St. John’s Cancels Pact for Treatment of Poor Mental Health Patients

St. John’s Hospital in Santa Monica has canceled a $1.7-million contract with the county to treat indigent mental health patients, after negotiations with the county broke down.

Dr. Thomas Ciesla, director of mental health services at St. John’s Hospital, said the contract, which covered as many as 900 poor patients last year, was canceled because the county’s proposal was financially unacceptable and would have risked lowering the hospital’s standards of care.

“It was a take-it-or-leave-it offer,” Ciesla said in explaining why the hospital canceled the contract.

Under the proposal, he said, the county wanted to refer patients for treatment without guaranteeing that additional funds or bed space would be made available if hospitalization was needed. The county also wanted more group and less individual therapy, Ciesla said.

Robert Quiroz, the county’s mental health director, said the county Department of Mental Health has been under pressure to close an estimated $18.2-million deficit in its $300,000 budget for the 1988-89 fiscal year. In addition to cutbacks at St. John’s, the county is considering closing up to 10 clinics and canceling contracts to reduce expenses, he said.

St. John’s decision to cancel its contract immediately affects about 500 county patients who are hospitalized or receiving treatment as outpatients.

Ciesla said patients will not be “turned out on the street, but we will make sure there is an easy transition to other facilities.”

He said the majority of patients, those in need of outpatient care, will be transferred to nearby mental health clinics, such as Santa Monica West and Didi Hirsch mental health clinics. Patients in need of overnight hospitalization will be transferred to other county hospitals. St. John’s had operated the only facility on the Westside to which the county referred seriously disturbed patients for overnight stays.

In the meantime, Ciesla said, St. John’s will continue to operate its 87-bed mental health center to treat private, paying patients.

Ciesla did not blame the county for the failure to reach an agreement. “The problem is more global; there is crisis in mental health care,” he said. “It is a catastrophe. There is a shortage of beds and a shortage of trained professionals. It is becoming increasingly more difficult to do business, because we are required to do more and more on fewer and fewer dollars.

“One problem is that psychiatric patients do not get the attention and do not enlist the sympathies from the public as other patients do. People with cancer or suffering from heart ailments are not treated like this. The public would be outraged if heart attack patients or those suffering from cancer had to endure (what mental patients must endure). It is a nightmare.”