Officials Take Aim at Call by Stirling to Shut Hospital

County officials Thursday staunchly defended steps to correct widely publicized problems at the county’s mental health hospital in Hillcrest and assailed a call by Assemblyman Larry Stirling (R-San Diego) for the state to immediately close the hospital.

County officials said such a move would be “detrimental to the best interests of the community.”

Chief Administrative Officer Clifford Graves, in a prepared statement, said “corrective measures have already been taken or are in progress,” in response to the allegations of mismanagement and poor patient care at the facility. He said Stirling’s statement that patients at the 61-bed hospital are being subjected to life-threatening danger “is simply not true.”

At the same time the Board of Supervisors late Thursday called a special closed meeting for Monday morning to discuss the hospital. Sources said the future of James Forde, the county’s embattled health services director, would probably be discussed at that meeting.

Forde refused to comment on Stirling’s letter. Bob Lerner, a spokesman for the county, said Thursday that Forde “had no immediate plans to resign.” Lerner said his office had been “flooded with calls concerning rumors about Forde.” Stirling said Forde should be “fired immediately.”

Stirling’s letter to Gov. George Deukmejian asking that the state “do whatever is necessary to close (the hospital) as quickly as possible” sent shock waves throughout county government but officials in Sacramento were unruffled.

Larry Thomas, Deukmejian’s press secretary, refused to comment on the letter. William Ihle, a spokesman for the state Department of Health Services, said Stirling’s action would have no effect on the recommendations in the soon-to-be-released report on his department’s investigation into the hospital.

Ihle said the results of the investigation would be reviewed by state Health Director Kenneth Kizer. “This doesn’t change our timetable a bit,” he said. Recommending that the hospital be shut down “is an alternative he (Kizer) will address,” Ihle said, “but the bottom line is providing the best services for the people of San Diego County. We’ll be making recommendations along those lines.”

Stirling said he had “assurances from the front-line guys” that the Health Services Department would support his move to close the hospital. The assemblyman said he will meet with Deukmejian Monday. “I hope the governor can be convinced that (the hospital) should be shut down immediately . . . He could issue an executive order to do that, and the documentation supporting such an action is clear.”

Kizer could deliver his recommendations as early as next week, Ihl said. Stirling already has released copies of 33 deficiency reports issued against the hospital by the state Health Services Department in the course of its investigation. Many involved improper administrative procedures, but the state also uncovered instances in which patients were physically mistreated.

One patient, according to the documents, was restrained in a supine position for more than seven hours. Several reportedly were found sleeping on the floor, and one locked himself inside a locker for more than two hours before being discovered by the medical staff.

Graves said some of the allegations in the documents released by Stirling were “months old,” and Ihl agreed that they included “very little new information.” Ihl said his office gave Stirling the documents, which included the county’s proposals for correcting the 33 deficiencies, “more than a week ago.” Stirling, in an interview Thursday, said his office had received them from “concerned sources on the county staff.”

Supervisors Susan Golding and Brian Bilbray maintained that the hospital should remain open, although both said they may support revamping management within the hospital or the county’s Department of Health Services, which oversees the facility. “The county needs to aggressively look at the management structure,” Bilbray said. “There have been management deficiencies in the operation of CMH.”

Bilbray, unlike his colleagues at the county, was not critical of Stirling. “This is a very critical situation,” he said. “I can understand why he came out as strongly as he did.”

County Mental Health has been under fire since late last year, when a supervising psychiatrist at the hospital blamed several recent deaths on poor judgment by the medical staff. A San Diego County Grand Jury investigation followed, and was harshly critical of Forde and the hospital’s staff.

In response to the charges, the county conducted an internal investigation, which led to the ongoing reorganization of the Health Services Department’s mental health division. Dr. Warren Higgins, a top administrator at CMH for almost 20 years and another frequent target of criticism, was transferred to another post within the county.

The Board of Supervisors also has allocated $678,000 to hire additional staff at the hospital, and a nationwide search is being conducted for a new medical director. This week, the board also voted to hire a consultant to recommend additional changes. In light of these changes, Graves said, to close the hospital would be “self-defeating and . . . detrimental to the best interests of our community.”

Stirling maintained that administration at the hospital has resisted efforts to change procedures. He said the situation at the hospital “is not at all like Edgemoor, where they moved right away to turn things around. It’s the reverse at Hillcrest. Their attitude basically is, ‘Stuff it.’ ”

(The county’s Edgemoor Geriatric Hospital, also administered by the Department of Health Services, also has been severely criticized in recent months by Stirling and other state and county officials).

Bilbray said the state should share the blame for the problems at the hospital. “The state can’t relinquish responsibility when our mental health funding is so inadequate,” he said. “What kind of people do they think we’re going to get to run our programs here under the current funding situation? The best management in the world is not going to turn CMH around unless we have the money available to do the job.”