How Media Can Help Medicine and the Law Protect Patients

The widespread abuse of mental health patients at Bridgewater State Hospital has been the subject of ongoing reporting by Boston Globe reporter Michael Rezendes and its Spotlight team. Photo by Lisa Poole, courtesy of AP Photo

In April 2009, a 23-year-old man suffering from paranoid schizophrenia was admitted to Bridgewater State Hospital. A month later, Joshua Messier was dead.

An autopsy found that his heart and breathing stopped while he was subdued by six of the facility’s guards during a schizophrenic episode, a sudden outburst that made Messier go from placid to violent and back again within minutes. Messier’s body showed signs of head trauma consistent with a beating. A video of the incident showed that even after Messier had calmed down, two of the guards folded Messier’s torso down into his knees and held him there in a banned technique called “suitcasing.”

Boston Globe reporter Michael Rezendes has spent more than a year investigating the legal, medical, and administrative questions surrounding Messier’s death, many of which are still unanswered. Rezendes’ digging found that Bridgewater State Hospital was using procedures for handling patients that were either outmoded or banned outright. Guards and medical staff frequently isolated patients for extended periods without treatment, and violated multiple Massachusetts laws and regulations governing the use of restraints. His initial story about practices at Bridgewater State appeared in the Globe in February. Since then, Rezendes has continued to report on problems at the troubled facility, including calls for reforms there. His latest reporting appeared in this past Sunday’s Globe.

Rezendes will speak about the intersection of media and health law at tomorrow’s Pike Lecture, held annually in honor of Neal Pike (LAW’37), a lawyer and advocate for individuals with disabilities. The title of his lecture is “Abuse of Mentally Ill Patients at Bridgewater State Hospital: How the Media Can Help Medicine and the Law Protect Patients.”

As a member of the Globe’s investigative Spotlight team, Rezendes shared a Pulitzer Prize for his reporting on the Catholic Church’s decades of concealing serial sexual abuse by its clergy. A movie about the investigation, Spotlight, is currently filming in Boston, with Mark Ruffalo playing Rezendes.

Despite its name, forensic hospitals like Bridgewater State occupy the hazy terrain between hospital and prison. Those sent there because they’re a danger to themselves or other people, as Messier was, and exist as both patients and inmates within a system that may be ill suited to handle the distinction.

In a recent conversation, Rezendes emphasized that Bridgewater State Hospital is governed by state statutes and multiple regulations regarding appropriate methods of controlling patients, but staff at the facility repeatedly violated these policies.

BU Today: Can you explain a bit about the scope of the abuses that you found?

Rezendes: One of the issues here is, of course, the use of seclusion and restraint. These are tactics that have been discredited all over the country. What I found is that doctors, nurses, and guards were all responsible for the wholesale illegal use of seclusion and restraint. When I say illegal, I am getting back to the issue of Bridgewater being a regulated facility. In fact, there is a very good law on the books here. The issue is not that the facility is unregulated. The issue is that the people running Bridgewater State Hospital don’t follow the regulations.

For example, state law restricts quite radically the legal use of restraints and seclusion to emergencies. And the law actually defines what an emergency is. It is the occurrence of or the threat of extreme violence. And that is the phrasing of the state statute—“of extreme violence”—either to another inmate, patient, or to him- or herself. So that is the definition. And it is written that way because of a crisis that occurred in Bridgewater back in the 1980s that led to some very good reforms. The problem here is not that we need legislative reform of the use of seclusion and restraint. We need people to abide by the law.

All that said there are some other issues here regarding the law that are quite complicated. And the legislature does need to take a look at some of these issues. For example, after my stories began appearing, the Disability Law Center, which is a federally mandated legal agency set up by the federal government to protect disabled people, did an on-site investigation at Bridgewater State Hospital. I think they had six or seven attorneys there full-time for several weeks and interviewed 50 or 60 patients.

One of their conclusions—and perhaps the most important conclusion, in my view—is that Bridgewater State Hospital should not be administered by the Department of Correction, which is the current administrator. The Disability Law Center says that Bridgewater should be run by the Department of Mental Health.

How would a seemingly minor administrative change make a difference?

I think that is important because this facility—I say facility because it is not a hospital—is a medium-security prison for the mentally ill. It seems just a matter of logic that it should be run by the Department of Mental Health and not by the Department of Correction, which has its own culture, for dealing with criminals. It is a completely different mindset and the training is very different.

One of the issues here is that the guards that work at Bridgewater State Hospital don’t get any particular training in mental illnesses or care for people who are mentally ill. Therefore a lot of inappropriate things happen that are really not the fault of the guards. They are not trained to know the difference between someone who might take a swing at them on a street corner after committing a robbery and someone who might take a swing at them because they are hallucinating and hearing voices. They don’t know when to make that distinction. They don’t know how to make that distinction. So they don’t react in the appropriate ways.

In addition to moving the facility under the Department of Mental Health, would there be any further patient protections or other benefits if the facility was fully accredited as a hospital?

That’s a good question. I think the answer is probably yes. To be fully accredited as a hospital, Bridgewater would have to do things that it doesn’t really need to do in order to increase the quality of mental health care. For instance, to be accredited as a hospital, it would probably need to have an emergency room. It would have to have the kind of facilities that are typical of a well-run hospital, but not at all typical of a prison. And that is another reason I think that rather than go for accreditation as a hospital, and make a lot of expensive changes that probably have nothing to do with delivering better mental health care, the more obvious solution is to transfer it to the Department of Mental Health, a group of people who are trained specifically in dealing with the mentally ill.

Does this issue with Bridgewater State play into the national debate over the outsourcing of prison care to privately held companies?

Yes. I think the issues at Bridgewater State Hospital, where there is a private contractor that is providing both the medical and mental health care, do play into this national debate. I addressed that issue in the story that appeared in Sunday’s Globe.

The Pike Lecture focuses on some of the legal and medical issues that can arise when taking a broader look at health care administration and infrastructure. How do you see journalism participating in that discussion?

I agree there is a fascinating juncture here of media, legal, and health-related issues. And I think the role of media is really as a watchdog—which is the case in the stories I have been writing in the last year. As I said before, the laws that are on the books are really pretty good when it comes to regulating the use of seclusion and restraint. The policies of Bridgewater State Hospital itself are quite admirable. The problem is nobody is following them. And that is where the media can play a significant role in putting the spotlight on the violation of the laws, regulations, and policies. I think that is a very important role for media to play.

Are there other facilities like Bridgewater State—either in Massachusetts or in surrounding states—that should be looked at more closely?

What I highlight in my stories is the fact that Bridgewater State Hospital is a forensic hospital—and is a real outlier. In other words, I looked at the statistics on the use of seclusion and restraint at other facilities that are similar to Bridgewater, other facilities that have similar populations. And these populations are fairly unique. They are a mix of convicted criminals who have committed very, very serious crimes—very dangerous people.

At the same time you have a lot of folks at Bridgewater and other forensic hospitals who are accused of minor infractions like, say, taking a swing at an orderly in a mental institution and being charged with misdemeanor assault and battery. Those people end up at Bridgewater as well to be evaluated for their competency to stand trial.

Massachusetts is the only state in the country—the only one—that has its forensic hospital administered by the Department of Correction, with the exception of a very small 28-bed facility in Iowa. Every other state has its forensic hospital managed by the equivalent of the Department of Mental Health. And I think that says a lot.

The other thing I found when comparing Bridgewater to other similar facilities is that the use of seclusion and restraint at Bridgewater was off-the-charts higher. I think those are two really salient points that need to be looked at very, very carefully here. Why is it that we are the only state in the country that has the Department of Correction managing the forensic hospital? And why is it that we are the only state that has a forensic hospital using seclusion and restraint as if it were a 19^th-century asylum?

A new film, Spotlight, directed by Tom McCarthy and starring Michael Keaton, Mark Ruffalo, Rachel McAdams, and Liev Schreiber, recounts efforts by the Globe’s Spotlight Team to uncover the clergy sex abuse story. What was your reaction when you heard a movie was going to be made about your team’s reporting?

It is very rewarding, to be honest. To have the work acknowledged, of course, but also the problem: clergy sexual abuse in the Catholic Church has not gone away. There are literally tens of thousands of victims all over the world who would like to see this problem dealt with in a more decisive way.

I think it is great to have our work acknowledged, but I think it is great to have consciousness raised about the issue again, and raised about the victims of clergy sex abuse, which I think this movie will do. I have read the script, and I think the movie will accomplish that very effectively. I am quite happy about that.

Michael Rezendes will give the eleventh annual Pike Lecture on Health Law, “Abuse of Mentally Ill Patients at Bridgewater State Hospital: How the Media Can Help Medicine and the Law Protect Patients,” tomorrow, Thursday, October 16, at noon in the Medical Instructional Building, Room L-112, 72 E. Concord St. The lecture is free and open to the public. The lecture is cosponsored by BU School of Law and the Department of Health Law, Bioethics & Human Rights at BU School of Public Health.

To read more of Michael Rezendes’ reporting of practices at Bridgewater State Hospital click here and here.

Michael Saunders can be reached at msaunders@bu.edu.