Psychiatrists, Employees, Patient Families Decry Preventable Deaths at Greystone Park Psych Hospital

August 17, 2019

Before he died at 29, Michael Vecchio of Hanover, New Jersey spent the last three months of his life in hospitals.

He didn’t have a terminal illness. He had schizophrenia. And had he not been at Greystone Park Psychiatric Hospital in Parsippany for most of that time, his mother believes he would still be alive.

Privacy laws prevented Beth Vecchio from knowing her son had stopped eating weeks earlier until an ambulance rushed him, writhing in pain, to Morristown Medical Center. He died the following day, on Jan. 25, 2017 after his impacted colon ruptured and he developed sepsis, according to hospital records.

“How dare they use the word ‘hospital’ in their name. They let him starve for at least 30 days,” said Beth Vecchio, Michael’s mother. “It’s a baby-sitting service with pills.”

The list of Greystone’s failings as a psychiatric hospital are extensive in the New Jersey Office of Public Defender’s ongoing lawsuit against the Murphy administration.

Psychiatrists and other employees gave sworn statements in June describing how violence, mismanagement and despair have become "normalized.” One doctor said the institution was “unsuitable for human beings.”

But the Public Defender’s lawsuit also raises serious questions about Greystone’s ability to provide adequate medical care. The details of Michael Vecchio’s death illustrate what is at stake if conditions don’t change.

Carl Herman, director for the division of mental health advocacy for the Public Defender’s Office, said multiple instances of medical neglect, including three preventable deaths, were uncovered while the office researched Greystone’s problems.

“They are court-ordered to be in Greystone, and can’t leave to see a doctor, so their medical needs must be taken seriously by hospital staff,” Herman said.

The state Attorney General’s Office has filed a motion to dismiss the case, saying the complaint “fails to state any viable claim.”

“To be clear, the State remains strongly committed to providing the best medical care possible to the patients at Greystone and at all state hospitals,” according to the state’s response.

A federal judge overseeing the public defender’s lawsuit last month ordered state and the public defender into mediation, which is scheduled to begin next week, according to court records.

The deficiencies in medical care are symptomatic of the “lack of psychiatric care and understaffing throughout the system,” said Lycette Nelson, senior staff attorney at Disability Rights New Jersey, a federally funded legal advocacy group which makes frequent visits to the state hospitals.

“They don’t have (enough) staff responsive to the needs of patients,” Nelson said.

The shortage of psychiatrists has been acute for years at Greystone, which, according to the public defender’s lawsuit, was intended to employ 29 full-time psychiatrists to treat 460 patients when it opened in 2008. As of Aug. 17, there were 16 full-time psychiatrists as well as 12 full-time physicians at the hospital, state Health Department spokeswoman Donna Leusner said.

There were 367 patients at Greystone on Aug. 9, Leusner said, down from 498 in April 2018 and 560 in March 2017. To address the overcrowding, former Health Commissioner Shereef Elnahal signed a contract last year with the privately run Carrier Clinic in Belle Mead to accept up to 14 Greystone patients.

“Thank goodness the overcrowding has been resolved,” said Louan Lukens, a veteran social worker for Disability Rights.

But even with fewer patients, “with each passing month it becomes less of a hospital and more of warehouse," Robert Davison, executive director for the Mental Health Association of Essex and Morris, Inc. said, based on reports he received from families and the revelations in the public defender’s lawsuit.

“I’ve been doing this a while, this is about as bad as I have seen it,” he said.

Is it an emergency or not?

No one would confuse Greystone or the state’s three other psychiatric facilities with typical acute-care hospitals, which are equipped with an emergency department, an intensive care unit and an extensive suite of specialty services.

But the U.S. Centers of Medicare and Medicaid Services requires government-funded psychiatric facilities like Greystone to submit a plan to respond to medical emergencies, either on-site or off. A trained staff is expected to be capable of carrying it out.

More than two years ago, the state stopped training its psychiatric hospital employees in advanced cardiac life support and removed key equipment on the mobile “code carts” to respond to cardiac arrests and other life-threatening emergencies. These decisions were made, according to the public defender’s lawsuit, to reduce the state’s potential liability and save money.

Greystone physician Walter Bakun gave a sworn statement in support of the lawsuit describing how he saved a patient dying from a drug overdose by administering Narcan through the tube of his stethoscope because the code cart "was so inadequately stocked.”

Only a doctor has the authority to call for a code cart in an emergency, “significantly limiting the opportunity during what is frequently a narrow window of time to administer lifesaving measures,” Bakun’s statement said.

Bakun cited instances in which four patients and one employee died because emergencies were not treated like emergencies.

Had epinephrine — “a necessity in any adequately equipped code cart” been available, one Greystone patient suffering a heart attack could have been saved, his statement said. Another patient died from a pulmonary embolism, a blood clot that travels to the lungs.

“His death could have been prevented with Advanced Cardiac Life Support,” Bakun’s statement said.

Problems were also cited with getting ambulances swiftly enough to transport distressed patients to hospitals with emergency rooms.

Even after a doctor says “immediate/emergent transportation” is essential, a transport within 45 minutes to 60 minutes is still “acceptable” depending upon the doctor’s recommendation, according to the state’s policy manual.

“The ambulance response time ranges anywhere from approximately 20 minutes to 1 hour, which is completely unacceptable and likely constitutes a fatal delay during a life-threatening emergency,” the public defender’s lawsuit said.

Nelson from Disability Rights agreed ambulance response times have been a longstanding concern. The ambulance services, “who were quite upset,” pointed fingers at Greystone for not calling them fast enough, she said.

Keith Kazmark, Parsippany’s business administrator, said the township’s paid emergency medical service, Par-Troy EMS, made 39 trips to Greystone over the last 18 months, with an average response time of eight minutes.

“There have been no complaints since I got here,” in October,” Kazmark said. “I can’t speak to what happened before.”

In response to the Public Defender’s lawsuit, the state Department of Health submitted a report that said the average wait time for an ambulance to arrive at Greystone was 25 minutes in 2018 and 21 minutes in the first half of 2019.

That’s a longer average wait time than for emergency services overall in Morris County, where Greystone is located: 16 minutes in June 2018 and 2019, according to the health department’s website.

“We’re very concerned by the length of time that patients at Greystone must wait for critical medical services,” Herman said. “In a serious or life-threatening situation, and given that Greystone no longer provides advanced life-saving on-site at the hospital, this is much too long.”

Michael Vecchio suffered severe stomach pain “for a few days” before Greystone called the ambulance on Jan. 24, 2017, according to his mother, Beth, recalling what she said a nurse told her during a telephone conversation that day.

Twenty hours later, Michael was dead.

He was “encouraged” to eat

Almost everything Beth Vecchio knows about her son’s final months she read in medical records after his death. Vecchio, a single mother of three adult children, is suing the state and Morristown Medical Center for wrongful death and negligence. Officials for the state and Morristown declined to comment on her suit.

The last time Michael was in her care was Oct. 2, 2016. They had gone to church that Sunday morning but he spent the rest of the day in his bedroom and refused her offer to go out for dinner. She called the police after he locked her out of the house.

He told the Hanover Police officers he wanted to hurt his mother, according to medical records. Beth said she wasn’t afraid of her son, who liked to write poetry, paint pictures, play guitar and read voraciously about religion. But she recognized he was in a paranoid, psychotic state. She expected he would stabilize and return home — just as he had done before many times in the last decade.

Michael Vecchio spent six weeks in the psychiatric unit in St. Clare’s Hospital in Boonton and refused visitors.

“He would not see me. He was actively psychotic. They told me they would try to get him to sign the HIPPA form,” a document that would have allowed the hospital to discuss his treatment with his family, she said.

A nurse “took pity" and told her Michael was moving to Greystone on Nov. 21, 2016, Vecchio said. “I started to go every night to Greystone. He would see me through the window and wave, then wave me away."

As Christmas, Michael’s favorite time of year, approached, he finally allowed his family to visit him. He still refused to allow Greystone to share information about his care.

“He started to look different around Christmas," Beth Vecchio said. Her sister who came for a visit noticed his bulky frame looked more wiry and frail but his belly was bloated. He said he was “fasting.”

Really, he was starving himself, and for weeks at a time. He told his doctors he was a “Zen master,” and like Gandhi, would not eat, according to his medical records. Staff, including a dietician, “encouraged” him to eat and drink. His staples were soy milk, fruit and candy, and occasionally broke his fast, according to his medical records.

Beth Vecchio said Michael’s sister spoke to a Greystone employee the day he died, when she went to pick up his belongings. She said the employee told Michael’s sister: “I’m sorry to hear of his passing. I thought he was going to start to eat. What a shame.” How long had he not eaten, his sister asked. "About 30 days,'' was the reply.

“They were aware of this and there was no treatment?" Vecchio said, her eyes narrowed in disgust.

When Beth Vecchio arrived at the emergency room at Morristown Medical Center, no one questioned her right to information about his health.

“Miraculously, I mattered. I was his mother again," she said.

Doctors told her he had an impacted bowel and they need to give him an intravenous drip to release the blockage. “They had to empty the two colons that were completely filled and hard as rocks...It would not have ever been like that had he been eating and drinking properly at Greystone,” she said.

Hours later, she said, “I don’t exactly remember when it started happening, but there was blood - a lot of blood - (he was) throwing up blood. Then there was a lot of suctioning.” Still, there was “no sense of urgency” or fear Michael would not recover, she said.

“When I came in the early morning, the nurse was adding another bag of saline. Each time saying, ‘this is too much saline’ but giving it anyway," Beth Vecchio said. "Michael looked up at her and said, ‘I am going home today — I am going to die.’ "

The cause of death was sepsis, a widespread infection, after his colon ruptured, according to the lawsuit and medical records.

“They call this Greystone Park Psychiatric Hospital," Beth Vecchio said. “Hospital is a word for a place that takes care of people. If I were the one giving him care, he would have eaten. If he refused to eat because he was psychotic, I would have taken him to the hospital where they would have nourished him."

Source: “Preventable deaths at N.J. psychiatric hospital spark anger: ‘It’s a babysitting service with pills’,” NJ.com, August 17, 2019. URL: https://www.nj.com/news/2019/08/preventable-deaths-at-nj-psychiatric-hospital-spark-anger-its-a-babysitting-service-with-pills.html