Tip Sheets

'A Hidden Shame:' Tips for reporting on deaths in mental hospitals

Alan Judd and Andy Miller of The Atlanta Journal Constitution reported a series about deaths in Georgia's mental hospitals. They shared how they did the story, including the following tips for reporters pursuing similar stories.

Expect the agencies that operate the hospitals to cite patient privacy as a reason to withhold virtually all information, even in cases where state employees are at fault. Negotiate for whatever data and material you can get: incident reports, even if they are heavily redacted; dates that incidents occurred; names of employees involved in the cases you are interested in, etc.

Especially for investigations of deaths in state hospitals, other sources of information exist. But it may require piecing together a full picture from several disparate documents and databases. These are some that we used in Georgia:

Vital records databases: Most states compile a vast amount of information in electronic form on every death. You can use this resource to winnow out the identity of people who died in particular hospitals, along with other information including the cause of death. (In most such databases, cause of death information is coded; to decode, go to www.who.int/classifications/apps/icd/icd10online.) Look for patients who died from trauma or from such causes as choking or aspiration pneumonia.

Death certificates: Some states redact some of the information recorded on the paper documents. But the cause of death may be listed, and the names and addresses of family members generally are available.

Autopsy reports: These are public record in most states. They often contain the most detailed account available of the events surrounding a patientâ€^TMs death. Remember to also ask the medical examiner for investigators' notes, photos and any other documents that recorded the death scene.

Police reports: Most police agencies do not feel constrained by HIPAA to withhold information. If a state hospital patient dies under mysterious circumstances, chances are a police agency will be called in to assist the investigation.

Risk management documents: Families of patients who die or are injured in state hospitals often file claims against the state. And often those are settled through a risk management process. The agency that handles such claims generally will release complete files on closed cases.

A patient's complete medical chart can be helpful, but generally is available only to family members who are the patient's legal guardian.