Alternatives to Hillcrest

The federal government’s decision to cut off Medicare funds to the county’s mental health hospital came as bad news indeed to a county government that has struggled for months to improve conditions at the Hillcrest in-patient hospital.

Although the hospital had undergone various inspections in the past year, and state health officers had already recommended a cutoff of federal funds, the decision by the Department of Health and Human Services--based on a separate review of the care provided at the hospital--nonetheless was an added blow because it made the prospects of a quick return of the Medicare funds unlikely.

Unless the county successfully appeals the decision, Hillcrest will lose its right to receive Medicare payments for at least three years. Medicare funds amount to about $1 million a year, or 12% of Hillcrest’s annual budget.

Not surprisingly, county officials have called the federal decision unjust, saying it was based on old information. Unquestionably, significant improvements have been made at the 60-bed mental hospital since its many deficiencies--including poor patient treatment and patient abuse--were brought to light in 1985. But have the changes been enough?

Less than a month ago, state licensing officials told the county that an inspection team that visited the hospital in November and December found that two of six areas that earlier had been discovered to be out of compliance with federal standards still were. Four other areas, including dietary programs and nursing, had been brought up to minimum standards.

That report seems to summarize the situation at Hillcrest--a good deal of rapid progress has been made, but only after conditions had gotten so bad that not everything could be brought up to par at once.

The loss of Medicare funds will not help the county solve the problems at Hillcrest, and it’s hard to see the light at the end of this tunnel. The county cannot do without facilities where mentally troubled people can be taken on a 24-hour basis. But alternatives have been suggested to operating the Hillcrest hospital as it is.

One possibility would be to contract with various hospitals for psychiatric care, as the county recently decided to do in the North County. And, Assemblyman Larry Stirling, the loudest critic of the Hillcrest hospital, has suggested asking the UC San Diego Medical Center to take it over.

Neither of these options offers a quick fix to the existing problem. But it would seem time for the Board of Supervisors to seriously consider these and any other reasonable alternatives.