Dept. of Justice seeks continued federal oversight of two state psych hospitals--failed to comply with judgment

December 9, 2011

The U.S. Department of Justice has asked a judge to extend federal oversight of two state mental hospitals, saying the facilities have failed to comply with critical provisions of a sweeping consent judgment imposed 5 1/2 years ago.

In a filing late Friday night, federal officials detailed key failings at Napa State Hospital and Norwalk's Metropolitan State Hospital: preventable suicides, nursing errors leading to unnecessary suffering, improper use of some restraints and a failure to adequately analyze and prevent violence.

"People confined in these two hospitals have died or suffered serious harm, and will remain at an unreasonable risk of serious harm, including death, absent further orders from this Court," federal attorneys wrote, adding that "both those residing and those working" at the facilities "are seriously assaulted on a continuing basis."

The scathing federal assessment of conditions at the hospitals comes as a blow to the California Department of Mental Health, which had expected to be free from federal oversight by year's end.

The Justice Department's entreaty to Chief U.S. District Judge Audrey B. Collins came on the day that the consent judgment expired. The judgment was imposed in 2006 to settle a lawsuit alleging unsafe conditions and poor treatment at four state mental hospitals. It required extensive reforms that have cost the state tens of millions of dollars.

The court filing asks Collins to extend oversight of the two hospitals in the deficient areas until they comply. A hearing is scheduled for Jan. 23.

Last month, federal officials released San Bernardino's Patton State Hospital and the Central Coast's Atascadero State Hospital from oversight, deeming them in compliance with the "bulk" of the consent judgment's demands. The fifth state hospital, Coalinga, was not covered by the agreement because it had just opened, but it has similar reforms in place.

Cliff Allenby, acting director of the Department of Mental Health, said in a statement Saturday that all the hospitals have made "significant enhancements in mental health treatment" under the terms of the consent judgment and that the state "remains committed" to achieving full and continuous compliance at Napa and Metropolitan.

The federal probe of California's psychiatric hospitals began nine years ago at Metropolitan, and the state has invested the most in fixing that facility. But neither Metropolitan nor Napa — where a psychiatric technician was strangled by a patient a year ago — has imposed adequate reforms to keep patients safe, according to federal attorneys and Virginia psychiatrist Mohamed El-Sabaawi, who as the court monitor has visited each hospital twice yearly to assess compliance.

The reforms laid out years ago focus on preventing suicide and violence, improving treatment planning and curtailing overmedication and use of restraints. Yet Friday's filing noted that the original federal findings against the two hospitals "detailed very similar inadequacies to those that still exist."

Among the problems cited were arguably preventable suicides at Napa, one by a man whose psychiatrist was on vacation with no substitute and another by a man who had already attempted suicide by similar means and had not been reassessed.

The filing detailed Napa's use of prohibited face-down, or prone, restraints, which were placed on one patient who later died of cardiac arrest and another who suffered broken bones. At Metropolitan, the federal document said administrators failed to heed El-Sabaawi's warnings about a poorly performing physician whose actions allegedly contributed to the death of one patient and disability of another.

The filing also said both hospitals suffer from "consistent failure to perform required nursing reassessments." Metro nurses described a patient who had just had a seizure as "resting comfortably with no complaints of distress," while he was in fact unconscious because of a dangerously low sodium level, it said. And at Napa, nurses failed to notice that a patient had suffered a fracture even though he was screaming and his leg was abnormally rotated.

Violence was also key among Justice Department complaints, namely the hospitals' failure to identify aggressive patients and prevent them from reoffending. Referring to the October 2010 strangulation of Napa's Donna Gross, federal attorneys said that the hospital began developing a "performance enhancement system to protect people from preventable harm" only after the slaying, despite earlier warnings from El-Sabaawi.

Gross was killed on the grounds, where the alarms that staff carry do not work. In a declaration, El-Sabaawi wrote that Napa and Metropolitan have acknowledged the need for campus-wide alarm systems and Napa had promised to create a high-security unit with enhanced staffing to house the most violent patients. "Defendants, however, have not implemented those measures," he wrote.

Continued federal involvement would come as a relief to some hospital clinicians. In a letter to Collins last month, Napa's medical staff asked the judge "in the strongest possible terms" to extend oversight of that hospital. The staff contended that the state has consistently failed to provide a safe environment and, because of budget cuts, plans to reduce staffing levels below the ratio accepted as the standard of care and required by the Justice Department.

The letter, signed by Dr. Shakeel Khan, the hospital's chief of staff, on behalf of 177 physicians, psychologists and dentists, also said the state had backed away from its plan for the high-security unit and was not planning to install an improved alarm system until April.

Assemblyman Tony Mendoza (D-Artesia), who sits on a state select committee to improve hospital conditions, said Saturday: "While we are disappointed that Metropolitan State Hospital hasn't met the safety standards set by the federal government, if this court oversight ensures that patients and staff are safe, then we welcome the request."

Source: Lee Romney and John Hoeffel, "Extended U.S. oversight sought for 2 California mental hospitals: The U.S. Department of Justice says Napa State Hospital and Norwalk's Metropolitan State Hospital have failed to comply with critical provisions of a sweeping consent judgment imposed in 2006,"  Los Angeles Times,  December 4, 2011.