Injunction Grants County More Beds at Mental Hospitals

San Diego County won the first round of a major legal battle with the state Thursday when a Superior Court judge issued a preliminary injunction that more than doubled the number of state mental hospital beds allocated to the county, while saving the county about $200,000 a month.

After a brief hearing Thursday afternoon, Judge Jack Levitt issued a ruling that will immediately increase the county’s allotment of state mental hospital beds from 32 to 71--a decision that, if ultimately made permanent, could save the county about $2.3 million annually.

Levitt’s ruling represents only a tentative, not a final, decision in a lawsuit that the county filed against the state last month in an effort to obtain additional beds that officials here contend are needed to treat severely mentally ill people. Nevertheless, enthusiastic county officials hailed the preliminary injunction as a significant step in their longstanding complaint that the county is being seriously shortchanged in the allocation of beds in state mental hospitals.

“We’re very, very encouraged and are glad that this will make a big difference to mental health patients in the county,” said Terence Dutton, the deputy county counsel who argued the case. County administrators added that the additional beds will help relieve overcrowded conditions at the County Mental Health Hospital in Hillcrest.

State Plans Appeal

State Department of Mental Health officials, however, were predictably dismayed by the ruling and vowed, in the words of department spokesman Dean Owen, to “appeal this as high as the moon.” The state plans to file its appeal “in the next day or two,” Owen said.

“We’re just about at the limit in all five state hospitals in terms of bed capacity and money, so we’re very concerned about the impact of this ruling,” Owen added.

Stemming from what County Supervisor George Bailey describes as the “woefully inadequate . . . and unfair formula” used by the state to allocate mental hospital beds, the lawsuit contends that San Diego County currently receives only about one-sixth of the beds to which it would be entitled if the beds were apportioned according to population.

Similar to two 1986 lawsuits that the county filed against the state concerning alleged inequities in the distribution of property taxes and other revenues, the suit points out that San Diego County currently is allotted only 32 beds in state mental hospitals--175 fewer than what county officials characterize as their population-based “fair share.” Moreover, other counties with substantially smaller populations than San Diego receive more state mental health hospital beds, county officials note.

In response, state mental health officials argue that San Diego contributed to its own bed-shortage problem by “selling back” 28 beds--nearly half of its allocation--to the state in the early 1980s in exchange for a payment that now equals about $1.6 million annually. But San Diego officials emphasize that, even with those beds, local mental health needs--and equity in the distribution of state resources--still would demand far more space in the state facilities.

Level of Usage

In Thursday’s hearing, Levitt indicated that he sided with the county’s version of the dispute, telling the attorneys: “When I balance the equities, they’re clearly in favor of the county.”

Under Levitt’s preliminary injunction, the county’s allotment of state mental health hospital beds will increase by about 120% to 71, with that number representing the county’s level of usage in the 1986-1987 fiscal year, according to State Mental Health Department spokesman Owen.

The ruling also prohibits the state from continuing its practice of charging the county for using more beds than the 32-bed allotment. County Mental Health Director J. William Cox said that San Diego patients typically occupy about 60 state beds, with the additional beds costing the county about $2.3 million annually--money that the state withholds from the county’s general mental health funds.

Pending resolution of the case, which county lawyers said could be months or years away, the state will not be able to charge San Diego for any beds up to the 71-bed level. However, if the county ultimately lost the suit, it could be forced to repay the funds for the additional beds, county attorney Dutton said.

Faced with the prospect of having to provide San Diego County with more beds for less money, state mental health officials plan to meet with the directors of the five state hospitals today to discuss the possible ramifications of Levitt’s ruling, Owen said.

“Potentially, it could be a real problem,” Owen said. “Currently, another 12 or 15 beds might be available (in the state hospitals). But we’re on a real tight budget. We’re concerned about where the money is going to come from. Until we know how many more beds San Diego might want to use . . . we don’t really know what to expect.”

The lawsuit is the latest chapter in the county’s long-running effort to rectify what it perceives as unfair state funding formulas that have cost the county tens of millions of dollars a year. But local officials concede that the predicament is also the result of a lack of clout carried by the county’s delegation to the Legislature.

Question of Fair Share

In 1986, the county, at Bailey’s urging, filed two lawsuits against the state charging that San Diego County has not received its fair share of property tax and other revenues. San Diego’s per capita allocation of general revenues was the second lowest of the state’s 58 counties during the 1985-1986 fiscal year, resulting in a $132-million shortfall, and county officials also contend that the county received $72 million less in property tax revenues than the statewide average that year. Both of those suits still are in preliminary pretrial stages.

At the heart of the bed allocation lawsuit is the county’s contention that the most equitable manner to distribute state mental health beds among counties is on the basis of population. But under the current allocation formula, set by the Legislature in the early 1980s, even many counties that are much smaller than San Diego receive more state beds. For example, San Francisco is allocated 246 beds, Contra Costa County 96 and San Mateo County 75, even though each of their 1986 populations was only about one-third of San Diego’s 2.2-million figure, according to county figures.

Communities’ mental health needs, as well as their legislative delegation’s clout, influenced the Legislature’s decision on how to divide the approximately 4,800 state beds--nearly half of which, Owen said, are devoted to criminally insane patients institutionalized by the state.

While pleased with Thursday’s development, county attorney Dutton emphasized that Levitt’s ruling was “only a first step toward equity” in the distribution of the state mental health hospital beds.

“All we’ve done is obtain the status quo,” Dutton said. “To get where we should be, we still need a lot more beds.”