State is sued over hospital staffing crisis

Lawyers for mentally ill prisoners will ask a federal judge today to force the state to take drastic action to stem a staff exodus from California’s mental hospitals that has jeopardized patient safety and left psychotic inmates to languish in jails and prisons without proper treatment.

U.S. District Judge Lawrence K. Karlton in February ordered the state Department of Mental Health to formulate a plan to reverse a staff exodus from the state’s beleaguered hospitals in recent months. The staff departures occurred after the same court had ordered raises for prison mental health staff that made prison jobs more attractive than those at hospitals.

A state plan submitted to Karlton proposes solving the problem by hiring a headhunter to recruit staff and offering raises to hospital workers. But attorneys for the ill inmates contend that the plan is grossly inadequate, saying that the raises, which would apply only to existing workers and not to new recruits, would not bring hospital salaries to the level of those at prisons.

“The plan ... is akin to placing a Band-Aid over a gaping hole in an almost empty bucket of water, while doing nothing to refill the lost water,” lawyers for the prisoners wrote, calling the approach a “wait, see, and hope for a miracle” strategy that “is reckless and must be immediately addressed by this court.”

In their court filings, Department of Mental Health officials concede that the staff shortages have left them in violation of both state and federal regulations and jeopardized patient safety. But they contend that their plan is adequate to address the problem.

“We are hopeful that resolution can be reached on this issue and our staffing problems will be alleviated,” department spokeswoman Kirsten Macintyre said.

Today’s hearing comes as part of a class-action lawsuit on behalf of the state’s mentally ill prisoners. Karlton, who deemed the care they receive unconstitutionally poor, has acted aggressively to order raises and other improvements for mental health workers of the Department of Corrections and Rehabilitation.

But the prison and mental health systems are deeply intertwined. Although state mental hospitals once mostly treated people committed through the civil courts and against their will, the vast majority of current patients arrive via the criminal justice system.

The state Department of Mental Health is included in the suit, which mainly targets the Department of Corrections and Rehabilitation, because among its hospital patients there are mentally ill prisoners who are too sick for prison facilities and must be stabilized. The department also runs two facilities inside state prisons.

Karlton may rule today on plaintiffs’ request that he order the state to submit a more comprehensive plan within five days to reverse the staff departures, which have left vacancy rates among some key disciplines at more than 70%.

The attorneys have also called on Karlton to require salary increases equal to the prison pay hikes and immediately make 100 beds at Coalinga State Hospital in the Central Valley available to sick prisoners.

Gov. Arnold Schwarzenegger and Department of Mental Health Director Stephen W. Mayberg announced the proposed raises last month, saying that salary increases equal to the prison hikes could lead to an interagency bidding war. They also called for a comprehensive approach to recruiting that would include the departments of Developmental Services and Veterans Affairs, which have suffered a similar staff exodus as a result of the court-ordered prison raises. The proposed headhunter would recruit for all agencies.

Department of Mental Health officials plan to move as many as 150 sex offenders from the Central Coast’s Atascadero State Hospital to Coalinga in coming months. Still, they argued in filings to Karlton’s court that the crisis at Atascadero is so acute that no new patients would be accepted to backfill the vacated beds.

Melvin Hunter, the executive director of Atascadero -- the facility most severely affected by shortages -- took an unprecedented step in late January to severely curtail admissions, saying staff could no longer guarantee patient safety.

Although it is difficult to determine with certainty whether there is a direct link to staff shortages, two Atascadero patients have killed themselves in the last few months and four others have attempted suicide, which is a dramatic rise in such incidents for the hospital.

On April 13, another patient -- 36-year-old John Julius Kappa -- was found dead in his room just weeks before his scheduled release. Autopsy results are pending, and the hospital refused to comment.

But a psychiatric technician who asked to remain anonymous said officials are investigating the possibility that Kappa died after snorting methadone that he purchased from another patient.

“Obviously they don’t get watched real carefully, if they can buy drugs from each other,” said Kappa’s aunt, Linda Rigney. “I’m just devastated.”

Staff members at Atascadero argue privately that not only do shortages mean less policing of illicit drug use and other infractions but more exhausting overtime and more “floats” -- staffers who are dispatched to a foreign unit, where they know little about the patients and often go through the motions, acting as if they are “just a body,” the psychiatric technician said.

The raises announced last month would bring most workers’ paychecks within 18% of the salaries of their prison counterparts. Psychiatrists and senior psychologists, who will get the largest raises, would receive 5% less than prison counterparts.

For patients and potential patients, the crisis has meant poorer care or no care at all. Mark Duarte heads a Central Valley program that contracts with the state to place jail inmates too sick to stand trial and prison parolees into the hospitals and manages them upon their release.

Not only are inmates languishing for up to eight months while they wait for hospital beds -- in many cases without medication -- but those in the state hospitals have received increasingly poor care over the last year, Duarte wrote in a court declaration.

Before the crisis, if a patient participating in the conditional release program needed treatment, Duarte could return the patient to the hospital. Now, with hospital beds unavailable, he must put his clients in jail.

“It destroys the therapeutic rapport that we may have spent years building with a client,” Duarte said in an interview.

Today’s hearing comes as both the prison and mental health systems are under federal scrutiny. Four of the five state hospitals are operating under a sweeping federal consent judgment.

Reached last year after a four-year federal civil rights investigation, the judgment spelled out specific changes needed to improve patient care. The court-monitored plan requires significant increases -- not decreases -- in staff, a point not lost on state officials.

“If insufficient staffing renders the hospitals unable to serve patients, as the state is required by law to do, DMH could find itself in the same position as [the prison system]: subject to intense federal oversight and besieged by court orders,” mental hospital officials wrote in seeking raises for the next budget year.

State Sen. Elaine Alquist (D-Santa Clara), chairwoman of a legislative committee that oversees state mental health spending, called the staffing crisis at the mental hospitals a “severe problem” and linked it to safety issues, including recent deaths.

“Society has not come to terms with the great problem that we have,” she said. “We are going to have to come to terms with it.”

Alquist’s committee will delve into the issue again at its next scheduled meeting April 30. She said the state is going to have to get more creative and aggressive in confronting the crisis.

For instance, Alquist said she intends to ask state officials whether they have considered measures such as moving psychiatrists and other staff to facilities where the crisis is most acute.

The state’s current plan to address the crisis seems to fall short, she said, pointing to the state’s plan to hire a headhunter to start luring more staff next year.

“We have a problem today,” Alquist said. “The administration really needs to do something about it.”

*

lee.romney@latimes

scott.gold@latimes.com