UCSD Readies Plan to Manage Hospital : County, State Leaders Seek Broad-Based Backing for Hillcrest Mental Facility Move

In an effort to improve patient care at the county’s Hillcrest mental hospital, UC San Diego will submit a formal proposal to both the state and county to take over the hospital as part of a new UCSD Academic Mental Health Center.

The UCSD Medical School’s department of psychiatry is preparing a detailed plan for how the center would operate, with emphasis on state-of-the-art treatment for the type of seriously ill patients now seen at Hillcrest, a facility for violent and impoverished mentally ill individuals.

The department chairman, Dr. Lewis L. Judd, said he intends to move vigorously on the proposal, which he outlined in a letter this week to county Supervisor Susan Golding and state Assemblyman Larry Stirling (R-San Diego). Golding and Stirling have been in the forefront of officials supporting an arrangement between the county and the university.

The long-beleaguered Hillcrest hospital early this year lost its eligibility for federal Medicare funds because of cases of substandard care. The county has moved within the past year to improve care by reducing the number of beds, hiring new administrators and psychiatrists, and spending more money on the fewer patients admitted. But county supervisors have said that a UCSD affiliation could be the best long-run solution, especially since mental health specialists agree that many people needing help are still unable to get adequate treatment.

Judd, who discussed his idea during a Times interview last month, believes several factors will help spur a county-UCSD agreement, including the need to improve the longstanding problem of providing top-flight care for San Diego’s seriously mentally ill, the willingness and availability of top academic talent at UCSD to care for such patients, and an apparent turnaround among politicians at all levels of government to provide more money for mental health.

“We see this as a unique window of opportunity . . . (to) promote a mutually beneficial agreement between the County of San Diego and UCSD,” Judd said in his letter.

Judd hopes to soon send an outline of the proposed center’s programs and legal relationship with the county to University of California officials in Berkeley for approval, after which the plans will be formally submitted to the county. The outline “will ensure the operation of a responsive, quality inpatient program for the patients the county is responsible for, but which also provides sufficient protection for both the county and the University of California,” Judd said in his letter.

Once the county and UCSD conclude negotiations, the plans will be shepherded through the state Legislature for the necessary funding, Judd said.

On Friday, Golding called the concept “solid and exciting,” adding that she is eager to see a specific proposal approved by university officials and presented to the county.

Stirling said Friday that Judd is a key player in getting the proposal going but warned that many San Diegans, including the entire 11-member legislative delegation and local representatives on the UC Board of Regents, must throw their support behind the plan if it is to be successful.

“I want to see broad-based support for Judd and the county if we are going to be able to get this through (the state),” Stirling said.

Unlike existing mental health research centers at UCLA and UC San Francisco, Judd envisions a San Diego center as a model inpatient program for persons with major mental disorders, where research and teaching are keyed directly to clinical treatment.

In the outline, Judd notes potential pitfalls that could complicate a final agreement between UCSD and the county. A new facility with modern patient rooms as well as adequate classroom and laboratory space would be needed, requiring use of the $17 million now available to the county for a new hospital as well as some additional state construction funds, Judd said.

Annual operating costs, estimated to be $12 million, would have to be covered from the present $7.5 million now supplied Hillcrest by the state and from new UC funds similar to those given the UCLA and UC San Francisco institutes.

“It would have to be understood from the beginning that these (UC) monies are additional funds added to the university’s budget but will be earmarked for the operations for the UCSD center,” Judd said. He does not want uncertainty from year to year over the source of operating funds, he said.

“It should be noted that the state year after year perpetuated a serious and inappropriate inequity in (state) Department of Mental Hygiene funds to the county. San Diego expends approximately $14.72 annually per mental health patient, whereas over $40 per patient is spent in San Francisco County, $28.88 in California, and the national average is $30.27,” Judd said.

Golding said Friday that the county will be unable to provide additional funds and that more state money will be essential. Stirling has previously indicated that, if the county and university can agree on a proposal, a united San Diego legislative delegation would be able to come up with the cash through negotiations with colleagues.

While UCSD draws up the specifics, the county has held off on construction of a new 111-bed mental hospital in the Sports Arena area. In addition to Golding, Supervisors George Bailey and Brian Bilbray have expressed strong interest in having the university take over the mental health functions. Bilbray said he has been very much impressed by UCSD’s operation of the former county general hospital in Hillcrest, now known as UCSD Medical Center.