Acting Director Defends Move at Mental Hospital

On his first day as “acting-interim” medical director at the beleaguered county mental health hospital in Hillcrest, Dr. Harold Mavritte found that one of his first duties was convincing people that his predecessor, Dr. Warren H. Higgins, had not been fired.

“Dr. Higgins is still in the same capacity,” Mavritte stressed repeatedly. “Dr. Higgins is still the chief of our Adult Services Bureau.”

But effective Wednesday, the chief of the Adult Services Bureau was relieved of one of his primary duties--supervising medical care at the mental hospital. Higgins will continue to be in charge of the psychiatric security unit and the special rehabilitation, extended care and forensics programs.

Some state and county officials have questioned whether Higgins’ “reassignment,” the first of several expected at the hospital, might have something to do with investigations by the county grand jury, the state auditor general, the state Department of Health Services and the Board of Medical Quality Assurance into allegations of inadequate care, negligence and patient abuse.

“I would guess it’s a reaction to the press and the grand jury, maybe in anticipation of an unfavorable report,” said William Egan, grand jury foreman. “I don’t know that it’s any solution to the problem. I suppose that it’s supposed to pacify the public. There’s always a scapegoat, and I guess Dr. Higgins is the guy.”

The hospital has periodically been the target of charges of mismanagement by administrators, and of drug abuse and gambling by staff members. But hospital officials have been the center of an increasingly turbulent maelstrom of controversy in the past six months, during which one patient was killed, another died of a drug overdose and two people committed suicide shortly after being discharged from the hospital.

Last month, Assemblyman Larry Stirling (R-La Mesa) touched off investigations by three state agencies with his release of allegations by a disgruntled physician who blamed the “poor judgment” of his colleagues for the patient deaths and called for the firing of a hospital psychiatrist. State authorities are also reportedly investigating a male nurse who was placed on leave of absence after allegedly assaulting a female patient last weekend.

Stirling agreed that Higgins was “a sacrificial lamb” in the controversy and said county mental health officials were sidestepping allegations of improprieties by transferring the medical director.

“Either he’s the cause of the problems or he’s not,” Stirling said. “If this guy’s bad enough to be transferred, he’s bad enough to be fired.”

But according to Mavritte, who as clinical director was the person to whom Higgins reported, the reason for the change was not job performance but the need for direct supervision of the hospital staff.

“We feel that the hospital needs an on-site medical director with full-time, hands-on responsibility every day,” Mavritte said, adding that the hospital originally had such a full-time medical director.

“As our system grew, (county mental health officials) just added more responsibilities to that (medical director) position, rather than add positions to handle the new responsibilities,” he said. “We were trying to run a sophisticated operation as a mom-and-pop operation.”

Mavritte will serve as clinical director and medical director while county mental health officials search for a permanent medical director.

As for allegations that inadequate care and staff negligence led to the deaths and injuries of patients, Mavritte said that such incidents cannot be prevented, given the county mental health system’s lack of personnel and money.

“Patient deaths cannot be avoided,” Mavritte said. “We are running a very, very acute facility here. If you look at any other 90-bed facility with the kind of patients we have here and compare the number of adverse incidents, we would come out looking damn good.”

Mavritte said he hopes that publicity will put pressure on the county Board of Supervisors to allocate more money for the facility.

“I look upon all the negative press as an opportunity for people to focus on the system and its needs,” he said. “The facility is completely inadequate for the job we’re trying to do. We’ve had to eliminate many of our staff positions because of budget cuts. We have trouble getting qualified staff members, and I don’t mean that the people who are working here now are not the cream of the crop. We have cream working here, but we have trouble attracting new cream in here with the current salary structure.”

Mavritte, however, added that negative publicity has taken its toll.

“There’s a terrible morale problem,” Mavritte said. “The people who work here eight hours a day, sometimes 24 hours a day, have done a damn good job considering the facility they have to work with and the patients they have to care for. Then they get accused of killing patients and mismanaging things . . . It’s very frustrating.”

Considering how long staffing and budget problems have existed at the hospital, some question how much good the reassignment of Higgins will do.

“Their strategy seems to be ‘management by disaster,’ ” Egan said. “They wait for a crisis and then they move people around, instead of trying to prevent the crises in the first place.”

Pat Stalnaker, public affairs officer for county mental health services, disagreed. “An administrator or a leader sets the tone. If they’re bright and have the chutzpah to run things, they’re worth their weight in gold,” he said. “That may have been the problem in the past, and I think Dr. Mavritte can offer that kind of leadership. He knows the ropes.”