Mental Facility Staffing Called a Peril

In a scathing report, high-ranking police officers at the state’s newest mental hospital condemned as dangerous the plan to house most patients in units with minimal supervision from licensed caregivers.

“It would border on negligence to sustain the idea of the proposed minimum staffing levels,” the police sergeants assigned to Coalinga State Hospital warned in their report last fall as the hospital began accepting patients from overcrowded Atascadero State Hospital.

“The reality is that patients that harbor a propensity toward violence or propagate illegal activities would ‘slip through the cracks’ and immediately recognize the extreme weakness in staff’s span of control.”

The analysis was requested by administrators at the Coalinga facility, which was built to house sexually violent predators who are confined to the state’s mental hospital system beyond their prison terms.

But the hospital’s management, which has struggled to recruit staff, declined to make use of the analysis, submitted in October.

The state mental hospital -- the first constructed in half a century -- has drawn criticism for its low staffing levels. Mental health officials secured an unprecedented change in state law last summer that suspended the required staff levels at Coalinga. The criticisms come at a time when the state system is under scrutiny by federal officials concerned with patients’ rights and by staff concerned with unsafe working conditions.

Hospital Executive Director Tom Voss said that the decision to lower the licensed staffing levels had already been made and that the police sergeants were asked to help implement it, not criticize it.

“It was not at all what they were supposed to have done,” he said.

Administrators initially refused to release the report to union negotiators, who contend that the unarmed officers are forced to perform duties outside their contract. But the hospital released the report this week in response to an unfair labor practice charge.

The report calls for measures such as security locks on patient doors and surveillance cameras, saying that the $388-million complex was designed to be a “staff-intensive treatment facility” and that without more caregivers it is unsafe. The “warehousing style of housing” is unlikely to provide effective treatment, the report added.

The abridged report contains a cover sheet stating that officials from the hospital and state Department of Mental Health disregarded its findings because it “contains numerous inaccuracies.”

For example, Voss said in an interview, the report made “oranges-and-apples types of comparisons” to staffing levels at Atascadero, where low-maintenance patients are housed in units with acutely mentally ill sex offenders, and to the state prison in Coalinga, where inmates are deemed violent security risks.

Voss insists that the 1,500-bed hospital -- which currently houses 261 patients -- is operating as it should.

“In terms of whether or not it is safe here, they’ve been up and going for seven months and we’ve had no incidents. None,” he said. “I will tell you emphatically that I attribute that directly to the hospital police and the good job they are doing.”

Several Coalinga housing units have the required staff ratios: one caregiver for every six to eight patients.

But licensing requirements were waived for the remaining 50-bed dorms, which are assigned two hospital police officers and one senior psychiatric technician.

State and Coalinga hospital officials devised the new model last year, reasoning that many sex offenders do not suffer from acute mental illness and decline to participate in treatment anyway, so they do not need to be surrounded at all times by licensed professionals.

The patients pose a challenge to the state hospital system: Courts have ruled that they can be held there involuntarily only because the facilities are therapeutic, not punitive. But most refuse treatment.

Hospital police stand by the report’s concerns and say problem behavior by patients is cropping up and is being “brushed under the carpet” by administrators.

Staffing is so thin that units are at times left attended only by officers -- and no licensed staff, said Sgt. Andrew Berard, a police sergeant at Coalinga and a representative of the Hospital Police Assn. of California.