April 8: Judge slams St. Peter state hospital for misleading him on a patient's care

Two psychiatrists at the Minnesota Security Hospital in St. Peter deliberately misled a Hennepin County judge about the care of a mentally ill woman after the judge concluded she had suffered medical neglect, according to court documents reviewed by the Star Tribune.

In a stinging order issued Thursday, Judge Jay Quam accused the woman's psychiatrist, who has since been fired, and the hospital's medical director of engaging in a cover-up to hide violations of medical protocol and create the impression that the 49-year-old woman was receiving timely psychiatric care.

Quam said it appears that medical staff left the woman undermedicated and deprived of sleep, and then tried to hide the fact by reconstructing medical records to document her treatment. "They made up records months after the fact ..." Quam wrote. The episode, he concluded, "caused her to lose a year of her life without any gain to show for it."

The woman's case is the latest sign of dysfunction at St. Peter, the state's largest psychiatric hospital, which cares for nearly 400 patients deemed mentally ill and dangerous. It was placed on a conditional license in late 2011 by Human Services Commissioner Lucinda Jesson after reports of patient maltreatment, and then it suffered the resignation of several staff psychologists during a stormy change in top management in 2012.

Alarmed by the record-keeping irregularities that surfaced in his courtroom, Quam has ordered the state Department of Human Services (DHS) to produce medical files for another six patients from Hennepin County.

Court supervision, Quam said, has become necessary "to ensure [patients] are being properly treated and not held longer than necessary."

DHS officials say the woman's psychiatrist, Dr. Edward L. Kelly, did keep appointments with his patients and kept some records of the woman's care, but they acknowledge that the case was handled badly.

Three days before a February court hearing to review the woman's status, Kelly was fired by the hospital's medical director, Dr. Steven Pratt. Pratt has acknowledged ordering Kelly to reconstruct records of the woman's care, according to court documents and interviews. Last week Barry ordered that Kelly's actions be reported to the Minnesota Board of Medical Practice.

Kelly could not be reached for comment last week.

Court records indicate that the woman's case is not an isolated incident. Kelly allowed other patient files to fall into similar disarray, according to court documents and interviews. As a result, more than two dozen other patients in a unit called the Competency Restoration Program at St. Peter may be experiencing delays in approval for their release.

Barry said Kelly's actions have deeply shaken the hospital's staff and that her agency is examining the case."I feel like we're turning a corner [at the security hospital], but there's a long way to go," Barry said in an interview.

The patient whose case came under Quam's review had been charged with a felony in 2011 for spitting on two police officers. After spending time in jail, she was committed to the St. Peter hospital, where she was placed in the Competency Restoration Program, which is supposed to stabilize patients so they are capable of working with attorneys and facing legal proceedings. As part of his treatment protocol for the woman, Kelly apparently instituted what Pratt described as "a lockout program so she couldn't go into her room and sleep during the day." Pratt said the protocol was "something I personally wouldn't have done."

A transcript of the hearing shows that the judge, generally known for a calm courtroom demeanor, became extremely irritated.

"Dr. Pratt, would you mind telling us what is going on here?" Quam said.

Pratt replied, "I had individual performance issues with a psychiatrist [Kelly] who was delinquent in his documentation." He added that Kelly had gotten a "month" behind in completing his progress notes. Quam: "So these didn't exist at the time we got together?" Pratt: "That's right." Quam: "So he is re-creating what happened months before?" Pratt: "Yes."

In the order issued last week, Quam wrote: "The CRP presented the made-up records as if everyone else had carelessly overlooked them the first time around. The truth finally came out only after the Court and other parties looked carefully at the documents."

In a surprise move, Pratt then concluded that the woman was competent to stand trial and should not have been held in the St. Peter program for what turned out to be nearly 16 months.

Dr. Paul Reitman, a court-appointed examiner who read the reconstructed records, told Quam and Pratt in court that he was troubled by conditions at the hospital. "It's concerning to me that the security hospital has some of the sickest people in the psychiatric population and yet they're getting a level of care lower than people would have in a psychiatric hospital," Reitman said. "The sleep-deprivation program that was implemented is incomprehensible to me." Criminal charges against the woman have since been dropped by Hennepin County, and Barry's agency is trying to find her a group residence that offers mental health services and support."We're horribly frustrated by what happened," Barry said.