How we did it: Uncovering mystery deaths in state mental hospitals

By Alan Judd and Andy Miller
The Atlanta Journal-Constitution
From the Summer 2007 issue of HealthBeat.

It began with intriguing calls from employees of an Atlanta mental hospital.

Twice in one week, patients had died under questionable circumstances at Georgia Regional Hospital. One was a 14-year-old girl.

Basic details about the deaths were confirmed by patient advocates.

Soon after our initial investigative work, we faced a decision: Pursue a story about the two deaths, or go deeper to probe all deaths and other patient-care incidents at Georgia's seven state-run mental hospitals.

We chose to widen our scope. That led to a series of articles in The Atlanta Journal-Constitution called "A Hidden Shame," which began publication in January. The series reported that at least 115 patients had died under suspicious circumstances in Georgia's mental hospitals from 2002 to 2006. More than 190 patients over that time were victims of employee abuse.

Beyond our phone conversations with hospital employees who demanded anonymity out of fear of losing their jobs, we quickly ran into information roadblocks from the Department of Human Resources, which operates the hospitals. The state agency released thousands of pages of reports on patient deaths and other serious incidents, but refused to identify any patients, including those who died.

Citing HIPAA laws, the agency's lawyers heavily edited reports on patient deaths. In some cases, they blacked out entire pages, obscuring details on employee actions that may have contributed to deaths.

What was left was the age of the people who died, their gender and, in most cases, their race.

We compared that information to a state vital records database, which included names, counties of death, hospitals, and coding for the causes of death. Other crucial facts came from death certificates, autopsy reports, police reports, lawsuits and claims filed against the state.

Using these records, we identified 80 percent of the 364 deceased patients and pinpointed the causes of their deaths – information that, in many cases, even the patients' closest relatives had been unable to obtain.

Two nationally known psychiatrists, along with other patient care experts, agreed to examine the records we compiled. The psychiatrists went through our entire database of names and circumstances of deaths, and disagreed with very little on the deaths that appeared questionable.

Another issue we confronted was the fact that some patients and their families did not want their names used because of the stigma surrounding mental illness. Others agreed to step forward, names included, to tell their stories.

Since the initial articles in the series were published, state legislators established a commission to study ways to reform Georgia's mental health system. A consulting team put together by the Medical College of Georgia, hired by Human Resources, has begun critical reviews of patient care at the hospitals.

The U.S. Justice Department has launched an investigation of the state mental hospitals to determine whether patients' civil rights had been violated.

Alan Judd and Andy Miller are reporters at The Atlanta Journal-Constitution.