A patient who suffocated in January at the bottom of an improper dogpile of S.C. Department of Mental Health hospital employees had previously sued the state agency, alleging it unnecessarily institutionalized him and other patients.
William Avant, a 35-year-old Georgetown native, fought to be discharged from the Bryan Psychiatric Hospital in Columbia so he could return to his community, work and pursue art. But he was forced to languish at the facility for years because the state wasn’t providing the community treatment and services he needed to live at home, according to a 53-page lawsuit filed in May 2017.
The complaint, filed on behalf of six Bryan patients by a nonprofit that fights for people with disabilities, accused Mental Health of violating the Americans with Disabilities Act by “unnecessarily or illegally” institutionalizing patients for lengthy stays instead of investing in treatment that would allow them to return to their communities.
“The culture of the asylum persists tenaciously,” attorneys for Protection and Advocacy for People with Disabilities wrote in the complaint.
The lawsuit was settled a month after Avant’s death, with Mental Health agreeing to improve its community-based treatment and work to discharge patients faster.
“The biggest regret we have is that we weren’t able to do it sooner, especially in Mr. Avant’s case,” said Anna Maria Darwin, an attorney for the watchdog group. “We’ll never know if we could have avoided losing him if we had been able to work this out sooner. There’s a lot of what ifs.”
Avant’s death was first reported in The State earlier this month. The case was ruled a homicide after Mental Health hospital staffers piled on top of Avant to restrain him after he attempted to push his way into a medicine room. Unable to breathe under their weight for four minutes, Avant suffocated and could not be revived.
The employees’ actions were explicitly prohibited in their training. Records obtained from a February investigation by state health regulators show three of the 13 employees involved in the incident had not completed their required training.
Since The State’s July 14 report, the Joint Commission that accredits hospitals has opened a review into Avant’s death, and the S.C. House Oversight Committee has begun to probe what went wrong.
Avant’s family declined to comment through an attorney. Avant had Klinefelter syndrome — a chromosomal disorder linked with anxiety, depression, learning disabilities and behavioral problems, such as impulsivity, medical records show.
Asked about the lawsuit last week, Mental Health referred The State to its April 15 statement on the legal settlement.
In that statement, agency Interim Director Mark Binkley said, “This agreement came about because both the Department and (Protection and Advocacy) want comprehensive public mental health services to be available for any citizen, young or old, wherever they live in South Carolina, whenever they need those services.”
‘Warehoused at Bryan’
Avant was a key piece of Protection and Advocacy’s legal case against Mental Health as the watchdog group sought to illustrate that the department was systematically mistreating adult patients.
He was the first of six Bryan patients whose stories were shared in the lawsuit, their names disguised to protect their identities.
Listed in the complaint as “AW,” Avant had racked up at least $622,000 in medical bills during his 12-year stay at Bryan, according to the complaint.
The lawsuit also said:
▪ Avant enjoyed art, but hospital staff limited how much time he could spend on his craft as well as what materials he could use. He wanted to work in his community, but the agency did not provide necessary services near his home to make that possible.
▪ Avant and his fellow adult patients at Bryan remained behind locked doors most days, leaving only in supervised groups for activities or to go to the cafeteria, canteen and library.
▪ Their visiting hours and phone calls were limited, and their only opportunity to work was as janitors in their lodges.
▪ Hospital staffers made virtually all their decisions for them, including when to wake up, what to eat, what to do, when to shower, where to sleep and when to go to bed.
▪ The cost of the patients’ care — $503 a day, and about $183,600 a year at Bryan — creates “a perpetual burden of debt that will follow them to their death” and discourages them from trying to make money or plan for the future.
Two other patients mentioned in the complaint had accumulated more than $1 million in medical bills at Bryan.
“Just as they were at the State Hospital (on Bull Street in Columbia), individuals with mental disabilities are warehoused at Bryan, isolated from their families, friends, and communities,” the lawsuit said.
Avant was deposed as testimony for the lawsuit, but efforts to obtain his sworn statements this week were unsuccessful.
“As one of the named plaintiffs, he would have been extremely important,” said Darwin, an attorney for Protection and Advocacy. “They have to speak for themselves and the rest of the (patients).”
The lawsuit also said Mental Health harmed patients by prioritizing inpatient care over support in the community.
According to Protection and Advocacy’s complaint, Mental Health created arbitrary delays and barriers to discharging patients and failed to invest in community-based services, leading to unnecessarily long stays at Bryan for Avant and other patients.
Those community services — such as assisted living facilities, local mental health centers and mobile crisis units — could have allowed the agency’s psychiatric patients to live outside of a restricted hospital setting, the advocacy group said.
According to the lawsuit, patients in some parts of the hospital stayed there for more than 800 days, on average, and as many as half of the roughly 150 adult patients living at Bryan were “stable and could be discharged to a less restrictive setting.”
And some patients eligible for discharge lost hope and regressed after their departures were delayed because they agency could not provide them with mental health services or a place to live in their communities, according to the suit.
Part of the problem was Mental Health’s overemphasis on inpatient care, Protection and Advocacy attorneys wrote.
State lawmakers cut nearly 40% of Mental Health’s budget — more than $86 million — during the Great Recession. But as state funding has recovered, the agency has focused the money toward inpatient facilities — including providing more beds at Bryan — while spending less on community-based services, the lawsuit alleged.
Darwin said mental health care should more closely mirror physical health care — patients experiencing a crisis should be stabilized and returned home as quickly as possible, rather than kept at the hospital for lengthy stays.
“The goal is not to go to the hospital,” she said. “The goal is to be healthy.”
A month after Avant’s death, lawyers on both sides agreed to settle the case, with Mental Health admitting no guilt or wrongdoing. Avant was removed from the lawsuit, with his family retaining the right to press its own legal claim against the agency.
The settlement stated both sides had a common interest in improving the care of mental health patients. Protection and Advocacy did not seek monetary damages or even attorneys’ fees from the agency. Instead, the agreement called for Mental Health to work with the advocacy group on a strategic plan to improve its discharge process.
Mental Health also committed to:
▪ Expand its community crisis response teams and mobile crisis units across the state to address emergencies locally and prevent unnecessary hospital stays
▪ Hire a new team of transition specialists to focus on discharging patients and helping them transition to the community
▪ Work in good faith to reduce staff-to-patient ratios in community treatment teams by pursuing grants and more state funding
▪ Expand community housing programs by up to 40 beds per year for five years. That would add 200 new beds in communities across the state, but it depends on Mental Health getting funding to pay for it.
▪ Study expanding operating hours at community mental health centers. In its lawsuit, Protection and Advocacy complained that Mental Health’s outpatient centers offer “a limited and inconsistent array of services, office hours and options.”
Those are positive, long-term changes that were worth the fight, Darwin said.
But for Avant, who was on a waiting list to be discharged when he was killed, the settlement came too late.
“Even though we lost him, hopefully, there’s going to be a lot of people in the future who will not have to wait so long,” Darwin said.