Supervisors’ Failure to Buy Hospital Rankles Activists : Crisis Grows in North County Psychiatric Care

The failure of the county government to buy a psychiatric hospital in Encinitas because of bureaucratic slowness has left North County mental health activists frustrated and concerned that the county cannot cope with the area’s growing population of people in need of psychiatric care.

The county Board of Supervisors, after considering the issue on and off for at least two years, last fall authorized negotiations for the purchase of the 83-bed San Luis Rey Hospital to serve North County residents needing emergency or acute psychiatric care.

But before those negotiations could be completed, the Santa Ana-based hospital chain that owns the San Luis Rey Hospital announced several weeks ago its sale to Scripps Memorial Hospitals of La Jolla for $6.9 million, the same price the supervisors had been willing to pay.

Dr. Paul Alberton, a psychiatrist and medical director at the mental health unit of Tri-City Medical Center in Oceanside, called the county’s failure to buy San Luis Rey “a tragedy.” He said mental health problems in North County “will continue to get worse before they get better.”

“The county is a big, slow bureaucratic machine,” Alberton said. “Unfortunately, the guy in the street, the mentally impaired, isn’t able to make much of a stand.

“If you don’t have enough open-heart surgery facilities, businessmen give eloquent speeches, but if you don’t have adequate psychiatric care, nobody cares except a few parents and people in the field.”

Couldn’t Wait Forever

Alberton said he was “disappointed at Scripps (for buying San Luis Rey) but I understand economics. They couldn’t sit around forever (waiting for the county).”

Dorothy Costa, an Oceanside psychiatric social worker and member of the county Mental Health Advisory Board, said the failure of the negotiations “reflects an inability of the county to deal with the growth in North County.”

“When you have rapid growth like we’ve had, you naturally have a corresponding growth in the number of people who desperately need psychiatric care,” she added. “Superimpose that over the overcrowding at (the county mental health hospital in) Hillcrest, and you have a true crisis.”

Some mental health workers fear that the long drive to Hillcrest, and the increasing wait once they arrive, discourages some North County law enforcement and social service personnel from bringing disturbed persons to county mental health for the 72-hour evaluation permitted by state law.

As a public agency, the county has the power to buy San Luis Rey through condemnation. Attempts to convince Scripps to sell the hospital to the county have been unsuccessful.

Supervisors are currently considering a confidential report from the county counsel’s office outlining their options, and warning how lengthy, expensive and controversial a condemnation process can be.

A final report and recommendation from the Department of Health Services to the supervisors is not expected for at least two weeks.

But the health department official closest to the San Luis Rey negotiations says he does not see condemnation as a realistic alternative because of the time and expense involved.

“It is more realistic to start entirely over in looking for ways to meet those needs,” said Bill Burfitt, the department’s deputy director for management services. “We need a psychiatric facility to handle that strategic I-5 corridor in North County. We just have no safety valve for the Hillcrest facility, which is at ‘bedlock’ much of the time.”

San Luis Rey would have served as a psychiatric emergency ward for adults experiencing continuing mental problems or considered by law enforcement or health officials to be a potential danger to themselves or others.

There were also plans to reserve beds for children and adolescents with psychiatric needs, and possibly have a section for the elderly.

For Medi-Cal Patients

Like County Mental Health, San Luis Rey would have primarily served patients who cannot afford care at a private psychiatric facility. That category often includes people whose only health insurance is through Medi-Cal.

Medi-Cal and “medically indigent” patients from throughout the county are currently taken to the 50-bed Hillcrest complex, which leads to frequent overcrowding. Health officials had hoped that San Luis Rey could relieve at least some of the problem.

“The pipeline just gets clogged,” said Dr. David McWhirter, psychiatrist and medical director at Hillcrest.

“It is common to have all our beds full, as well as 12 to 14 patients in a room 30-by-15, with four of them strapped to litters, and three or more police cars waiting to bring people in, and sheriff’s deputies holding two to three people in our courtroom.

“There is nowhere for these people to go.”

Owned by Santa Ana-based Community Psychiatric Centers of California, San Luis Rey is run as a private psychiatric hospital for adults and children, with programs for the treatment of alcohol and drug abuse and eating disorders.

As a psychiatric hospital, it has the safety and patient-care features required by the state for facilities that care for mental patients. The county had a contract for several years with San Luis Rey until funding evaporated.

Dorothy Costa said activists in the mental health field were “crestfallen” when the San Luis Rey purchase collapsed.

“Our beds are just so limited in North County,” said Costa, who is chairwoman of the advisory board’s North Coast Regional Planning Committee. “People are not getting the psychiatric care they need. We were all terribly disappointed that the county moved so slowly.

“It was our one ray of hope to improve psychiatric services in North County. We’re still hoping but it doesn’t look promising.”

Burfitt said health officials were just as disappointed as the advisory board members. But he said he does not think the county government could have gone faster, given requirements to advertise for competing offers and check with county supervisors before proceeding.

“What we’re entrusted with at the county are public funds, and there are procedures that work as checks and balances on us,” Burfitt said. “We can never move as fast as private enterprise. We went as fast as we could.

“I can sense and share the frustration of everyone involved.”

Take It Or Leave It

San Luis Rey administrators have said they would have preferred to sell to the county but that the Scripps’ offer was presented as a “take it or leave it” proposition and represented a more attractive real estate transaction with a shorter escrow and larger down payment.

San Luis Rey is off Devonshire Avenue, just north of Scripps Memorial Hospital-Encinitas, which is undergoing a $19-million renovation and expansion. Scripps also owns a vacant acre next to San Luis Rey.

Community Psychiatric Centers decided to sell San Luis Rey because it is building a $10-million, 163-bed replacement facility near Quail Gardens in Encinitas. The company will continue to operate San Luis Rey until the new hospital is completed, which will be more than a year.

Mike Bardin, director of Scripps Memorial Hospitals, said Scripps has not yet decided what to do with San Luis Rey, except that it will not be used as a psychiatric facility because Scripps-La Jolla already serves those patients.

To dispel any idea that Scripps swooped in at the eleventh hour to snatch San Luis Rey from the county, Bardin noted that Scripps first talked to San Luis Rey owners more than five years ago about a possible purchase.

And he noted that Scripps is expanding throughout the coastal region of North County.

Scripps, a community-based, nonprofit hospital group, recently bought the troubled Oceanview Convalescent Hospital in Encinitas. It also is considering plans for 62 acres it owns in Carlsbad south of Palomar Airport Road and east of El Camino Real.

“We are very cognizant of the needs the county is trying to address,” Bardin said, “but we have some needs and logical uses of that property (San Luis Rey) that the county proposal doesn’t fit.”

North County Supervisor John MacDonald declined to discuss the San Luis Rey issue because the supervisors have not yet discussed the county counsel’s report in closed session.

“We’re all very frustrated over this,” said MacDonald’s chief of staff, Nancy Allen. “We would have liked to have San Luis Rey. We’ve got to find some place.”