State Faults U.S. Report on 2 Mental Hospitals

A standoff between the U.S. Justice Department and the California mental health department escalated late last week, as a key state official accused federal regulators of unfairly exaggerating problems at two of the four major state-run mental hospitals.

Stephen W. Mayberg, director of the California Department of Mental Health, said in an interview Friday that he was surprised when the Justice Department posted a report on an investigation of Napa State Hospital on its website last week that included wide-ranging allegations of improper care at the 1,146-patient hospital.

“When you read through [their findings], the implication is that we have people locked up all the time and they’re overmedicated,” Mayberg said. “The Department of Justice had information other than that -- more current information that they chose not to use.”

The report alleged that suicidal patients were not receiving prompt intervention, that patients didn’t get prompt medical or psychiatric care, and that employees were dealing drugs to patients.

The Justice Department also alleged that a patient hanged himself in December just minutes after a family member called a nurses station at the hospital and warned them the patient was despondent.

In addition, the Justice Department said, the state denied its inspectors entry to the hospital.

The rift between the agencies has been growing for more than two years, since the Justice Department issued the first of two scathing reports on Metropolitan State Hospital in Norwalk. State officials disputed accusations that they did not track infections, that they used restraints more often than necessary, and that they refused to allow some patients to speak to Justice Department representatives.

Eric Holland, a spokesman for the Justice Department, which looks into alleged violations of patients’ civil rights, said the agency had no comment beyond the reports it had issued.

The state runs four major mental hospitals that collectively house about 4,700 of California’s most severely affected patients, almost 89% of them placed there by the courts.

“In our view, we were working as a collaborator and as a team [with Justice Department officials] to improve our care to patients in California,” Mayberg said. “Maybe it was our mistake to think that this was about patient care when it was about something else.”

Mayberg denied the allegation in Justice Department documents that inspectors had been barred from visiting the Napa facility. He said negotiations over reforms at the hospital were proceeding smoothly until an attorney for the state died in April.

“The next thing you know, we get this letter that we’re uncooperative and have denied access,” he said, referring to the Napa report. “That certainly was not our intent and put a spin on it that was not accurate.”

He added that the state may be willing to let Justice Department officials into its hospitals, but not until it can negotiate an inspection plan that does not disrupt services.

Mayberg said the Napa report was misleading about the amount of time that patients were kept in restraints or seclusion, failing to take note of a huge improvement. He said that patients at the hospital spent 8,913 hours in seclusion in January 2004, but that the time was reduced to 936 hours in March of this year.

Mayberg said other significant changes are underway systemwide. For instance, he said, the number of patients in the hospital system is dropping because they are being treated more effectively. At the same time, he said, the percentage of patients referred by criminal courts has risen, and they tend to be more aggressive.

“To make the really substantive changes ... will take three to five years,” he said. “This is not something we can fix overnight.”

The tensions between state and federal officials began with federal inspectors’ visit to Metropolitan in the summer of 2002.

After issuing its two reports on the Norwalk hospital in May 2003 and February 2004, the Justice Department notified the state in March 2004 that it wanted to tour Napa that month and complained that the state wouldn’t arrange access.

State officials said they wanted first to negotiate a plan with the Justice Department to fix Metropolitan, although the state disputed some of the findings.

“The findings letter makes sweeping generalizations that are not borne out by fact,” wrote John Rodriguez, the deputy director of long-term care services for the state Department of Mental Health, in a letter dated April 8, 2004.

A day later, the Justice Department informed the state that it intended to investigate Patton State Hospital in San Bernardino.

In June 2004, state officials asked to avoid on-site visits, saying they would provide patient records instead. That idea was rejected, and the matter has not been resolved.

In January, the Justice Department told the state it was investigating Atascadero State Hospital, although the department has not yet gained access to Atascadero or Patton.

For the Napa report, Justice Department investigators relied on inspections by the federal Centers for Medicare and Medicaid Services and the state Department of Health Services. They also interviewed patients and their families.