Western State patient-care case ruling expected next week

By Bill McKelway, Media General News Service
Published: August 29, 2008

The state’s commissioner of mental health faces a rare decision next week in which he must choose whether to uphold major revisions in a controversial mental patient’s care.
In what apparently amounts to his first direct involvement in a single patient’s care since his appointment in 2002, James S. Reinhard must decide the fate of Cesar Chumil, a 57-year-old patient at Western State Hospital who has been held in some form of seclusion or restraint for much of the past 20 years.
Lawyers for Chumil and his family have been working for more than two years to move Chumil from the hospital in Staunton to less restrictive quarters where he will be closer to his family in Northern Virginia.
In an apparently unique situation within the state’s mental health system, Chumil is considered too dangerous to mingle among the hospital’s staff and patients, yet he is considered docile enough to make visits away from Western State with his family for short periods of time without supervision.
In major victories for Chumil, his Charlottesville-based legal team has won decisions from two independent human-rights panels — one based in the Staunton area and the other a statewide panel — finding that Chumil’s living quarters amount to seclusion and have violated aspects of state law.
The State Human Rights Commission decided Aug 1 that Western State violated state regulations by not properly documenting Chumil’s condition as frequently as necessary to warrant continued seclusion. And it agreed to extend Chumil’s continued seclusion only until early December.
“At that point, it’s our feeling that our client must be moved to another facility closer to his family,” said one of his lawyers, Nathan Veldhuis.
In the interim, the state panel directed Western State to provide treating physicians fluent in Spanish and to document Chumil’s condition as often as every 15 minutes.
The case has now moved to Reinhard, a psychiatrist and longtime advocate of community-based care, who by state law must issue orders addressing the findings of the state and local human-rights committees.
State regulations set up a timetable for the commissioner’s action, in this case by Wednesday.
“The ball is definitely in the commissioner’s court,” said Alex R. Gulotta, director of the Legal Aid Justice Center in Charlottesville.
A spokeswoman for the state Department of Mental Health, Mental Retardation and Substance Abuse Services said the case is a rarity.
“I am not aware of another [State Human Rights Committee] matter regarding the care of an individual patient where the commissioner has been directly involved,” the spokeswoman, Meghan McGuire, said in an e-mail.
She added that Reinhard’s training as a psychiatrist is a benefit to the state’s mental health system both in individual matters and in decisions affecting the general population.
At a meeting last week, Chumil and his family met with his lawyers and state representatives, but there was no word about what decision may have been reached.
Chumil has remained within the state mental-health system for more than 20 years. His long periods of being shackled with restraints were cited by the Justice Department almost a decade ago as evidence of abusive practices at Western State.
But after the federal government ended its investigation and oversight of Virginia’s mental-health system in 2003, Western State devised a locked, private, limited-containment suite for Chumil that allows him some movement within a large, dormlike cell; an adjacent bathroom; and an outside patio area that is fenced in.
The series of rooms minimized opportunities for Chumil to strike out at patients and care givers but severely limited his contact with other people.
Chumil’s assaults have lessened since his placement in the unit, but his lawyers have equated his confinement to a form of continuous punishment. Documentation of his condition lapsed last year,
Chumil’s lawyers have said that Chumil’s conduct clearly shows that he responds and opens up to treatment providers fluent in his native Spanish and to the presence of family members. They say that Western State has refused to acknowledge that its treatment of Chumil has failed and that he would benefit by another setting.
Reinhard is expected to clarify to what extent the state can abide by the findings of the human-rights panels, including determinations by both panels that Chumil should be moved.
Bill McKelway is a staff writer for the Richmond Times-Dispatch.