CHEYENNE - Patient-on-patient assaults, teens housed with adults and an overburdened staff at the Wyoming State Hospital are putting the health of patients at extreme risk, an advocacy group said Tuesday.

"We have concluded that immediate, comprehensive, remedial action is warranted," said Jeanne Thobro, executive director of Protection and Advocacy System Inc., a group that has been investigating the Evanston institution for the mentally ill the past two months.

Mandatory overtime resulting from chronic understaffing remains a top concern, Thobro said.

"It is causing staff burnout, it is causing staff turnover and it is causing staff discontent, and those things impact significantly on good patient care," she said.

The organization's probe, and a separate investigation by the state, are continuing.

Deb Fleming, director of the Wyoming Department of Health, said conclusions from the agency's review team are expected by the end of May.

The final report will be shared with Gov. Dave Freudenthal, the Legislature, Protection and Advocacy and other interested groups, she said.

Protection and Advocacy, based in Cheyenne, is part of a congressionally mandated and funded nationwide network that seeks to safeguard the rights of people with disabilities.

In 1994, P&A filed suit against the state on behalf of a state hospital patient, known as Chris S., alleging inadequacy and unavailability of appropriate facilities and services for people with mental illness.

An agreement reached on Jan. 24, 2002, required, among other stipulations, adequate staffing at the state hospital, development of community-based mental health services and increased access to services.

The latest investigations into the hospital were launched after a 43-year-old female patient hanged herself March 16.

"Our findings indicate this death could have been and should have been avoided," Thobro said. "There are systemwide failures and wholesale violations of the Chris S. agreement."

P&A has found adolescents placed in adult units and, in some cases, with adult felons.

"This practice must cease immediately," Thobro said. "That is in direct violation of the Chris S. settlement."

P&A also found "numerous" reports of assault of patients and staff by other patients along with patients in possession of weapons and contraband, successful and unsuccessful suicide attempts, self-mutilation and inoperable safety equipment, Thobro said.

Under a provision of the 2002 settlement, either party is allowed to request mediation to resolve disputes. P&A invoked that right shortly after the suicide but has not heard a reply from the state.

Fleming said she is awaiting guidance from the state attorney general's office.

"We haven't been given that word from them at this point," she said. "They're probably very interested in what our surveyors and our review team will come up with."

Attorney General Pat Crank was not available for comment Tuesday. A message left for Chief Deputy Attorney General Michael O'Donnell was not immediately returned.

The first phase of the state's probe consisted of an inspection requested by the federal Centers for Medicare and Medicaid Services after the suicide. A follow-up survey, which will involve CMS staff, will occur later this month.

The second step was creation of an independent review team, which includes in- and out-of-state private and public mental health professionals, plus two legislators: Sen. John Schiffer, R-Kaycee, and Rep. Jane Warren, D-Laramie. Protection and Advocacy is also taking part.

The onsite review began Tuesday and was scheduled to wrap up Wednesday, with a report due by the end of May.

Last month, Freudenthal joined Fleming in visiting the state hospital.

"It was an opportunity for employees to voice some of their frustrations and some of their concerns," she said.

Those comments helped frame the issues for the review team and resulted in creative suggestions to reduce overtime, she said.

"I think we are responding to a lot of their concerns," Fleming said. "You can't fix it all overnight, but I think we're taking a lot of positive steps."

Adequately staffing the hospital is hampered by Evanston's nearness to a competitive health services market in Salt Lake City, she said.

Thobro said a variety of fixes are needed besides more staff members, including better training, a safe and therapeutic environment, increased accountability and proper housing of patients.

"We remain hopeful the state will make the right choice in responding to our demands," she said. "If not, that's why we have federal judges."