Western State director details isolation

By Bill Mckelway, Media General News Service
Published: July 31, 2008

The director of Western State Hospital has told a state oversight committee that he needs more time to work with a mental patient who’s been kept restrained or secluded for much of his 22 years in the hospital.
“It’s too early to tell ... whether this current strategy will soften his position on aggression or prove to be a system that we can operate with,” Dr. Jack Barber told the State Human Rights Committee last month.
Barber was describing a system of confinement — a so-called limited containment suite — that has been used to house 57-year-old Cesar Augusto Chumil at the hospital for the past five years.
The locked, three-part enclosure suite is the latest in a series of measures over more than two decades taken to control Chumil’s violence and to protect staff and other patients.
“It’s not the case that the [suite] means we are giving up on Chumil,” Barber assured the panel, which is investigating alleged human-rights violations involving Chumil.
Barber also acknowledged that the hospital made “an error in judgment” in letting exemptions from state law, which allowed the patient to be kept in seclusion, lapse in 2007.
“In retrospect, I should have come here,” Barber told the committee, which approves the exemptions.
The statements are in a 133-page transcript of proceedings before the State Human Rights Committee on July 11; most of the six-hour meeting was conducted behind closed doors.
Barber’s testimony represents the most direct assessment of Chumil’s care — and the reasons for it — that has ever been made public over the course of federal and state investigations dating back to 1998.
The Richmond Times-Dispatch obtained the transcript and other records concerning Chumil from his lawyers and with his family’s permission.
The lawyers and family have been fighting for two years to ease restrictions on Chumil, arguing that the hospital is violating state human-rights laws and that its years of work to treat Chumil have failed.
Barber described Chumil, who is deeply paranoid and schizophrenic, as a patient so troubled that he is considered “unique” among the thousands of patients who have passed through the hospital in Staunton.
“We have not seen the constellation of issues that trouble him in any of the 20,000 or so people who have been at Western State in the 23 years since I have been there,” Barber told the committee. He said the containment system was meant to “resolve the ongoing misery” of Chumil’s assaults and of his nearly constant life being shackled or kept in a small, matted seclusion cell until five years ago.
Chumil’s care was part of a federal Justice Department investigation of the hospital in 1998 that ended in 2003 with a broad list of criteria for improving patient care.
A Justice Department spokesman said this week that the office is no longer tracking Chumil’s care or conditions at the hospital.
While Barber predicted that allowing Chumil to mix with the rest of the hospital’s population would merely “repeat the cycles of aggression and seclusion and restraint,” he said Chumil’s “condition is the same [now] as it was when we first created the [suite].”
The Human Rights Committee, whose nine members are appointed by the state Department of Mental Health board, has said it will issue a decision today on whether the hospital should continue holding Chumil in his locked suite and other issues related to monitoring him and planning his transfer.
This year, the Local Human Rights Committee in the Staunton area concluded that Chumil is being held in seclusion against state regulations. Chumil’s lawyers in Charlottesville, Alex R. Gulotta of the Legal Aid Justice Center and Nathan J.D. Veldhuis, want that decision upheld.
They also want him to be moved to a facility closer to relatives in Northern Virginia and provided with more Spanish-speaking help. Chumil’s use of English is limited.
In September 2007, Western State ignored the expiration of exemptions that permitted the hospital to seclude him and monitor him less than required by state law.
Veldhuis and Gulotta argue that the seclusion has become not only part of Chumil’s treatment plan but that it is used to punish him, a violation of state and federal law.
Chumil’s confinement in the suite began in August 2003, the same month that the U.S. Department of Justice ended oversight of Western State; it had cited the hospital in 1999 for manifold violations, including its restraint and seclusion practices involving Chumil.
All parties acknowledge that Chumil is seriously mentally ill and that he has engaged in hundreds of assaults against Western state staffers and patients.
At the same time, however, he has been allowed for years to leave the hospital with his family without supervision.
That conflict cannot be reconciled, Chumil’s lawyers assert; nor can the hospital’s position that it is not holding Chumil in seclusion but still needs exemptions to continue holding Chumil that way.
Barber, though, argued before the committee that the hospital has made extraordinary steps to provide Chumil comforts in his cell and allows him to wander about a day room alone when other patients are receiving treatment.
“He is able to retain a personal dignity by having a safe haven over which he has control,” Barber said. He said Chumil in the many years of his confinement for mental problems has never indicated he cared to have a friend.
“Thus, it seems unreasonable and disrespectful, as well as clinically unwise, to require him to go in that direction,” Barber said referring to more association with other patients.
The containment unit, though, and the monitoring of Chumil’s actions inside his cell “would contribute to anyone’s paranoia, even if they had perfect mental health when they went in,” Veldhuis told the committee July 11.
“I encourage you to think of him as a human being. This person is not a lost cause,” he said.
On one hand, he said, Chumil is regarded “as so deathly dangerous that he must be locked in a room all the time. Yet, he is “not too dangerous to go out to Wal-Mart with his mother.
“Impossible to reconcile,” Veldhuis said.
Bill McKelway is a staff writer for the Richmond Times-Dispatch.