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New Changes for CMH Listed : Report to State Aims at Avoiding Decertification

Times Staff Writer

San Diego County officials Friday gave the state a lengthy proposal to correct problems at the Hillcrest mental health hospital--known as CMH--in hopes of avoiding a decertification that could force the facility’s closure.

Officials are worried that closure of CMH would cause a serious shortage of beds for mental health patients in the county.

Assistant Chief Administrative Officer David Janssen said county officials have been informed by the state that “decertification (of CMH) is inevitable. We realize the state is required to notify the (federal government) to start the decertification process. But we think what we have delivered to the state today is responsive to the problems that would lead to decertification, and we’re confident that we can reverse the process in the next 30 to 60 days.”

Janssen said the county remains “extremely concerned about the problems in the mental health area that could be caused by the closure of CMH. We’re doing everything necessary to solve the problems the state has been addressing at CMH.”

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In a cover letter to Dr. Michael O’Connor, director of the state Department of Mental Health, Kathy Wachter-Poynor, the county’s local mental health director, said the county was “confident that the decisive corrective actions that have been taken, and the actions that are being initiated, will resolve the serious problems identified in an expeditious manner.”

State officials said they had not reviewed the county’s proposals, which did not arrive in Sacramento until late Friday afternoon.

Jean Karr, head nurse at the hospital, said late Friday that she could not comment on the proposals, but added that to close the hospital would “create a hardship in the community. There are not enough mental health beds available as it is.” (Earlier, the county reduced the number of beds at CMH from 92 to 62 in hopes of improving the quality of care.)

While local officials have consistently opposed efforts to immediately close CMH, the report indicated that the county would consider further reducing its patient load if private facilities would take some of its severely troubled patients.

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“In the long term, the county will determine the feasibility of contracting for 24-hour acute psychiatric inpatient services on a regional basis,” the report said. “The Hillcrest Mental Health Facility would be reduced in size and would primarily serve as a backup, core unit.”

CMH has been under fire since late last year, when a supervising psychiatrist at the hospital blamed several recent patient deaths on poor judgment by the medical staff. Subsequent investigations by the county grand jury and the state departments of Mental Health and Health Services resulted in scathing criticism of the hospital’s administration and treatment procedures, and to a call by Assemblyman Larry Stirling (R-San Diego) for its immediate closure. Stirling charged that patients at the hospital were being subjected to “life-threatening danger on a daily basis.”

Investigators reported that patients had been physically abused, inappropriately admitted and discharged. There were allegations of sex among patients. A CMH program manager, later fired, was found to be working without a proper license. And doctors on night shifts reportedly slept on the job.

A cornerstone of the proposal sent to Sacramento Friday was the reorganization of the county’s Health Services Department initiated this week by Chief Administrative Officer Clifford Graves. Graves has disbanded the department and reassigned its frequently criticized top administrator, James Forde, to other duties. He has also temporarily created a separate Department of Mental Health to spearhead the changes at CMH.

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“These supportive actions . . . demonstrate this county’s commitment to resolving the problems faced at Hillcrest and to restoring a program of high-quality patient care,” the county’s report said.

The report outlined plans to more effectively adjudicate complaints of patient abuse and screen potential patients on a 24-hour basis. It also included numerous proposals for improving administrative and record-keeping procedures at the hospital. “The communication system is now more open, dynamic, and allows for more input,” the report said.

A charge that a patient was forced to stay in a supine position while locked in one of the hospital’s isolation wards led to the discontinuation of the four seclusion rooms, although they might be moved closer to the nurses’ station so patients placed there could be monitored more effectively.

Earlier, the Board of Supervisors allocated $678,000 to hire additional staff at the hospital and initiated a nationwide talent search for a new medical director.

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