State Gives Hillcrest Hospital 2 More Weeks to Get Its Act Together

Patients’ health and safety are still endangered at San Diego County’s Hillcrest mental hospital, but the county should be given at least two more weeks to make improvements before the place is closed, state health officials said in a report released Friday.

The report, issued jointly by the directors of the state departments of health and mental health, said inspectors who visited the hospital in June found evidence of patient abuse, poor record-keeping and an overall lack of supervision. The report also said the hospital’s treatment program was inadequate.

The report expressed the opinion that two recent patient deaths at the hospital could have been prevented.

In a letter to Clifford Graves, the county’s chief administrative officer, Dr. Kenneth W. Kizer, director of the state Department of Health Services, and Dr. D. Michael O’Connor, director of the Department of Mental Health, said “immediate and aggressive action” is needed before Sept. 13, when the county’s performance will be reviewed again, to halt state closure of the hospital. The letter said there was little the county could do by then to keep the state from recommending that CMH, as the county mental health hospital is known, lose the certification it needs to obtain federal Medicare funding.

“It appears that (the county’s) plans of correction are adequate to address the deficiencies cited,” the letter said. “However, this will only be possible if dramatic administrative action is taken to implement the needed changes. Stopgap measures will not be acceptable.

“If it is the desire of the county . . . to continue to operate Hillcrest, the facility must provide an acceptable level of patient care and it must be operated within the licensing laws and regulations governing such institutions.”

Graves, in a prepared statement, said the county was committed “to taking whatever corrective action is required to ensure the continued operation of Hillcrest.” He said those improvements began “within days” of a mid-June visit by state inspectors.

David Janssen, Graves’ chief deputy, said in an interview that his reaction to the state report was “mixed.”

“It’s an indication that they recognize the fact that there is no alternative care available for these patients at this time, and they want to work with us to make this facility what it ought to be,” he said. “It’s obvious they feel it’s necessary to use a club to ensure that the county continues to make progress in solving the problems at the facility.”

Janssen said he and three members of the health department’s staff planned to travel to Sacramento next week to meet with state officials in hopes of finding out exactly what the county can do to keep the hospital open.

Janssen declined to comment on the state’s assertion that two recent deaths at CMH could have been prevented. He said a San Diego Psychiatric Society’s peer review team had completed a county-requested report on the cases, but he would not reveal the report’s conclusions.

The state’s report said the two deaths were evaluated “in depth and it was determined both could have been prevented.”

In the first case, in January, the state said that a patient who strangled his roommate in bed “was not seen by a psychiatrist in a timely manner,” and nurses did not properly monitor the patient before he attacked his fellow patient.

In the second case, in March, a patient admitted while suffering from a drug overdose was restrained in a seclusion room at 2 a.m. and not checked for several hours. He was found dead at about 7:30 that morning. The report said CMH “medical and nursing staff failed to exercise good medical and nursing practice in treating” the patient when he was admitted.

In preparing the report, the Department of Health Services investigated 22 complaints and “unusual occurrences” at the hospital.

Among the areas of concern were:

- Patient abuse. The report said nine complaints of patient abuse were investigated and four were substantiated.

“In one instance, a line staff person was verbally attacked by a patient on two consecutive days, which resulted in the patient being attacked on the third day,” the report said. “This was documented in the patient’s medical chart. There was no evidence . . . of anyone intervening on behalf of the patient or the staff person.”

- Treatment. The hospital’s “active treatment program is insufficient to meet the patient needs,” the report said. It said patients are not encouraged by staff to participate in the program and that the activity schedule “is permanent and not flexible nor individualized to meet the patients’ needs.”

- Medical records. The report said an inspection of the hospital’s medical records prompted “serious concern” because it revealed several problems ranging from “inaccuracies to the absence of documentation regarding treatment and patient responses.”

- Management. “It has been determined that CMH is not exercising strong management control over their staff in all services, resulting in patients receiving fragmented care on a day-to-day basis,” the report said.