The master, U.S. Magistrate Kevin Chang, identified a need for better treatment planning among lingering weaknesses at the hospital.

In 1991, the federal court appointed Chang as the court master to oversee the state hospital, which had been criticized for overcrowding, a rash of escapes in recent years and for keeping people at the hospital longer than necessary.

In his fifth report, filed at U.S. District Court, Chang said ongoing improvements justify extending the Feb. 21 deadline for compliance with the hospital "remedial plan" devised almost two years ago. He set September 30 as the new date.

State health officials were unavailable for comment this morning.

The report, based on a September visit by an evaluation team, notes progress in areas such as forensic services for development of programs for psychosocial rehabilitation through the hospital’s new "treatment mall" that involves patients in activities.

However, the primary concern stems from inadequate treatment planning, the blueprint charting the course from diagnosis of the illness to the patient’s return to the community. That process was under revision during the September visit, Chang said, but the shortage of time to complete it is one factor behind the deadline extension.

Other flaws noted in Chang’s report include:

• Behavioral intervention involves an "ineffective" method of consultations.

• Forensic services, linking mental health treatment with the criminal justice system, is improving with the placement of a part-time attorney at the hospital. But he listed shortcomings in monitoring of patients on conditional release among other flaws and noted the loss of expertise with the resignation of hospital forensic coordinator John Sousa.

• Nurse staffing is a problem area, in part because the hospital meets required nurse-patient ratios by relying heavily on hiring agency nurses and putting staff nurses on overtime, Chang said.