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"HOW COULD THEY KEEP ME FROM MY HUSBAND?" --

A no-visitor policy at the Hampton VA hospital psychiatric

unit leaves a widow questioning her husband's care.

 

Nancy Washabaugh

 

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'How could they keep me from my husband?'

A no-visitor policy at the Hampton VA hospital leaves a widow questioning her husband's care.

BY STEPHANIE HEINATZ
247-7821

When Nancy Washabaugh admitted her husband to the psychiatric unit at the Hampton Veterans Affairs Medical Center in January, she was hopeful.

Two weeks later, 63-year-old Floyd "Chip" Washabaugh was dead. A state medical examiner said the cause was a pulmonary embolism, a blood clot that enters the lung's arteries. Pulmonary embolism is the third-leading cause of hospital deaths, according to the Mayo Clinic. It can be caused by prolonged bed rest or inactivity, which is why hospitals encourage patients to get out of bed as quickly as possible after surgery.

Nancy can't say how often Chip moved around while in Hampton. Other than one consultation - where he appeared unwashed and unkempt - she was not allowed to see him.

At the Hampton hospital, psychiatric inpatients are not allowed visitors.

That policy, in effect at the hospital since 2004, appears to violate the patient rights laid out by the U.S. Department of Veterans Affairs.

It also appears to violate generally accepted medical practice.

"I have never heard of a psychiatric unit that never permits visitors," said Margaret Walsh, director of the office of human rights for Virginia's mental health department, "and I have been in this field since 1967."

Dr. Priscilla Hankins, chief of the VA hospital's mental health services, defended the policy.

"I recognize that it's highly restrictive," Hankins said, "but it's for patients' safety."

"How could they keep me from my husband?" Nancy Washabaugh asked. "He needed me as much as I needed him."

BENEFITS AND RISKS

Receiving visitors has a healing benefit for patients, psychiatry experts said.

"It's widely believed that people with mental illness, as with physical illness, benefit from a support system" and having access to that support system, said Mary Cesare-Murphy, executive director for the Joint Commission on Accreditation of Healthcare Organizations' behavioral health program. "I don't think that a lot of people have done research on that because it's just kind of accepted."

Visitors also act as monitors: Hospital staff members know that somebody is coming in and likely will point out any care issues they see.

They can also present risks. Cesare-Murphy points out that if a mental health patient's problem is linked to his or her family, visits might be a bad idea. The decision, she said, should be made case by case.

The VA hospital's blanket ban on visitors was imposed in response to two overdoses in the unit, Hankins said. One was in 2000, the second in 2001. The second overdose was fatal.

Both stemmed from contraband sneaked inside, she said. She wouldn't say what the contraband was.

Hospital staff first tried restrictions, allowing only family members to visit. Then they tried enacting a no-visitors policy on half of the unit.

Hampton's psychiatric unit, which is authorized to hold 60 patients at a time, is divided into two wards: acute and sub-acute.

Patients are admitted on the acute ward. They come in voluntarily, Hankins said, and they can leave voluntarily, though the unit can pursue a court order to force patients to stay if doctors think that they present a danger to themselves or others.

Hankins said most of the patients arriving on the acute ward were suicidal, severely psychotic, depressed, confused, combative or going through detoxification from drugs or alcohol.

After patients are stabilized and have completed an initial phase of treatment, they're transferred to the subacute ward. By then, they are more self-sufficient and working toward discharge.

The first blanket no-visitors policy was on the acute ward only.

"In spite of those changes, it didn't eliminate all of the threat," Hankins said. "We had to do something to stem the tide of contraband getting in."

Even without visitors, contraband is still found on the unit, Hankins said.

Regarding whether hospital staff could be responsible, Hankins said she couldn't theorize.

"People are clever," she said. "As much as you try, people can't be 100 percent foolproof."

LOOKING FOR HOPE

In 38 years of marriage, there wasn't a time when Nancy Washabaugh could have foreseen the deep depression that Chip Washabaugh would enter.

He was a kind and loving man who smiled every time he was around his growing family, which now includes grandchildren.

To Nancy's knowledge, he hadn't even suffered from post-traumatic stress when he returned from the Vietnam War with fresh scars. Chip was wounded when an explosive detonated near him as he helped look for Viet Cong. He got out of the Army and had a successful career teaching history near Richmond.

Seven years ago, Chip retired. When Nancy retired in 2005, they set out to travel.

Last fall, they spent several weeks in England and Scotland.

It was when they returned that Nancy noticed changes in Chip - confusion, memory loss, insomnia. It wasn't long before Chip wouldn't even get out of bed.

"I knew then that something was seriously wrong, especially for someone who was so happy," she said.

In November, Chip was admitted to a civilian hospital in Richmond.

Nancy was scared. She did not understand mental illness and told only family members what Chip was dealing with. When friends called, she told them that Chip had the flu and would call back when he was feeling better.

Nancy was sure that he would get better. Doctors prescribed various medications and started Chip on electroconvulsive therapy, or shock treatments.

When their mental health insurance ran out before Chip showed any progress, Nancy turned to the Department of Veterans Affairs. First, Chip was admitted to the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, the closest to their Colonial Heights home.

The McGuire center doesn't offer electroconvulsive therapy, but doctors there tried to treat Chip with medications. Nancy was by his side each day, during posted visiting hours.

She needed to be there, she said. At times, only she could get him to shower or get out of bed.

When she got him up, they'd walk the halls for hours. A nurse had told Nancy that physical activity was crucial.

Chip was physically healthy, Nancy said. He'd had no major medical issues since being wounded in Vietnam. But even healthy people can develop blood clots if they are idle for too long.

By the end of the year, it became clear that relying on medication alone wasn't helping, Nancy said.

Doctors told her that Chip needed to resume the shock treatments. The medical center in Hampton was the closest VA center that offered them.

On Jan. 11, Nancy followed an ambulance carrying Chip to Hampton. Occasionally, he would wave to her through the back window.

"I thought to myself then that this was it - he was going to get better."

RIGHTS VS. PRIVILEGES

Patient rights are displayed throughout the medical center on giant posters.

In the first section of the lengthy list, under the heading "respect and nondiscrimination," the posters read that "as an inpatient ... you may have or refuse visitors."

VA medical centers are governed by federal regulations. The right to "have or refuse visitors" is a policy set by the Department of Veterans Affairs.

The Hampton medical center receives its accreditation from the Joint Commission on Accreditation of Healthcare Organizations. According to the commission's written standards, "when an organization restricts a client's visitors ... the restrictions are determined with the client's participation and, when appropriate, his or her family."

If a restriction is imposed, the commission says, it should be evaluated for therapeutic effectiveness and documented.

At Eastern State Hospital in Williamsburg - the country's first public mental health institution - visitor restrictions are decided case by case, according to Joyce Natson, who works in the hospital's admissions office.

When restrictions are deemed necessary, usually it has been determined that visitors are adversely affecting a patient's treatment. That determination is documented in the patient's medical files.

Substance abuse treatment centers are the only places in the state with blanket restrictions now, said Margaret Walsh of the state department of mental health.

Even that restriction is limited to the first few days of detoxification. And before that policy was approved, Walsh said, it was reviewed by several human rights committees.

Hankins wouldn't discuss Chip Washabaugh's case, citing privacy regulations.

But she would, in general terms, discuss the psychiatric unit's policy and why it seems to violate the departmentwide right that inpatients "may have or refuse visitors."

Having visitors, Hankins said, is "a privilege" if it affects patient, staff or visitor safety.

"We encourage family participation and support," Hankins said. Under the no-visitors policy, though, the vehicle for that participation is during consultations with doctors and via telephones on the unit.

She also defended the policy by saying most patients are in the unit for short periods. The average stay on the acute ward is three to five days, she said, and on the sub-acute ward, it's 10 to 12 days.

Nancy Washabaugh said her husband's doctors said he could need up to 12 electroconvulsive therapy treatments - three each week.

He could have been there for four weeks.

Hankins said she realized that "it may seem like we are on the other side of the spectrum," compared with visitor policies elsewhere.

She said Nancy Washabaugh's complaint was the first major one since the policy went into effect.

FIGHTING THE POLICY

When Nancy checked Chip into the psychiatric unit's acute ward, an emergency room doctor said to her, "Maybe they'll let you visit him." She paid him no mind.

Then a cleaning lady walked up and whispered, "They're not gonna let you in there."

Nancy didn't believe it until she watched the door to the unit close, with her on the outside.

"I cried all the way home. How could they keep me from him?"

The next day, she contacted U.S. Rep. Randy Forbes, R-Chesapeake.

Legislative aides in his Colonial Heights office helped draft a letter of inquiry to the medical center, asking whether something could be worked out for the Washabaughs.

In a letter to Forbes, the medical center's director, Wanda Mims, explained that "face-to-face visits were not permissible on this ward," but that Nancy "could stay in contact with her husband by telephone."

The policy will be reviewed to see whether there are areas where they can be flexible, Hankins said last week.

Nancy returned to the medical center a week after Chip was admitted for a treatment planning session.

She was happy to finally see him but disturbed by his appearance: "His clothes were dirty. His pajamas were dirty. He had a bad body odor."

Nancy smiled for him, encouraging him to get his treatments, so they could be together again.

Later that day, she said, she got a call from a doctor. Chip was refusing treatment - which is another right listed on the Department of Veterans Affairs posters.

"I truly believe it's because I wasn't there to be with him," Nancy said.

"When he received the treatments in (the civilian hospital in) Richmond, I was with him when he woke up.

"He'd be confused, his face would be twitching, and I'd tell him everything was going to be all right."

She said she told the doctor that she could get Chip to cooperate, if they would let her in.

He said he would check to see whether that was possible. Minutes later, Nancy said, he called back and told her no.

"You won't get him to do it, then," Nancy said she replied.

According to medical records now in Nancy's possession, Chip never did receive the treatment that he went to Hampton for.

In the following week, Nancy decided to move Chip from the Hampton VA hospital to the Medical College of Virginia hospital in Richmond, even if she had to try to pay for it herself.

On Jan. 24, she was at McGuire Medical Center, gathering Chip's records so he could be transferred. While she was there, she got a call from Hampton:

Chip was dead.

Nancy was left with grief, anger and questions.

"If they weren't taking the time to keep him clean, how can I be sure that they were taking the time to get him out of bed?" Nancy still wonders. "I don't know what they were doing with him or for him in that locked facility."

Staff researcher Tracy Sorensen contributed to this report.

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Larry Scott  --