4 Deaths Linked to ‘Poor Judgment’ : Hillcrest Mental Health Hospital Investigated

State and county health authorities have launched inquiries into allegations by a psychiatrist at the county mental health hospital in Hillcrest that “poor judgment” by other doctors there has resulted in at least four deaths in the last six months.

The investigation was prompted by the release last week of several documents by Assemblyman Larry Stirling (R-San Diego). The documents, including confidential patient records and a letter from a disgruntled physician at the institution to the head of county Mental Health Services, cite improprieties ranging from licensing violations to negligence in a fatal drug overdose and a killing that occurred recently at the hospital.

Stirling sent the information, which he said had been leaked to him by hospital employees, to the state Department of Health Services, the state attorney general and auditor general, and the state Board of Medical Quality Assurance, all of which are looking into the matter, he said.

The agencies refused to confirm Friday whether they were investigating the charges.

Stirling said he also gave the information to county Supervisor Leon Williams to pass on to county officials, though administrators say they did not receive the documents until Thursday. A county investigation was begun immediately, according to Assistant Chief Administrative Officer David Janssen.

The material released by Stirling included a letter signed by Zalman Magid, a supervising psychiatrist at the hospital, in which the physician attributed three of the four deaths to the “poor and dangerous judgment” of a staff psychiatrist. In the letter, dated April 22, Magid informed county Mental Health Services chief Dr. W.H. Higgins that he would no longer take responsibility for the doctor’s actions.

Magid said the psychiatrist “should have been terminated a long time ago, rather than be left to continue to leave a trail of potential dead bodies.”

The letter implicates the psychiatrist in the death of a patient who was admitted to the hospital “hallucinating, delusional and agitated.” Although police told the screening physician that the man had taken more than 100 assorted pills, the psychiatrist did not order the patient’s stomach emptied nor did he check his vital signs, Magid said.

Instead, the psychiatrist ordered the patient placed in restraints and seclusion, the letter said, and four hours later, a nurse found the man dead.

Magid also cited the death of Ermerito Cabel Mateo, who was strangled by Garland Alan Marcroft, a patient who shared his hospital room. Marcroft, who was found not guilty by reason of insanity Friday, had been admitted to the hospital three days earlier, after he had been found wandering naked around Cowles Mountain. Magid claims that the death of Mateo, who was catatonic, could have been avoided if Marcroft had been secluded.

The letter goes on to hold various hospital personnel responsible for turning away two severely depressed people who later committed suicide and charges hospital administrators with violating state licensing and personnel regulations.

Stirling said that although the allegations have yet to be substantiated by the agencies investigating the hospital, he gives a lot of credence to the employees’ complaints.

“These are just allegations at this point, but the fact that these people are willing to put their jobs on the line to make this known makes me think that they may have some grounds,” he said.

However, James Forde, director of the county Department of Health Services, does not agree.

“I’ve already taken a look at the charges and, with the exception of one, it’s just a lot of smoke,” Forde said. “Most of them are old news, and we feel we’ve already exercised the appropriate action.”

Nonetheless, Forde said that he had asked the county Psychiatric Society to conduct an independent investigation.

Forde said he was upset that Stirling’s efforts to make the allegations into “a media event” included releasing confidential information to the media.

“There was a public disclosure of confidential patient records that I am very concerned about,” Forde said. “I don’t know what his motivation was. I do know he never sent us a copy of his concerns, though he did release it to the press.”

Stirling criticized Forde’s response to the allegations as “defensive,” saying, “If Mr. Forde would spend more of his time cleaning up his county administration instead of worrying about me, he wouldn’t have a lot of these problems.”

Janssen said the county will coordinate three investigations: an examination into staff-related allegations by the Office of Employee Operations; a review of administrative actions by Steve Harmon, the acting assistant deputy for administrations, and the Psychiatric Society’s independent investigation of the psychiatrist’s professional decisions.