2 Psychiatric Facilities Criticized

Los Angeles County is paying millions of dollars to house seriously mentally ill patients at two locked psychiatric facilities beset by escapes, assaults and patient-care violations, according to records and interviews with county officials.

Last year alone, at least 50 residents escaped or attempted to flee from the Foothill and Sylmar health and rehabilitation centers in Sylmar, according to the county Department of Mental Health. In the fall, one Foothill escapee was arrested on suspicion of battery after two weeks on the lam.

Earlier this year, a Sylmar employee had sex with a 23-year-old female patient, prompting his dismissal and a county investigation. Patients also assaulted other patients at each facility, leading to one arrest.

Partly because of the pattern of escapes and assaults, L.A. County has stepped up oversight of the privately owned centers and prepared contingency plans to move patients if problems persist.

“Since last November, we’ve had somebody there just to make sure that a disaster of immense proportions is ... not taking place,” said Marvin Southard, director of the county Department of Mental Health.

On Thursday, the county and state launched surprise inspections of Sylmar and Foothill, in part because of inquiries by The Times about conditions there, Southard said.

Robert Sherman, an attorney for the facilities’ owner, Golden State Health Centers Inc., said both centers have “a record of success” over many years despite occasional complaints.

“We do a tremendous job with the patient population, and the county recognizes it each time they renew a contract,” he said.

Inspectors for the county, which has contracted with the centers since 1987, have consistently documented assaults and other deficiencies there since at least 1998. During those five years, the county has paid Sherman Oaks-based Golden State nearly $41 million, including $8.9 million in the fiscal year ending in June.

In June and again in December, the Board of Supervisors extended the county’s contract with Sylmar and Foothill for six months instead of the usual three years because of recent problems cited by county inspectors.

In an October memorandum recommending the latest extension, directors of the departments of Mental Health and Health Services wrote that it “is troubling ... that problems, especially in the area of staffing and supervision, show no improvement over the past year.”

But the department directors recommended against canceling the contract outright in view of the “poor impulse control and extreme sexual acting-out behaviors” characteristic of such seriously ill patients.

Among the violations and penalties listed in an attachment to the memo was a $3,000 fine by the state in September against Foothill for failing to protect a 33-year-old female patient from being raped by a male patient.

The citation quoted the woman as telling investigators: “I tried to stop him but he would not. I cried for help but no one came.” The man was arrested.

A hearing officer with the California Department of Health Services upheld the fine in November. Foothill has appealed.

‘A Short Leash’

In a recent interview, Supervisor Zev Yaroslavsky, whose district includes the centers, defended the contract extension. “I think that the county acted responsibly in keeping them on a short leash and determining exactly what ... the seriousness of the problem is,” he said.

In fact, nearly all facilities treating seriously mentally ill patients have some problems with escapes, assaults or patient-care violations. It is the number and degree of deficiencies at Foothill and Sylmar that concern authorities.

The two centers, which stand beside each other on Foothill Boulevard, are among 12 centers in Los Angeles County called Institutions for Mental Disease. The facilities are essentially state-licensed nursing homes for psychiatric patients, less restrictive than acute-care hospitals but more so than unlocked group homes. Patients are confined inside but are able to move about the facilities and sometimes are allowed out on passes.

‘Close Supervision’

Such centers house patients who, because of such illnesses as schizophrenia or bipolar disorder, need close supervision. Demand has increased markedly as state hospitals have emptied their mental wards.

Sylmar and Foothill collectively house about 400 patients at a time -- 180 placed by L.A. County and the rest by the state, other counties and the U.S. Department of Veterans Affairs.

Some patients have been committed by conservators; others have been diverted from the judicial system after committing minor crimes. A minority, placed by the state and housed under tighter security, have been found not guilty of serious crimes, including murder, by reason of insanity.

Regulating the centers is difficult because no single state or county agency oversees the gamut of services -- and the various regulators don’t always compare notes. Some counties say they rely on L.A. County for quality control, for example, but L.A. County officials say they don’t oversee the mental health treatment of residents from other places.

In fact, Southard, the Mental Health Department director, did not know the number and details of all recent patient escapes until he was asked by The Times to research them.

And state officials said they had not been informed of any serious problems at Foothill. They are paying the center $893,174 this year to care for 20 patients found not guilty of crimes by reason of insanity.

“We find that they’re in compliance,” said Nora Romero, spokeswoman for the state Department of Mental Health. “We review them on a yearly basis. We have nothing in the files, no complaints from patients, staff or anybody outside of the facility.”

Some workers at Sylmar told The Times that they fear going to work. Last month, nurse assistant Mary Lyons said, a co-worker was punched in the neck by a patient as he walked into the nurses’ station.

“There’s no way of preparing yourself for that if it happens,” said Lyons, 58. “Every day I go in, it’s a chance of me being hit. I just haven’t yet.”

Another worker, Ismael Martinez, said he has been attacked three times by patients in the last five years. The 34-year-old housekeeper said he has not worked for nearly two months because of lingering neck and back pain caused by the last attack, in February 2002.

Sherman, the attorney for Golden State, didn’t dispute the workers’ accounts but said, “I’m not aware of employees on a statistical basis suffering extraordinary injuries at the hands of patients.”

There are other security problems. Foothill last year logged 29 escapes or attempted escapes among patients, including eight among residents who had been involved in minor crimes before they arrived, Southard said. Sylmar had 21 escapes or attempts.

Many got away by scaling a fence, including a Ventura County man last weekend who ended up at his brother’s house and who returned the next day, Southard said. Some overstayed approved visits with family or didn’t return from court proceedings. The Los Angeles Police Department was notified in many of the cases, and some residents never returned.

In July, a schizophrenic patient at Sylmar ran away while at a dentist’s office. He was found the next day, lying at the side of a freeway.

33 Escapes, 6 Attempts

Of 39 incidents involving L.A. County residents at the two centers, 33 were escapes and six were failed attempts, according to a chart provided by Southard. He said most of the escapes posed little risk to the clients or the public.

Sherman said the firm is trying hard to prevent escapes, and has installed cameras at Foothill’s exits and increased oversight of escape-prone patients.

The centers are “very concerned and dedicated to [their] residents’ not being AWOL,” he said. But “there are not security guards operating as jailers, because these people are not criminals.”

Many problems involving Golden State have been made public by the Service Employees International Union Local 434-B, which represents workers at Sylmar and is angry that Golden State has refused to negotiate since August. No contract is in place. The union does not represent workers at Foothill, although it does compile information about alleged deficiencies there.

At the union’s request, the National Labor Relations Board issued a complaint in December accusing Golden State of failing to negotiate in good faith.

Golden State’s labor lawyer, Thomas S. Pavone Jr., said the company wants to avert a labor board hearing by returning to negotiations.

In an effort to strengthen their bargaining position, union leaders are publicizing every perceived violation by Golden State, including guilty pleas in 2000 by Golden State’s former holding company and the firm’s controller to federal immigrant-smuggling charges.

Working with an employment company between 1994 and 1997, Golden State obtained expedited work visas intended for highly skilled laborers and used them to fill low-wage jobs, which is illegal, according to court documents.

Sherman said the company “made a business decision” to plead guilty to “save all that money and have more resources to provide to patient care.”

Golden State is owned by two couples, David and Miriam Weiss, and Jacob and Rose Kasirer. The firm, which owns seven other nursing homes statewide, has profited handsomely from Foothill and Sylmar, earning nearly $4.2 million from 1997 to 2001 on health-care revenue of $86.5 million.

In 2001, Sylmar had a profit margin of 9.3% and Foothill 5.4%, compared with a statewide average of 2.7% for nursing homes.

Union officials argue that more money should be spent on patient care.

“We feel that Golden State has delivered a quality of service that has been compromised,” said Ari Yampolsky, a union spokesman. “They’ve had very serious problems with keeping their workers, patients and neighborhood residents safe.”

Incidents Dating to 1998

The union has distributed a report, titled “Waiting for an Outbreak,” which calls attention to regulatory violations at Sylmar and Foothill dating to 1998. It notes -- and state records confirm -- that Foothill was fined $5,000 five years ago for failing to keep a patient from striking another patient and breaking her nose. The assailant had been involved in two previous attacks.

The same year, Foothill was fined $3,000 because it failed to protect three patients from being assaulted on multiple occasions by a 52-year-old schizophrenic patient, according to county inspection reports. He punched one, poured coffee on another’s neck and hit him with a food tray, and cut a third man’s face with a soda can.

Sherman acknowledged that Foothill and Sylmar had made some mistakes over the years, but he labeled the care at both centers overall as “first-rate.”

The “goal is 100% compliance at all times with all regulations,” Sherman said. “That is the dedicated goal.”