Ex-consultant to California mental hospitals criticized elsewhere

A consultant who led the troubled effort to overhaul California’s public psychiatric hospitals has played a lead role in federal reforms in at least five other states, where critics have raised similar concerns about cronyism and the quality of his work.

Nirbhay Singh, a psychologist from Virginia, abruptly resigned from his California post last year after The Times asked state officials about rising violence in the hospitals and the state’s hiring of Singh’s family members.

State mental health officials are now eliminating treatment approaches and elaborate paperwork that Singh imposed in a costly effort to satisfy a legal settlement between the state and the U.S. Department of Justice. Two of four hospitals targeted for reform by the department — in Napa and Norwalk — remain under federal court supervision because of concerns about patient safety and treatment.

In interviews, clinicians and others who worked with Singh around the country raised criticisms similar to those that surfaced in California: that excessive documentation requirements detracted from patient care and that close relationships among consultants and Justice Department lawyers appeared to compromise the process.

Singh, his relatives and his close associates have again and again received contracts to advise states and monitor reforms for the federal courts — often with the endorsement of Justice Department lawyers. The department itself retained Singh as a consultant over more than a decade, beginning in 1989, before he branched out to more highly paid work for states and courts.

Since 2002, when he began working in California, Singh has been hired in more than half the 23 states and territories where federal officials had reached court-supervised settlements intended to improve care at public mental hospitals and centers for the developmentally disabled, often playing a pivotal role.

Even as Singh’s efforts were foundering in California, he obtained contracts to work on federal reforms in Connecticut, Georgia and Washington, D.C.

“The things that are being undone in California should be undone here,” said Vittorio Ferrero, a former psychiatrist at Connecticut Valley Hospital, where since 2009 Singh has been the federally approved court monitor, earning $2,500 a day. “Everything they have done has resulted in less care.”

Stuart Forman, Connecticut Valley’s former medical director, said “meaningless garbage” was “required of hundreds of people all the time.” Both men said they left last year in frustration.

In response to written questions from The Times, Singh said paperwork in Connecticut is being reduced as the hospital improves. He said the criticism in that state and elsewhere reflected staffers’ discomfort with changes that were necessary. “In each case, the work that we did in partnership with staff ... improved patient care and will continue to improve patient outcomes,” he said.

In 2010, officials in Georgia awarded Singh a no-bid, $3.5-million contract to reform seven mental hospitals and allowed him to hire staff through American Health and Wellness Institute, a company owned by Singh and his son and run by his daughter-in-law.

Two former employees of the firm said they were told by higher-ups not to provide guidance to hospital caregivers but simply to fill out checklists gauging their performance. “My concern from a clinician’s perspective was: What are we really doing to make a difference? And how are we measuring it?” said Karen Foxworth, a licensed counselor who said she was terminated after Singh learned that she had offered a suggestion during a treatment session.

Singh said that employees were encouraged to offer feedback and that data showed significant gains “in all aspects of care.”

Dr. Frank E. Shelp, commissioner of Georgia’s Department of Behavioral Health and Developmental Disabilities, said last year that a Justice Department lawyer had urged the state to bring in outside expertise and recommended Singh, among others. A spokesman wrote in a recent email that the state is “pleased with the contribution Dr. Singh and his team have made.”

Concerns about Singh’s performance had emerged earlier in his career. In 2002, when he was the Justice Department’s representative on a consulting team at Hawaii State Hospital, a federal court magistrate found him ineffective and asked him to resign, according to two sources with knowledge of the decision who declined to be identified because it was a confidential matter.

“He was the weakest link in the chain,” said a third official, former hospital administrator Paul Guggenheim, who did not have direct knowledge of the magistrate’s action.

Singh said he left for personal reasons.

In Kentucky, where Singh was the court monitor, and Tennessee, where he was a state consultant, critics said the facilities were swamped with paperwork. “It was just a colossal waste of time,” said Judith A. Gran, a lawyer who represented patients at Tennessee’s developmental disabilities centers. “There really was no active treatment.”

Singh is among a small number of closely connected consultants who have built lucrative careers offering expertise on all sides of the reform process. In their revolving roles as federal experts, state advisors and independent monitors, they are able to recommend one another or evaluate one another’s work — sometimes with the direct approval of Justice Department lawyers. The department has no conflict-of-interest policy governing such consultants.

Singh has recommended his close associates and family members for jobs or brought them in under his contracts. For instance, he recommended Angela Adkins, a protege who eventually married his son, for a consulting job in California, he said. The state also gave a mental health consulting post to Singh’s wife, Judy, whose expertise is in adult literacy, and created an extra psychology internship slot that went to his son, Ashvind, who was earning his doctorate.

While five court monitors were evaluating Singh’s progress in California, four of them also worked under at least one of his contracts in Louisiana, Tennessee, Kentucky, Connecticut, Washington, D.C., and Georgia. Until the last two years, the monitors gave Singh largely favorable reviews, although violence was rising and patients were being confined longer at most hospitals.

One monitor, a psychologist named Ramasamy Manikam whose expertise is in pediatric feeding disorders, offered praise for a therapy co-developed by Singh’s wife and a behavioral questionnaire developed by his son. Manikam called both “critical” though they were untested and eventually abandoned. Manikam was later hired as part of Singh’s teams in Connecticut, Washington, D.C., and Georgia.

Manikam said that he worked independently from Singh and that Singh “does not ... tell me what I should write or say.” Manikam said a Justice Department lawyer who was aware of his oversight role in California recruited him for the Connecticut job.

“It always felt like everyone was scratching each other’s backs,” said psychiatrist Kenneth Marcus, who was formerly medical director of Connecticut’s mental health department and was chief executive of Connecticut Valley Hospital before leaving in protest. “It wouldn’t be so outrageous if you didn’t know how much money they were all making and how they kept switching sides.”

In Georgia, Singh’s team has included his wife, daughter-in-law and Manikam. Again, Manikam said a Justice Department lawyer sought him for the job.

Singh said neither he nor his associates are swayed by their connections. “These are professionals dedicated to improving the lives of people in state facilities,” he said.

Assistant Atty. Gen. Thomas E. Perez, who leads the U.S. Justice Department’s civil rights division, declined to discuss Singh’s role. He acknowledged that his department had relied on a “very small pool” of consultants and said he was actively working to expand their ranks.

“We need to ensure the avoidance of an actual conflict or appearance of a conflict,” said Perez, adding that he was moving “aggressively” to recruit new experts. “That’s going to be a huge part of solving the problems you have identified.”

lee.romney@latimes.com

john.hoeffel@latimes.com