care of its patients or else lose its Medicare and Medicaid funding.

Acting on complaints of dangerous conditions, investigators from the Colorado Department of Public Health and Environment (CDPHE) made an unannounced inspection of the state psychiatric institution in February, as reported by the Pueblo Chieftain.

This inspection directly followed contact between CDPHE and the Citizens Commission on Human Rights of Colorado concerning the complaints of staff neglect at CMHIP that we had filed with CDPHE.  One of our complaints concerned staff neglect that led to the death of a patient.

The deficient practices found by the February inspection were so serious that CMHIP was slapped with the condition of “immediate jeopardy” by CMS, indicating that noncompliance with federal requirements “has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.”

CMHIP submitted a plan of correction, which CMS accepted, and the condition of immediate jeopardy was removed.

However, “condition level” deficient practices remained, representing severe or critical health or safety breaches, which CMHIP was required to correct to qualify for CMS funding.

In a June 5 follow-up visit, CMS inspectors found that the deficiencies had not been adequately corrected and put the facility on a 23-day “termination track.”

CMHIP must comply with federal regulations to the satisfaction of CMS by June 28, or the 449-bed facility will no longer be certified to receive Medicare and Medicaid funding.

The publicly released CMS report from the February inspection cited noncompliance with standards for patient rights, nursing services, and quality assessment and performance improvement.

CMHIP failed to ensure that patients received timely examination by medical staff, that staff followed physician orders soon enough, and that recommended medical care and follow-up was provided, resulting in unsafe incidents and worsened medical conditions for patients.

CMS cited the failure of the nursing staff to notify the medical staff and provide ongoing evaluations when acute medical changes in a patient’s condition occurred.  This resulted in the delay of a physician assessing patients and in acute medical conditions for patients.

The facility also failed to analyze adverse patient events and take corrective actions to prevent reoccurrence of the errors.  The report specifically cited CMHIP’s failure to review the “unexplained” death of a patient, which left all patients in the facility at risk for a repeat of the same, uncorrected error.

The CMS report from the June 5 follow-up inspection has not yet been released by CMS.

Following the public revelations of substandard care of patients, CMHIP superintendent Ron Hale announced his resignation, effective July 9.

If you or someone you know has been harmed by treatment at the Colorado Mental Health Institute at Pueblo or any other mental health facility, we want to talk to you.  You can contact us by clicking here or by calling 303-789-5225.  All information will be kept strictly confidential.

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Colorado Mental Health Institute News for Colorado

Patient’s Death at Colorado Mental Health Institute at Pueblo Due To Staff Neglect

A state investigation has concluded that staff neglect was the cause of the choking incident last September at the Colorado Mental Health Institute at Pueblo (CMHIP) that caused brain damage leading to a patient’s death, according to the occurrence summary report recently released by the Colorado Department of Public Health and Environment (CDPHE).

The forensic pathologist who subsequently performed the autopsy on the decedent concluded that the brain damage was the cause of death.

The male patient in his 60s lacked bottom teeth and had a dietary restriction that required his food to be cut into small pieces.  After being served whole food by CMHIP staff, he collapsed when it lodged in his throat and obstructed his breathing.  Staff reportedly attempted, but failed to dislodge the food with the Heimlich maneuver, and then performed CPR, but the patient remained unresponsive.

He was rushed to a local hospital, where he was placed on life support, but his condition never improved.  Eight days later the support services were discontinued and he was pronounced dead.

The autopsy report states the cause of death was brain damage due to the lack of oxygen from choking on food.

Three CMHIP staff members were suspended during the state investigation.  Following CDPHE’s finding of staff neglect, one staff member was fired, one resigned, and one received corrective action that included additional training and supervision.

An accelerated response to the incident by CDPHE was triggered by a complaint filed by the Citizens Commission on Human Rights of Colorado.

If you or someone you know has been harmed by treatment at the Colorado Mental Health Institute at Pueblo or any other mental health facility, we want to know what happened.  You can contact us by clicking here or by calling 303-789-5225.  All information will be kept strictly confidential.

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Colorado Mental Health Institute News for Colorado

Patient Allegedly Kidnapped by State Hospital Staff

Civil Rights Lawsuit Filed in Denver Federal Court

A lawsuit has been filed in U.S. District Court in Denver alleging that a woman languishing in legal limbo at the Colorado Mental Health Institute at Pueblo (CMHIP) was kidnapped by CMHIP staff and forcibly transported to a Denver area hospital to undergo a surgical procedure against her will.

Gabriele Gundlach, 57, of Boulder, was found incompetent to proceed by Boulder County Court in October 2011 in cases involving minor traffic-related offenses and was sent to CMHIP.         

While there, physical conditions requiring that she receive medical treatment were detected, including possible breast cancer.  Gundlach, who has never been found incompetent to make decisions concerning her own body, researched treatment options and medical facilities.  She arranged to receive treatment at Rose Medical Center and lined up funding to cover the cost.

However, Gundlach was told by CMHIP staff that University Hospital was the only facility to which CMHIP patients can be taken for medical treatment, and that patients are treated there at state expense.  These are “bare-faced lies,” according to the complaint filed in the district court by Gundlach’s lawyer, Boulder civil rights attorney Alison Ruttenberg.

Gundlach told CMHIP staff she would not consent to undergo treatment at University Hospital, explaining that for continuity of care reasons, Rose Medical Center would refuse to treat her if she received any part of the treatment for her condition at any other facility.  It also would not meet federal guidelines for funding her long-term care.  She also explained she had chosen a less invasive treatment option available only from a doctor at Rose.

In direct opposition to Gundlach’s wishes, CMHIP staff allegedly scheduled a surgical procedure for her at University Hospital without her consent or knowledge.  When Gundlach was finally informed, she cancelled the appointment.  Ruttenberg called CMHIP Assistant Superintendent Beverly Fulton, who allegedly assured the attorney that CMHIP would never transport Gundlach to a medical procedure she did not want.

But that is exactly what happened on the morning of January 3, 2013.  According to the lawsuit, CMHIP charge nurse Pamela Jones forced Gundlach to get out of bed and prepare to be transported.  Gundlach was driven under guard and against her will to University Hospital for a surgical procedure that had been cancelled and that, if administered, would have destroyed her chance to receive her preferred treatment from her chosen doctor at Rose Medical Center and to receive federal funding for her long-term care.

Because the CMHIP staff had no court order or other authority to transport her against her will, the civil rights complaint asks the U.S. District Court for damages from those responsible for kidnapping her and unlawfully seizing her body (under the color of law) for the purpose of having a surgical procedure performed that she did not want or consent to.  Color of law refers to an act done under the appearance of legal authority, when in fact no such right exists.  It further asks the court to declare it a violation of her Fourteenth Amendment right to be free from unlawful seizures of her body without due process of law.

Gundlach alleges she suffered enormous emotional distress.  She also says she was informed at University Hospital that she would have had to pay for the procedure herself if it had been done there.

According to Ruttenberg’s civil rights complaint, “Ms. Gundlach has a Constitutional right to refuse any medical procedure she does not want, and the bullies at CMHIP have no right to force her to undergo invasive surgical procedures that she refuses, for their financial convenience or otherwise.”

The complaint continues: “She has the capacity and ability to make an informed decision regarding what is going to happen to her body and who is or is not going to have the privilege of cutting into it.  Her decisions regarding the course of care for the suspected breast cancer are reasonable, rational and hers alone to make.”

When Gundlach arrived back at CMHIP, her psychiatrist, Myra Kamran, M.D., allegedly threatened Gundlach with having a guardian appointed who would agree to Gundlach being forced to have the medical procedure either at University Hospital or on-site at CMHIP.

(Myra Kamran is not currently listed on the Colorado Department of Regulatory Agencies website as a licensed physician or listed under any other licensed profession.  The Citizens Commission on Human Rights of Colorado has asked the Colorado Medical Board to investigate the matter.)

Again in violation of Gundlach’s rights, the medical procedure was scheduled to be performed on-site at CMHIP.  According to the lawsuit pending in Boulder County Court, on the morning of Monday, January 7, 2013, the charge nurse allegedly told Gundlach to get ready to be taken to the CMHIP clinic for the procedure.  Gundlach was left with the clear impression that she would be put in restraints to receive the procedure if she refused to cooperate.

It was only cancelled by last-minute intervention by a member of the Colorado chapter of the Citizens Commission on Human Rights, who called the Superintendent’s office to draw their attention to the civil rights lawsuit that had been faxed to the Superintendent the previous Friday evening.

The legal complaint alleges that the psychiatrist for Gundlach’s ward at CMHIP, Thomas Ingraham, M.D., admits Gundlach is not gravely ill, is not a danger to herself or others, and that he is not treating her for any illness or condition.

It further alleges Gundlach’s continuing, unlawful confinement at CMHIP is not only a violation of the due process and equal protection clauses of the Fifth and Fourteenth Amendments, but is also life-threatening, and asks the court to order the woman’s immediate release.

Troubles Began with Minor Traffic-related Offenses

Gundlach’s troubles began when she was arrested in Boulder in 2010 and charged with minor traffic-related offenses after allegedly being involved in an auto accident. 

After telling Boulder County Court she did not want to be represented by the public defender with two large black eyes and a large lump on her forehead who visited her in jail, she was not provided with another public defender and subsequently represented herself pro se in court proceedings.  The lawsuit alleges that she never was properly advised of the charges against her or her right to a new attorney. 

In September 2011, the Court ordered a competency evaluation.  Based on a CMHIP psychiatrist’s report, the Court found Gundlach incompetent to proceed in her court cases and sent her to CMHIP in October 2011.

Six months later, during which time Gundlach refused psychiatric drugging, another evaluation at CMHIP found that Gundlach was competent to proceed and had a good understanding of her legal situation.

Inexplicably, however, her Boulder County public defender asked for yet another competency evaluation to be done.  Gundlach refused this and all subsequent attempts to re-evaluate her because she already had received a finding of competency.

Nevertheless, two subsequent competency reports, one by a psychiatrist and the other by a licensed psychologist at CMHIP, were sent to Boulder County Court, each concluding Gundlach was not competent to proceed.  According to the lawsuit, neither doctor ever interviewed or even met with Gundlach, who continued to refuse to be re-evaluated.

In October 2012, a third Boulder County public defender moved to terminate all criminal proceedings against Gundlach.  The motion was denied in December in Boulder County Court when the Boulder District Attorney wrongly represented to the Court that Gundlach was no longer refusing treatment, including medications, at CMHIP.

Not only was Gundlach continuing to refuse to be medicated at the time, but CMHIP in November 2012 sought a court order to forcibly drug Gundlach against her will.  The lawsuit alleges that the list of drugs Gundlach’s psychiatrist wanted to give her were variously at a dangerously high dosage, meant for mental or physical conditions for which Gundlach had never been diagnosed, or prescribed solely for the purpose of patient control, which is a violation of  ethical standards for physicians.  The motion for a hearing in Pueblo County Court on the issue of involuntary drugging was eventually withdrawn.

During this time, Gundlach contacted the Colorado chapter of the Citizens Commission on Human Rights, which started an investigation of her complaint, following which three legal pleadings were filed in separate actions by Ruttenberg.

A petition filed in the Colorado Supreme Court for Gundlach’s immediate release was denied, apparently on jurisdictional grounds.

A renewed motion to dismiss charges against Gundlach is currently pending in Boulder County Court.  This motion additionally challenges the constitutionality of the state law [C.R.S. 16-8.5-116(1)] that permits a defendant to be incarcerated at the state hospital up to the maximum amount of time the person could be sentenced if convicted, when in actual practice a maximum sentence would not be imposed on each of multiple charges and would not be imposed consecutively.  Therefore because Gundlach is being held as mentally ill, CMHIP is interpreting the law to allow them to involuntarily incarcerate her for 33 months, which is from 21 to 30 months longer than for someone who is not held at CMHIP.

Gundlach’s plight has been made worse by the fact that neither she nor her attorney have been given access to legal records relating to her court cases.  The civil rights complaint pending in U.S. District Court in Denver cites Debra Cross, Clerk of the Boulder County Combined Courts, for her unconstitutional policies of denying Ruttenberg, as Gundlach’s counsel of record, access to any portion of Gundlach’s prior court file, and asks the court for relief.  It further asks the court to declare that Crosser’s refusal to ensure that Gundlach’s legal mail is sent to her at CMHIP instead of her prior home address, then throwing it into the court file when it is returned as undeliverable, violates Gundlach’s constitutional rights to due process and access to the courts. 

The complaint pleads that Gundlach’s “continued incarceration at the CMHIP without due process, without a hearing, given the fact that she is competent, is not only unconstitutional, it is life-threatening.”

If you or someone you know has experience with the Colorado Mental Health Institute at Pueblo, we want to talk to you. You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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Colorado Mental Health Institute News for Colorado

Sleeping Patient Stabbed In Eyes At Pueblo Psychiatric Institute

 

Image by Cyril Bosselut
Image by Cyril Bosselut

An act of violence at the Colorado Mental Health Institute at Pueblo has cost a patient one eye and possibly her sight in the other.

According to the Pueblo Chieftain, a sleeping female patient was stabbed in the eyes and face with scissors last Wednesday by another patient at the state psychiatric facility.  Both were living in a unit that houses patients that psychiatrists have deemed ready to be transitioned back into society.

Police have arrested Lamar Del Ray Davis on suspicion of attempted first-degree murder.

According to an affidavit, Davis said he was feeling “aggressive” and “just wanted to lash out at somebody.”

While it is not known what psychiatric drugs, if any, Davis was taking (or was in withdrawal from) at the time of the attack, mind-altering drugs widely used by psychiatrists at CMHIP and other psychiatric facilities are known to have adverse effects that include aggression, acts of violence, and homicidal thoughts.

If you or someone you know has been harmed in a psychiatric facility or by psychiatric drugs, we want to talk to you. You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

Research studies, warnings from international regulatory authorities, and reports to the U.S. Food and Drug Administration on the harmful side effects of psychiatric drugs can be accessed through CCHR International’s psychiatric drug side effects search engine.

WARNING: Anyone wishing to discontinue psychiatric drugs is cautioned to do so only under the supervision of a competent medical doctor because of potentially dangerous withdrawal symptoms.

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Colorado Mental Health Institute News for Colorado

Shocking Video Released Of Man Suffocating in Prone Restraint

Man Struggles In Vain To Breathe While Strapped Down at Pueblo Psych Hospital.

RestraintsCall7 Investigators in Denver obtained the surveillance video of a man, strapped face down in restraints and left alone in an isolation room, struggling for air and slowly suffocating at the Colorado Mental Health Institute at Pueblo.

CMHIP staff are seen forcibly putting the man in prone restraint, then leaving the room.  They fail to monitor him adequately during his fatal asphyxiation.

Troy Geske, 41, was obese and suffering from a respiratory infection when he was forced face down on a table, then held down by four CMHIP staff while being strapped so tightly that he is unable to move, his own weight pressing down on his lungs.  During the take-down, one employee is seen pressing Geske’s face onto the table, and another has his elbow in Geske’s back, further impairing the man’s attempts to breathe at a time he was clearly panicked and in need of oxygen.

The reason for the restraint that ultimately led to this cruel and inhumane death?  Geske was refusing to take the psychiatric drug(s) staff were trying to administer to him.

The state had gone to court to try to block release of this shocking video.

Just as shocking is the fact that a Pueblo grand jury failed to return any criminal indictments against any of the staff involved.  (See our article, “You Be The Judge: Pueblo Grand Jury Returns Findings In Death of State Hospital Patient.”)

The Call7 Investigators report and video can be seen by clicking here.  WARNING:  This an extremely disturbing video.

If you or someone you know has been put in restraints at a psychiatric facility or has any experience with CMHIP, we want to talk to you. You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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News for Colorado Schools

Pueblo School District Fails To Explicitly Prohibit Teachers From Pushing Psychiatric Drugs

Policy Protecting Schoolchildren Has Been Required By State Law Since 2003

Pueblo City Schools is apparently in no hurry to adopt policy safeguarding children that has been required by state law since 2003.

An examination of Pueblo City Schools Board policy by the Citizens Commission on Human Rights of Colorado (CCHR) found that the School Board is in violation of state law by not having adopted policy explicitly prohibiting school personnel from recommending or requiring psychiatric drugs for any student.

CCHR first brought the noncompliance to the attention of the office of Superintendent Maggie Lopez on June 6, following guidelines set by the Colorado Department of Education.  Since that time, agendas for the school district’s Board of Education meetings – including the meeting scheduled for this evening – have not included any mention of action on adoption of this policy.

Several readings of a policy are required at Board of Education meetings before it can be adopted for Pueblo City Schools.  Thus, it appears that some 23,000 schoolchildren in the district will be starting yet another school year without this statutory protection in place.

C.R.S. 22-32-109(1)(ee) requires school district Boards of Education to adopt policy “to prohibit school personnel from recommending or requiring the use of a psychotropic drug for any student.”

The law further requires policy that “School personnel shall not test or require a test for a child’s behavior without prior written permission from the parents or guardians or the child and prior written disclosure as to the disposition of the results or the testing therefrom.”

The law was passed by the Colorado State Legislature eight years ago to protect against teachers, principals and other school personnel pressuring parents to put their children on psychiatric drugs.  These mind-altering drugs carry dangerous, even life-threatening side effects.  (Adverse reactions to psychiatric drugs, as detailed in research studies, warnings from international regulatory authorities and reports to the FDA, can be accessed through CCHR International’s psychiatric drug side effect search engine.)

Psychiatric drugs also do not address the real, underlying problem(s) the child is experiencing, which may be a lack of additional instructional help, poor nutrition, or an undiagnosed physical condition.

CCHR has sent Colorado Open Records Act requests to school districts throughout the state, requesting copies of the policy or policies that comply with this state law.

To date, CCHR has identified 21 school districts that did not have Board policy with the clear language of C.R.S. 22-32-109(1)(ee).  Twenty of the 21 districts indicated to CCHR that steps were immediately being taken to remedy the long-standing non-compliance with state law.

Only Pueblo City Schools has been vague about when it will adopt the required statutory language.

Pueblo is home to the psychiatric drugging center known as the Colorado Mental Health Institute at Pueblo.

Because a response from the superintendent was unclear as to when Pueblo Schools will act to bring its policy into compliance with the 2003 law, CCHR forwarded a complaint directly to the president of the Pueblo City Schools Board of Education, again following guidelines set by the Colorado Department of Education.

If you or someone you know has been pressured by school personnel to put a child on psychiatric drugs, we want to talk to you.  You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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Colorado Mental Health Institute News for Colorado

Pueblo DA Skeptical of Changes At Colorado Mental Health Institute at Pueblo

Says Whole Scrapping Of The Culture Is Needed.

Pueblo County District Attorney Bill Thiebaut publicly expressed his skepticism of claims by the Colorado Department of Human Services that improvements have occurred at the Colorado Mental Health Institute at Pueblo (CMHIP) in the wake of a patient death there last August.

According to the Pueblo Chieftain, Thiebaut said “I don’t have a lot of confidence that there’s been a change out there.”  He went on to say that change would require a whole scrapping of the culture at CMHIP.

“We have a culture that has permeated the institution for years,” Thiebaut said.

That culture was the focus of a report issued by a Pueblo County grand jury that investigated the August 2010 death of patient Troy Geske.  The 41-year-old, who was obese and suffering from a respiratory infection, suffocated while being restrained face down and left unattended in a seclusion room at the facility for refusing to take psychiatric drug(s) prescribed to him.  See a summary of that report in our article “You Be The Judge: Pueblo Grand Jury Returns Findings In Death of State Hospital Patient.”

“The grand jury said things need to change from the top down,” Thiebaut continued.

Geske had been readmitted to CMHIP in July 2010 because he was experiencing mental symptoms that included auditory hallucination, depression, worsening confusion and aggressive behavior.

All of these behaviors are side effects of psychiatric drugs.  Geske’s ultimate death while under the control of CMHIP staff may well have been the direct result of the psychiatric drugs he was prescribed by psychiatrists at CMHIP – drugs that he was struggling to refuse at the time of his death, drugs he may well have known were destroying him.

Adverse reactions to psychiatric drugs, as detailed in research studies, warnings from international regulatory authorities and reports to the FDA, can be accessed through CCHR International’s psychiatric drug side effect search engine.

   If you have experience with “the culture” at CMHIP, we want to talk to you.  You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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Colorado Mental Health Institute News for Colorado

State Psychiatric Facilities Abuse Emergency Drugging

State Audit Finds Lack of Documentation Supporting Involuntary Drugging Of Patients

Patients in the state psychiatric facilities at Pueblo and Fort Logan were drugged against their will without sufficient documentation to justify the action, according to an audit report just released by the Colorado Office of the State Auditor.

The review of some patient files at the Colorado Mental Health Institutes at Pueblo and Fort Logan found that a number of them “lacked sufficient clinical documentation to substantiate that a psychiatric emergency existed warranting an emergency medication order.”

Additionally, the audit uncovered patients whose legal rights were violated when they were involuntarily drugged on a claimed emergency basis for more than 72 hours without the proper documentation of a second opinion and/or a written request for a court hearing, as required by state law.

The report further criticized the psychiatric institutions for lacking documentation to substantiate that the condition of patients warranted psychiatrists’ petitions to courts for, or their continued use of, court-ordered involuntary drugging.

Some patients’ current medications were not discontinued before they were involuntarily drugged on a claimed emergency basis, which resulted in patients having two sets of drugging orders in effect at the same time, with an increased risk to them of serious side effects.

Significantly Higher Error Rates in Administering Drugs

Average error rates in administering drugs in 2010 were significantly higher at the Institutes than the average rate for a comparable peer group of facilities.  Specifically, Fort Logan averaged 4.50 errors per 100 drugging episodes, and Pueblo 4.93, as compared to an average of 2.71 in facilities in the peer group.

Further, there were cases in which the psychiatrist ordered two or three psychiatric drugs, including antipsychotics, on an as-needed basis for the same condition without sufficient documentation substantiating the need for multiple medications.

According to the report, several patients were found to have been put on the drug clozapine, an antipsychotic that has a potentially life-threatening side effect, without clear and sufficient documentation that less risky treatments had been tried first.

The psychiatric institutions also failed to do recommended medical follow-up on a number of patients to test for the dangerous side effects of certain antipsychotic drugs, such as the metabolic monitoring recommended by the American Diabetes Association for patients on certain antipsychotic drugs with well-known links to the onset of diabetes.

The facilities were found to have inconsistent guidelines and monitoring protocols for administering high-risk drugs, and in some cases, established guidelines were not followed.

The full audit report, “Psychiatric Medication Practices for Adult Civil Patients, Colorado Mental Health Institutes,” is posted in the June 2011 reports of the Office of the State Auditor.

If you or someone you know has experience with the Colorado Mental Health Institute at Pueblo or Fort Logan, we want to talk to you.  Please contact us privately by clicking here or by calling 303-789-5225.  All information will be kept strictly confidential.  We also welcome your comments below.

 

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Colorado Mental Health Institute News for Colorado

Man Died in Restraints at Colorado State Psychiatric Hospital

CMHIP withholds data requested by the district attorney and county coroner

An obese man who died in the custody of the Colorado Mental Health Institute at Pueblo (CMHIP) suffocated while being restrained face down on a table. He may have been hog-tied.

Troy Allen Geske, 41, died August 10 at the psychiatric institution. An affidavit for a search warrant says that Geske died after he was put in four-point restraint, in which the feet are attached to the hands behind the back.

A spokeswoman for the Colorado Department of Human Services, which oversees the psychiatric facility, denied Geske was in four-point restraint. But Pueblo County District Attorney Bill Thiebaut said the information in the affidavit is corroborated by evidence that has been collected, including video of Geske in restraints, according to the Pueblo Chieftain:
http://chieftain.com/news/local/article_f75a23c2-b72f-11df-9494-001cc4c002e0.html
http://chieftain.com/news/local/article_59e5ca9c-b653-11df-8d64-001cc4c002e0.html

At 5-feet-8 and 265 pounds, Geske was at greater risk of “positional asphyxiation” when he was restrained on his stomach with his own weight pressing down on his lungs and diaphragm. Federal law requires constant, close monitoring of anyone face down in restraints to prevent suffocation.

The results of an autopsy and toxicology tests have not yet been released.

After Geske’s death, hospital police could have called in the 10th Judicial District’s critical incident team (CIT) for an independent investigation of the incident by a team of investigators from outside law enforcement agencies, but did not do so, according to the Pueblo Chieftain: http://chieftain.com/news/local/article_b4e5d92e-b7f1-11df-abf2-001cc4c002e0.html

The CIT investigates serious incidents involving police officers under an agreement to which CMHIP is a party. Hospital police were reportedly present when staff attempted to revive Geske.

CMHIP has also refused to turn over certain information requested by investigators. District Attorney Thiebaut says he will go to court if necessary to get information he believes his office is entitled to, according to the Chieftain.

For more than 40 years, the Citizens Commission on Human Rights has advocated against any form of psychiatric treatment that is torturous, cruel, inhuman or degrading, as laid out in its Mental Health Declaration of Human Rights.

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