Hillcrest Doctors Fear Patient Mix in Sleep Areas

Doctors at the county mental health hospital in Hillcrest have warned county officials that a new policy of mixing men and women in the sleeping wings may endanger patients and open the beleaguered hospital to new lawsuits.

In a letter sent Tuesday to the director of the county Health Services Department, two doctors and a social worker said the hospital is inadequately staffed and designed for overseeing the intermingling of patients under the new policy.

“Our professional staff is scared and want no legal responsibility for this latest excess,” reads the letter, a copy of which was obtained by The Times. “We beg you to reconsider before other agencies may be forced to decide our Fate for us.”

But Dr. Harold E. Mavritte, the clinical director at the hospital, said Wednesday that integrated wings are common in modern psychiatric hospitals. He said the new policy was a logical next step in his program of upgrading practices at Hillcrest.

Mavritte called any fears of added risk “specious.” He said men have slept in Hillcrest’s women’s wing in the past when there were too many men for the male wing. Mavritte suggested that doctors were objecting to the 2-day-old policy because “they have to be more on their toes. They can’t use locked doors to supervise patients. You have to do your job.”

Integrated sleeping wings are common in psychiatric hospitals, according to administrators of several private hospitals in San Diego County. There and at Hillcrest, integration means that men and women share the same hallways but not the same bedrooms.

“I don’t think there’s any cause for concern unless you have a very unusual group of patients who are extremely ill,” said Dr. Sidney Bolter, medical director of Vista Hill Hospital, a private psychiatric hospital in Chula Vista.

But he added, referring to Hillcrest, “They probably have to exercise a little more caution there than in a hospital that is adequately staffed. They’re working under a terrific handicap. I really feel a lot of sympathy for those doctors down there.”

Hillcrest has been the subject of county and state scrutiny for months, since a supervising psychiatrist at the hospital charged that three out of four recent deaths there could be traced to poor staff judgment.

The doctors’ letter, delivered to Health Services Department Director James Forde, said that there was “virtually no support” for the new policy announced by Mavritte on Monday.

“We have been facing emerging lawsuits involving medical malpractice, incompetence of administration, and loss of leadership with violent shifts of personnel,” the letter said. “ . . . Why up the ante to new heights of controversy and possibly invite new lawsuits?”

The letter said Hillcrest was designed for segregated patient care. In the past, men and women have slept in separate areas with separate bathrooms. At night, the doors between the two wings have been locked.

“Is this to be our answer to protecting the patients from violence?” the letter asked. “We are confused as to the merits of this new change.”

Dr. Martin M. Schorr, a clinical psychologist who signed the letter, declined Wednesday to talk about it, saying hospital policy bars him from talking to reporters. The social worker, Sidney Rhodes, also refused to comment. Dr. Zalman Magid, the third signer, did not return a call to his office.

However, one official at the hospital said another group of psychiatrists has also objected to the sleeping policy.

The official, who spoke only on condition that his name not be used, said the psychiatrists wrote to the hospital’s medical director Tuesday saying that they feared a rise in attacks on female patients, as well as in fabricated claims by female patients that they had been attacked.

Mavritte, clinical director of County Mental Health Services, said the new policy is necessary to insure that the five “treatment teams” at Hillcrest have equal patient caseloads.

In the past, because of the disproportionate number of male patients in the hospital, the teams assigned to the men’s area ended up with a disproportionate number of cases, Mavritte said. Now, patients will be assigned directly to teams, rather than by area. Each team will have the same caseload, he said.

Mavritte pointed out that all daytime activities are integrated, including meals, group therapy and recreation. Mavritte said male patients will still use the men’s toilets in the former men’s wing. He said the door between the two areas will no longer be locked.

“That was an archaic practice,” he said of sex segregation. “Even if you go to most of the state hospitals now, they don’t practice that any more.”

Mavritte maintained that Hillcrest has enough staff to keep an eye on the patients. He suggested that staff members complained simply because they resist change. He insisted the hospital has sufficient staff to supervise integrated areas.

He drew a parallel to what he said used to be Hillcrest’s policy of furnishing bedrooms with beds and no other furniture--simply because on one occasion a patient had struck a staff member with a night table, he said.

“The method that some staff have got into in handling problems is, ‘We’ll take the furniture out,’ ” he said. “If you are structuring the activities, and monitoring and observing them properly, those things won’t happen. That was just an easier method of control.”