- The Washington Times - Sunday, July 8, 2001

STAUNTON, Va. — A state-run psychiatric hospital that has been the target of investigations and lawsuits over patient care fired a staff doctor who complained about the quality of care for years and subsequently went public with his criticism.
Dr. W. Harry Horner, an internist at Western State Hospital in Staunton for six years, received notice he had been placed on administrative leave May 7, the day he returned to work after six weeks of medical leave. He was fired May 15.
"I think this is very much in retaliation, not only because I had gone public, but had been unremitting in my protests of inadequate patient care," Dr. Horner said in an interview last week.
Dr. Michael T. Clayton, Dr. Horner's supervisor in the medical unit at Western State, said the charges against Dr. Horner "were, the best I can tell, all very contrived."
State personnel policies were followed in Dr. Horner's dismissal, said Martha Mead, spokeswoman for the state mental health department. She declined to comment further because of employee confidentiality rules.
In August 1999, Dr. Horner publicly criticized his bosses at Western State and the state mental health department, saying his efforts to get adequate psychiatric care for patients in his medical unit were like "talking into a void."
On March 14 this year, he wrote the hospital's medical director that "inadequate patient care persists and demands to be addressed."
Dr. Horner said the problem at Western State lies in organizing and delivering medical care. "The issues of who is responsible for doing what, how, when, to whom and for whom are long-standing issues of contention," he said in the memo.
Psychiatrists at Western State are the attending physicians for most patients and should take responsibility for their patients' basic medical care, Dr. Horner wrote. Not only is it good medicine but "paying someone to practice psychiatry then limiting their functions to that of a psychologist with prescribing privileges is not fiscally responsible," the memo said.
"This is no way to operate a hospital," said Dr. Clayton. "This is a psychiatric hospital. Everyone's primary physician really needs to be a psychiatrist. I believe psychiatrists as physicians need to make a determination when an individual needs consultation and need to be able to do physical examinations."
Miss Mead said Western State psychiatrists have overall responsibility for care of their patients. But patients with medical problems are referred to internists.
"For example, if a patient has diabetes the internist would manage that as part of the [clinical] team," she said. "The point is that the psychiatrist continues to maintain the overall responsibility and care of the patient."
Dr. Anita S. Everett, inspector general for the state mental health system, said she feels comfortable with the direction the hospital is headed in its basic medical care.
Two months after writing the March 14 memo, Dr. Horner was cited for violations:
* Disclosing confidential performance related information about an employee.
* Leaving work without arranging coverage for his shift or notifiying the medical director's office.

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