Los Angeles Times_ August 3, 2005
Steve Lopez / POINTS WEST

Officials Bicker as Mentally Ill Wither
BYLINE: Steve Lopez

Anyone who's been following the news out of California's four big mental hospitals can be excused for wondering if "One Flew Over the Cuckoo's Nest" is being used as a training film for employees.

Suicides, stabbings, drug abuse, neglect, inappropriate seclusion and restraint, escapes -- it seems like every day there's some new horror.

And let's not forget the sex scandals.

At Patton State Hospital, a psychotherapist has been criminally charged with "bringing a controlled substance" into the hospital along with "paraphernalia intended to be used for injecting and consuming a controlled substance." The psychotherapist then allegedly engaged in "sexual intercourse, sodomy, oral copulation and sexual contact with a patient."

At Atascadero State Hospital, an employee stands accused of engaging in oral copulation with a patient.

At Metropolitan State Hospital in Norwalk, meanwhile, reports of rape and AWOL patients are beginning to seem commonplace. And in the past 18 months, four patients have died there under unusual circumstances. The executive director has just resigned after two blistering reviews of the hospital, but he wasn't the only one headed over the wall.

On Tuesday, Metropolitan's AWOL tally grew yet again. A patient declared incompetent to stand trial for robbery and assault with a firearm claimed to have injured his ankle in a basketball game and then gave the slip to staffers at a medical clinic.

So what in the world is going on?

Depends on who's doing the talking, because bickering state and federal officials are telling starkly different stories.

Napa State Hospital is a house of horrors, judging by a scathing U.S. Department of Justice report.

No it's not, replies Stephen W. Mayberg, chief of the California Department of Mental Health.

Unsurprisingly, they can't even agree on whether the state is denying access to federal inspectors, as the Department of Justice contended in a June 27 report blasting conditions at Napa.

Mayberg admitted that the state's hospitals have "systemic problems" he's been trying to clean up for at least 12 years, including a drug problem bad enough that they've put drug-sniffing dogs in the hospitals.

He said staffing shortages -- 1,000 positions in the hospitals are vacant --make the job all the more difficult. It's understandable that nurses and other health professionals shun jobs as difficult as these, especially since the hospital population has become far more hard-core over the years, with nearly 90% of the 4,700 patients now referred by courts. But maybe the jobs would be more attractive if the state got a grip on its problems.

Mayberg insists great strides are being made. But judging by the federal report on Napa, one has to be fairly skeptical about such an upbeat assessment.

"On May 3, 2002," it says, "a patient was strangled to death by his roommate. The roommate had previously been convicted of several violent crimes and had a history of attacking peers, including two attacks on sleeping patients."

No bedrooms are set aside, the report said, for patients known to be dangerous.

"Between January and June 2003, one patient assaulted other patients at least 20 times.... Staff were afraid of this patient and failed to intervene to protect other patients."

"On November 11, 2003, one patient stabbed another in the face and back with an 11-inch 'shank' made from an antenna. Four days earlier, the victim had told staff that he feared that he would be attacked."

"On September 20, 2002, a 38-year-old woman suffered 'great bodily injury' when she was beaten by three male patients.... Staff did not intervene, nor did staff report to Napa authorities the significant bruises and injuries to this client."

"On March 20, 2005, Napa patient M.E. committed suicide by hanging himself in a locked bathroom."

"Napa patient Q.R. committed suicide by hanging in December 2004. Several months earlier, he had attempted suicide by hanging.... Napa staff failed to intervene or adequately supervise Q.R. when a family member called the nurses station ... the day of his death and informed staff that Q.R. was despondent and crying and in need of attention."

"Three different Napa patients overdosed on amphetamines and/or cocaine in fall 2004, including one patient who died of the overdose."

"In September 2004, a Napa physician testified under oath that Napa's staff brings drugs into the facility in exchange for cash."

It goes on and on, with "overuse and misuse of physical restraints," overmedicated patients, under-medicated patients, and one patient who suffered a seizure in the cafeteria in March and choked to death. The Department of Justice report was based on prior state and federal inspections along with fresh interviews of advocates, patients and their families.

"State officials have declined to cooperate with this investigation," says the department, "recently stating that access will not be provided before sometime in 2006."

Mayberg insists the feds are welcome to snoop around. Even I'm welcome to have a look, he said, an offer I promised to take advantage of as soon a possible.

"We have nothing to hide," he told me.

But he wants to know exactly what the feds want before they drop by. Staff shortages are bad enough, he said, without sacrificing more personnel to cater to the demands of inspectors, who in the past have come in and requested tens of thousands of records.

Given their description of conditions, it's not clear to me why the feds don't just bang the door down. Nor is it clear why there hasn't been a peep from the governor or state legislators.

Whether the problem is bad management, inadequate facilities, understaffing or all of the above, we're talking about dangerous and terrifying conditions for a population that's got more than enough problems already. Someone ought to be demanding answers, and I'm happy to oblige.

I'm told by mental health advocates that the vast majority of employees are decent, dedicated people. If any of them would like to shed some light on the situation before my visit, feel free to drop me a line.

* The columnist can be reached at steve.lopez@latimes.com.