Psychiatrist Is Selected Medical Chief for Hillcrest

A yearlong search for a medical director for San Diego County’s overburdened and undersized Hillcrest mental health hospital ended this week with the selection of a San Diego psychiatrist who is a specialist in human sexuality.

Dr. David P. McWhirter, who left private practice a year ago to supervise one of the hospital’s wards, was named Wednesday to the newly created position, heading the clinical staff of the county’s only public hospital for the severely mentally ill.

The hospital has been under scrutiny since 1985, when state and federal officials sharply faulted it for providing substandard care. Improvements have been made, but it remains ineligible for reimbursement under Medicare.

1,500 Patients Admitted

The facility admitted 1,500 patients last year and evaluated 8,000. Under agreement with medical and public safety officials, its staff evaluates all emergency patients who appear to have psychiatric problems and takes patients who do not qualify for insurance.

On Thursday, McWhirter, 55, said he will focus on improving patient care in the 60-bed facility by, among other things, closer supervision and guidance of patients and better ties to San Diego’s psychiatric and mental health communities.

He also said he intends to tap the resources of the UC San Diego School of Medicine, drawing on the experience of its respected psychiatry department and soliciting department members’ help in recruiting superior psychiatrists to work in the hospital.

Selection Welcomed

The selection of a medical director was welcomed Thursday by Dr. Jay Shaffer, former chairman of the county Mental Health Advisory Board and an early and outspoken advocate of an overhaul of the hospital. He called McWhirter’s desire to improve the hospital’s case-management system and to bolster communications with local psychiatrists “an admirable goal,” but he cautioned that there are pitfalls in the concept of county-university cooperation.

“There is a fundamental difference in the mission of the university and the mission of the county,” Shaffer said. “The mission of the county is to provide care for the indigent mentally ill . . . and the mission of the university is to provide teaching and research.”

McWhirter was trained at the University of Southern California School of Medicine. He has run an Air Force base hospital, a university health service and the adult inpatient service at Los Angeles County Medical Center.

Since 1974, he has been in private practice in San Diego, specializing in problems involving human sexuality. He also serves on the UCSD School of Medicine clinical faculty, teaching and supervising residents.

Tired of Private Practice

“Last year, I decided that I was real tired of the individual private practice business, and I saw that this hospital was in disarray and needed attention,” McWhirter said Thursday. “So I came over here.”

McWhirter applied 13 months ago for the job of medical director. Because the hospital was strapped for doctors, the acting director, Dr. Harold Mavritte, asked him to work on a ward until a decision on the director could be made, McWhirter said.

Asked for his definition of the hospital’s problems, McWhirter said simply: “Too many people, too few beds, too small a space.”

The hospital came under scrutiny in early 1985 amid charges that poor judgment had resulted in at least four deaths. Investigators found evidence of improper medical practices, unlicensed employees, sex among patients and sloppy administrative practices.

Next, after one interim director resigned in frustration a month into his tenure, there were calls to close the facility. So the county set about revamping the Department of Health Services and increased the hospital’s budget.

Some Improvements

Since then, inspectors and other observers say, there have been marked improvements. However, some also have noted that the decision to cut the number of beds to 60 from 92 has exacerbated longtime difficulties in getting patients admitted.

McWhirter outlined some of his plans:

- To improve education of patients and their families about the effectiveness of prescribed medication, a task that can greatly improve patients’ conditions but has been neglected in the past because of demands on staff time.

- To appoint a patient ombudsman to serve as a link between patients and the hospital administration and between patients’ families and the hospital.

- To set up a better case-management system in which each patient is assigned a case manager for assistance outside the hospital with such things as getting to appointments, getting food and general personal assistance. A well-managed system might avert some of the emergencies that bring some patients repeatedly back to the hospital and thus alleviate pressure on the constantly overburdened emergency screening unit.

- To improve ties with psychiatrists outside the hospital and with the community at large “to make our image more palatable.” In the past, the hospital has been faulted for the lack of communication between its inpatient services and other mental-health providers.

- To “tap into” the resources of the UCSD School of Medicine. McWhirter suggested that university doctors and researchers might benefit from the opportunity to study the hospital’s acute cases and that patients could benefit from the university’s expertise.

Takeover Plan Rejected

Last year, Dr. Lewis Judd, chairman of UCSD’s psychiatry department, proposed that the university take over the Hillcrest facility and create an academic mental health center to provide state-financed research and training while caring for the county’s poor and indigent.

But the San Diego County Board of Supervisors rejected the idea last July. Because the university wanted six months to consider the plan, the supervisors decided against delaying construction of a new county mental health hospital in Loma Portal.

McWhirter said he believes that one stumbling block to that plan might have been the state’s unwillingness to fund such a center. But he said county health officials and university faculty members have expressed a willingness to improve ties in other ways.

McWhirter, who has published extensively on the subject of human sexuality, is a co-author of the 1984 book “The Male Couple.” He holds numerous professional society appointments and offices, said Steve Escoboza, assistant director of the county Department of Health Services.

McWhirter’s new job entails supervising the 16 part-time general physicians, 11 part-time psychiatrists and 7 full-time psychiatrists on the hospital’s staff. Two of those full-time psychiatrist positions are unfilled.