Convinced that they stand little chance of being released and angry about perceived deficiencies at the hospital, patients are engaged in a tense standoff with administrators, according to interviews with more than 40 patients and staff members.
Almost all of the detainees at Coalinga have served time for serious sexual offenses. But instead of being released after completing their sentences, they were transferred to the state hospital system under a 1995 law that allows the state to declare certain high-risk sex offenders mentally ill and commit them to psychiatric facilities.
Detaining someone under the law is constitutional provided that the patient receives treatment. But today, significant treatment at Coalinga is rare. Administrators acknowledge that three-quarters of the hospital's 600-plus detainees refuse to participate in a core treatment program, undermining a central piece of the $388-million hospital's mission.
Some patients have also declined to eat for days at a time to protest alleged inadequacies in psychiatric and medical care as well as less important issues, including limited access to phones. Many have boycotted educational and improvement programs that include anger management workshops, computer training and Spanish classes -- a protest known inside the hospital as a "strike."
A severe staff shortage has further impeded treatment, patients and staff members say. As of last week, 26 of the hospital's 37 budgeted staff psychiatrist positions were vacant. On many wards, hospital police officers fill roles assumed by clinicians at other hospitals.
"We've got guys who camp out, waiting for clinicians to show up," one staff member said.
Staff members describe feeling overworked and harassed by patients who bang angrily on the nursing station glass if technicians or hospital police officers are a few minutes late to escort them on smoke breaks.
"We're calling it the Titanic State Hospital," said a psychiatric technician who, like most other current employees, spoke on condition of anonymity, fearing reprisal from administrators. "We've lost control. I've been saying for a couple of months now that the monkeys are running the circus."
Patients, meanwhile, are despairing.
"It's hopeless," said Robert Bates, 41, who was sent to Coalinga after serving a 10-year prison term for committing a lewd and lascivious act. "This is a therapeutic setting, supposedly. But it's nothing more than a mock-up prison. They can call it what they want. But it's prison."
State officials acknowledge the unrest, though they say there hasn't been as severe a disruption as patients and some staff members contend. They say they are doing the best they can with an unusually challenging patient population.
"When you undertake something of the magnitude of Coalinga, there is a growing and learning experience," said Stephen W. Mayberg, director of the state Department of Mental Health. "Where we are right now is certainly, I think, moving in the right direction."
Mayberg said the hospital can't force patients to take part in treatment.
"Am I disappointed that so many folks choose not to participate? Yeah. Do I think that's indicative of their illness, or their condition? Yes, I do," he said.
Coalinga opened in September 2005 amid promises of a new era, both in protecting the public and in treating sex offenders. Even empty, the facility stood out; its sleek architecture and tidy topiaries presenting a jarring contrast to the tumbleweeds and dust devils that dominate the surrounding landscape.
But the operation of Coalinga -- the only mental hospital built in California in half a century -- was never going to be effortless.
Sex offenders are a notoriously difficult group to treat. More than half the men confined at Coalinga are pedophiles, and many have had numerous victims. And sex offenders tend to be manipulative and charismatic, traits that helped enable some of their offenses in the first place.
Most Coalinga patients don't have mental illnesses that can be treated with medication, and there is no sure-fire way to rid the men entirely of their impulses. Many psychologists do not believe that hard-wired sexual deviance can be "cured"; instead, officials focus on what they call "relapse prevention."