It’s a ‘Zoo’ No More, Hillcrest Hospital Says on Media Day

Six months ago, the news media would have found “a zoo” had its members been allowed to tour the county’s Hillcrest mental hospital, according to its acting medical director. The place had a beleaguered, divisive staff dealing with too many patients by locking everyone in bedrooms to keep them from hurting themselves or each other.

On Friday, hospital administrators allowed the media to tour Hillcrest for the first time in more than a year, confident that their efforts to eliminate severe and well-publicized problems of care have been successful and should be displayed to the community.

Physical improvements were clearly visible: Walls and rooms have been painted, and murals added; the grounds have been cleaned, and plants and new grass added; new furniture has been installed or is on order for sleeping areas and activity rooms, and new bathrooms and linen closets have been built to meet health standards.

But more important to the hospital’s passing muster in coming federal and state medical reviews are major improvements to the quality of care, something not seen as easily as new paint and pictures, Dr. Harold Navritte, the acting medical director, said Friday.

The hospital has been under sharp attack by both state and federal officials for alleged substandard patient care, including at least one death and several alleged incidents involving staff mishandling of patients.

Compared to six months ago, the facility’s 60 patients--one-third less than the previous 92 maximum--now have access to a wide variety of daytime activities and to treatment as comprehensive as a mental health “crisis hospital” can provide, Navritte said. The zoo analogy no longer fits, he added.

“Sure, it’s easier to clean up a facility,” said Karenlee Robinson, the hospital’s new administrator. “The treatment, the quality of care, is harder to do. But we’ve reorganized the care, hired several new psychiatrists--we have almost two professionals for each patient--involved the staff in planning new programs, and have made this what we believe is a first-class (hospital) for the patients coming here.”

County officials will make that argument forcefully on Monday when they ask U.S. District Judge William B. Enright to prevent the Department of Health and Human Services from stopping Medicare payments to the hospital pending an administrative appeal of the government decision. The three-year cutoff is based on a review of the troubled hospital in June, 1985, by the California consultant responsible for enforcing Medicare health standards. That review was the culmination of months of problems with care at Hillcrest.

“They reviewed us before all of the vast improvements were done,” Robinson said Friday, although she was reluctant to go into detail before Monday’s legal arguments. “But I would like the federal people to come back and look at us now. We believe that we have quality programs and meet their standards of care.”

The federal review of 21 patients over an 18-month period revealed “serious violations” of patient care that held a “potential for patient harm.” In a separate review, federal authorities also barred a psychiatrist who practiced at Hillcrest from receiving Medicare reimbursements because of questionable care. The doctor was fired from the county before the federal ruling came down.

A federal government consultant said earlier this month that, while he recognized that recent improvements had been made at Hillcrest, the improvements appeared mainly to address administrative controls and had not yet been translated into acceptable care for patients.

But Robinson disputed that view on Friday. She said Hillcrest’s responsibility is to accept severely mentally ill patients--most of them arriving involuntarily with no other place to go--stabilize the immediate problems with drugs and suitable counseling, and design some sort of follow-up plan that the patient can then assume after being discharged to a less-restrictive clinic or outpatient facility.

Hillcrest has instituted team counseling, where teams made up of a psychiatrist, a physician, a registered nurse, an activity therapist and an occupational therapist have full responsibility for guiding the treatment of 15 patients.

“That reorganization is the cornerstone of our program,” Robinson said.

Robinson admitted that the unfavorable impression of Hillcrest both in the community and among mental health practitioners nationwide has made it difficult for the hospital to recruit the additional professional staffers authorized by the county Board of Supervisors last year.

“It is a problem finding people because they raise questions about whether we are going to maintain our (state) licensing,” she said. “That is why we want to improve our community image now, and that is why we invited the press.”