Jessica's law, as it is known, made it easier for authorities to designate someone a "sexually violent predator" and hold him indefinitely, and to put restrictions on patients' ability to challenge their confinements.
Staff members say that because such a wide spectrum of sex offenses qualifies people for post-prison commitment, decisions about who is released and who is detained are largely random. Some staffers question whether all the patients at Coalinga belong there.
Michael Feer, a psychiatric social worker with more than three decades of experience, worked at Coalinga for a year before leaving this spring. He now works in San Diego County with recently paroled sex offenders, men who in some cases committed the same crimes as those at Coalinga but who are being released into the community, he said.
Feer said that although all Coalinga patients qualify as violent predators on paper, he believes that more than a third of them would pose no threat if released.
"They did their time, and suddenly they are picked up again and shipped off to a state hospital for essentially an indeterminate period of time," Feer said. To get out, he added, "they have to demonstrate that they are no longer a risk, which can be a very high standard. So, yeah, they do have grounds to be very upset."
The hospital, Feer said, "is a setup" -- ostensibly a treatment hospital but one built with a wink to a public that has little compunction about locking up sex offenders forever.
Coalinga administrators insist that there is still a clear path to release, provided a patient completes the hospital's exhaustive treatment program.
"I wouldn't be working in this field if I thought it was a scam," said Deirdre D'Orazio, director of program development and evaluation services at the hospital. "I don't believe that there are any wastebasket cases, individuals who are so abnormal that they can't learn to put aside their deviant impulses."
The core sex offender treatment involves such activities as a "psychological autopsy," a detailed accounting of decisions that preceded an offense.
Patients offer a variety of reasons for declining to participate. Some believe they can overcome deviance on their own. Others believe, mistakenly, that mere participation could be viewed as their first public admission of guilt. But many patients shun treatment because they have become convinced -- not without reason -- that no matter what they do, they are never going to win their freedom.
As of August, two years after Coalinga opened, not a single patient had been released because of completion of the treatment program. Of the more than 600 sexually violent predators who'd been committed to the facility as of August, the latest figures available, 17 patients had been released, all of them after petitioning in court.
Hospital administrators argue that patients should participate in treatment not just because they want out but because they want to acknowledge and address their problem.
"They need to say, 'My freedom is less important to me than never creating another victim,' " D'Orazio said.
Coalinga patients are keenly aware that they are not a sympathetic crowd. So they have tried to sell their cause -- to hospital administrators, healthcare reformers and advocates for the mentally ill -- as a matter of governmental responsibility.
"They've sold this as a wellness-and-recovery program," said patient Greg Peters, 49, a former studio percussionist who served a five-year prison term for raping two adult women before being routed into the mental health system. "But they are deceiving the public. You guys are out there paying taxes for this."
Like most patients at Coalinga, however, Peters said he harbored little hope that he will ever get out. He says staff shortages have resulted in a failure by the hospital to monitor and document patients' progress, an important part of convincing a court that they are ready to be released.
The staffing shortage stems in part from the decision by state officials to build the hospital 60 miles southwest of Fresno, in an isolated, dusty pocket of California's Central Valley otherwise dominated by huge almond farms, hardly the stuff of recruitment posters.
Compounding the staff shortage, an ongoing salary dispute makes it possible for many of the people hired there to make more money doing the same job elsewhere. And many of those who do go to work at the facility leave quickly.
Between November 2006 and October 2007, the hospital hired 468 people, but 147 left.