Judicial Roadshow to Hospital Halts : Officials at Hillcrest Facility Unhappy About Taking Patients to Crowded Court

For about as long as anyone can remember, a Superior Court judge from downtown San Diego has been trekking to the County Mental Health Hospital in Hillcrest one or two afternoons a week to adjudicate matters for the facility’s patients.

At the start of this month, however, that system was quietly changed when the judges announced they would no longer be making the trip.

Shifting an entire court operation--including clerk, bailiff and court reporter--to the hospital for as few as one or two cases in a typical afternoon simply didn’t pencil out any more, the jurists concluded. From now on, the patients could travel downtown like everyone else to have their day in court.

It wasn’t just inconvenience that brought an end to the judicial roadshow, insists Supervising Judge Michael Greer. Greer said the change--which he called long overdue--was vital to helping the court operate more efficiently and better manage its burgeoning calendar.

Triggered an Outcry

While the decision may make sense from the standpoint of jurisprudence, it has triggered an outcry from administrators at the beleaguered mental hospital, which is the county’s largest--and only public--psychiatric facility and handles the most severely ill patients.

Hospital officials say that transporting patients away from the structured, secure environment of the hospital and forcing them to wait their turn in the noisy, unfamiliar swirl of the county courthouse is a traumatic experience that can further exacerbate their psychological problems.

Administrators predict the more agitated patients will have to be placed in leather restraints during the trip and the court proceedings, a tactic they say unfairly likens the sick to prisoners and constitutes a violation of their civil rights.

There are fears of “elopements,” or escapes, and concerns about the obvious logistical problems as well.

“If we have to load five patients into a van with as many as five staff who need to testify on their behalf, then that means there are patients at the hospital who are without the doctors’ care they need for that afternoon,” said hospital administrator Karenlee Robinson. “We’re trying to adjust, but it’s posing some very difficult problems. Hopefully, we’ll be able to reach some alternative solution with the court.”

Return Not in the Cards

While the judges sympathize with the hospital’s quandary, they say a return to the old system is not in the cards. The jurists also point out that 19 other private hospitals in San Diego County have been transporting their mentally ill patients to the downtown courthouse for years, and argue there is no reason the county hospital can’t manage as well.

Moreover, Greer and others say a shortage of judges, combined with a swelling caseload, has made the sacrifice of a judge and a courtroom to CMH one full day a week unworkable.

“It had to happen,” said Judge Perry Langford, who presides over the calendar for the mentally ill and recommended the change to his colleagues on the Superior Court executive committee. “We simply could not continue to waste two afternoons a week up there. It was not productive. It was a waste of resources we cannot afford at this point.”

Most of the matters for the mentally ill that are decided in Superior Court are requests to establish conservatorships and petitions by patients who believe they are being inappropriately detained at a psychiatric hospital.

In conservatorship cases, a judge weighs testimony from doctors and other information in attempting to determine whether a patient is “gravely disabled” and poses a danger to himself and others. If such a finding is made, a relative or county social worker is appointed to handle the patient’s affairs. A patient can ask the court to reevaluate the conservatorship every six months.

The second, more common, type of case occurs when a patient challenges his or her detention in a psychiatric facility, a challenge authorized under state law. In these cases, a judge evaluates whether the patient is able to provide for needs like food, clothing and shelter in deciding whether he should be held or sent home.

300 Cases a Year

Officials at CMH, a 60-bed facility that has been plagued by chronic overcrowding and other problems in recent years, said there are about 300 court hearings involving their patients annually. That number is greater than any other single hospital in the county.

Langford said Superior Court judges first began deciding such cases outside the courthouse several decades ago, when the county’s indigent mentally ill were treated at CMH’s predecessor on Vauclain Point.

“It started out with a judge going by in the morning, before the normal court calendar began, to hear several matters a time or two a week,” Langford said. That practice has continued mostly uninterrupted.

But as the number of patients housed by the county grew, judges began to question the arrangement. Langford said that, when he assumed control of the calendar for the mentally ill a year ago, his predecessor recommended he search for an alternative. Another colleague said the system was “just plain silly,” Langford recalled.

“I’d been thinking about it all year because we were having trouble up there,” Langford said. “For one thing, the facilities are terrible. The air conditioning wasn’t working during the summer and it was hot and crowded.”

More importantly, Langford said, it grew clear to him that packing his courtroom staff into a van and heading to CMH to hear an average of three cases during a typical afternoon “wasn’t worthwhile” in light of the court’s ongoing struggle to shoulder its mountainous caseload.

“We’d go up there and we’d never know if the calendar would blow up or take until 5 o’clock,” Langford said. Because of the uncertainty, “we couldn’t schedule any cases downtown. And even if we only heard a few cases up there, by the time we load up and drive back downtown, the afternoon is pretty well shot.”

As Superior Court Executive Officer William Pierce sees it, such an arrangement constituted “a terrible waste of public funds.” Pierce said studies show it costs the county $10,000 a day to operate a single courtroom, which covers salaries for judges and deputy district attorneys on down to the support staff and maintenance.

“To take a judge who could be hearing matters all day long in his courtroom to another facility where . . . he may just hear two or three matters is really wasteful,” Pierce said.

In December, CMH gave the judges a convenient opportunity to terminate the age-old system, Langford said. Desperate for space, CMH officials told the judges that they planned to convert the hospital courtroom into a badly needed treatment area for incoming patients. Administrators asked the court’s executive committee for a trailer to be equipped for use as a new courtroom on hospital grounds.

The idea did not win much support. By a unanimous vote, the committee instead voted to switch the CMH hearings downtown. An appeal by CMH was rejected last week.

“They think what we want is a beautiful courtroom and a raised bench, that we just don’t want to be in a trailer. But that isn’t it at all,” Langford said. “I don’t mind trailers. . . . Frankly, I’m disappointed in the hospital’s reaction. Instead of trying to find ways to make this work, they’ve spent the last month looking for a way out of it.”

Hospital Complaints

CMH Medical Director David McWhirter said the new arrangement causes consternation on several fronts.

“First, it hyper-agitates the patients,” he said. “When a judge tells a patient, ‘You’re too crazy to go out on your own,’ then the patient tends to escalate. There is no holding room there--we’re all just mingling with the public. And I think it’s really humiliating for a person who’s nuts and is having a psychotic episode to be exposed in a public hallway.”

There is also the risk of elopement, McWhirter said.

“Our patients are pretty sick people, and a lot of them don’t want to be here, obviously, or we wouldn’t be taking them to court,” McWhirter said. “So we run a serious risk of elopement, one that isn’t there when we’re in the secure hospital environment.”

To compensate for the danger of patient flight, hospital officials say that in some cases they will be forced to use restraints or possibly additional medication while patients are en route to the courthouse and before a judge.

While acknowledging that private hospitals from as far away as Oceanside and East County routinely transport mentally ill patients to the courthouse, CMH officials say their patients are the most severely ill of any in the county.

“Ours are the most dangerous and difficult patients in the system,” hospital administrator Robinson said. “Many times the private hospitals transfer their terribly aggressive, agitated patients to us because they cannot handle them. We are the court of last resort. So I think our situation is a little different than the others.”

Helen Teisher, a member of the county’s Mental Health Advisory Board and past president of the San Diego Alliance for the Mentally Ill, said the dispute dividing CMH and the Superior Court illustrates a disturbing reality: there are inadequate facilities for dealing with those who suffer from mental illness.

“When people are very, very psychotic, taking them into that court environment certainly adds to their anxiety,” said Teisher, whose son is mentally ill and under a conservator’s care. “It would be ideal to protect them from those stresses and strains, but the truth is the courts are in dire straits as well. There may be no alternative.”

Langford and his colleagues have an idea they believe may provide a way out of the conundrum. They hope to expand the court’s use of video technology to include mental health proceedings, thereby allowing the patients to remain at the hospital and the judges to remain downtown.

Assemblywoman Sunny Mojonnier (R-Encinitas) has agreed to carry legislation making use of the video procedure possible, but Mojonnier’s chief of staff said that unless the bill is given urgency status, authorization could be a year away.

Robinson has other concerns about the high-tech approach.

“I think there are some serious legal issues that would need to be examined,” she said. “For uncontested conservatorships, I think it would be ideal. But if a patient is contesting our decision, I don’t know if video would meet their rights or whether their attorney would agree to it. If it were my client, I’d want them right there in the courtroom.”

In the meantime, Judge Langford said he is attempting to make the transition as comfortable as possible for CMH.

“I don’t like to see sick people wait, and I think that’s a legitimate concern they have,” Langford said. “So we’ll simply triage--decide who’s sickest, who’s the worst off, and take those before the others. We should be able to get the CMH people through pretty fast that way.”