Fines Levied on Hospital County Uses for Mentally Ill

A Bakersfield hospital where Ventura County confines 30 severely ill mental patients has been assessed fines of $38,000 for alleged violations ranging from sexual abuse to negligent treatment of infected sores.

The state Department of Health Services office of licensing and certification has cited Crestwood Manor four times since February, including twice for “very severe” violations issued only when there is “substantial probability that death or substantial physical harm would come to the patient,” according to Bill Murray, a Department of Health Services district administrator. The most recent citation occurred last week.

“It’s really scary,” said Nancy Nazario, Ventura County’s advocate for mentally ill patients’ rights. “We don’t have a lot of places to put people.”

Wrongdoing Denied

A Crestwood spokesman denied any wrongdoing or negligence on the part of his company, which owns or operates 19 mental-health and geriatric homes between Eureka and Sylmar.

Crestwood, a skilled-nursing hospital, is owned by Stockton-based Crestwood Hospitals Inc. and contracts with the counties of Ventura, Santa Barbara, Kern and Tulare to provide care for up to 109 long-term patients. All the patients are on one-year court-ordered confinements and were sent to Crestwood, a locked facility similar to units at Camarillo State Hospital, because of crowding and insufficient beds at local hospitals.

Mental-health officials this week expressed concern that Crestwood failed to provide patients with extra treatment for which the counties paid $18.60 per day. In most cases, Medicare and Medi-Cal pay for minimum room-and-board care, but many Crestwood patients require additional treatment such as occupational therapy.

“We went in and checked it out . . . in our initial six-month survey . . . and couldn’t see that these programs were being carried out,” said Day Altair, the advocate for patients’ rights at Kern County’s Mental Health Department. Altair estimates that Kern County paid $10,000 per month to Crestwood for the extra treatments.

‘Audit the Books’

Bruce Yarwood, Crestwood’s vice president of operations, suggested that the counties “audit the books” to see for themselves about the augmented care. “In every case, there are two sides to the story,” he said.

Yarwood said he disagrees with the state’s findings of serious violations. He said he plans to contest a $30,000 fine assessed Aug. 24 that stemmed from an incident in which a 27-year-old Crestwood patient was hit and critically injured by a train after he was mistakenly allowed to leave the hospital grounds.

Crestwood did not contest three other fines that totaled $8,000 because “we’re better off paying it and moving on” than fighting the charges in court, Yarwood said.

Many mental-health advocates--including the Ventura County deputy public defender who argues conservatorship cases for the mentally ill--said they were unaware that violations had occurred at Crestwood.

But the news comes as no surprise to Christine Buck of Ojai, who moved her organically brain-damaged daughter from Crestwood last April.

“My daughter became very ill when she was there. She had running sores all over her body, and she lost 35 pounds in three months. It was horrible, absolutely horrible,” Buck said.

The fines levied by the state Department of Health Services stemmed from:

A March 15 department report that a patient--the same one who was later hit by the train--complained that the male nursing supervisor took him home on two occasions and engaged him in sexual activity, including sodomy.

(Crestwood officials said the nursing supervisor, who resigned after the allegations were made public, was a “good employee” who previously held the position of assistant head nurse at a Crestwood hospital in Sacramento. The Bakersfield police conducted an investigation, but no charges were filed).

A March 15 report that Crestwood’s medical staff failed to document or treat lesions on a patient’s foot for an entire month, which caused drainage of the infected area as well as cracking and bleeding of the skin.

Two June 13 reports that cited Crestwood for numerous violations of patients’ rights. The violations allegedly occurred when all patients were forcibly treated with anti-lice medication without first obtaining written permission, as required by law. The Department of Health Services found that many patients lost possessions, including clothes, personal papers, small amounts of money and, in one case, a set of dentures.

None of the counties say they plan to pull their patients out. On the contrary, mental-health administrators in local counties expressed support for Crestwood’s new hospital director and program director, who were hired in the wake of the recent violations and who say they are upgrading the facility, staff and programs.

“It’s not the greatest situation in the world, but the reality is we don’t have a facility that will do that here, and we’ve been all over to look for a place that has beds,” said William Wakelee, Ventura County’s chief of mental-health-program services.

The county also houses about 35 long-term, severely mentally ill patients at Camarillo State Hospital.

Wakelee’s comments about the paucity of local beds were echoed by mental-health administrators in Kern and Santa Barbara counties.

Concern over the well-being of patients and the quality of care at Crestwood--which has had three administrators in the past year--has prompted mental-health officials from the four counties to meet with Crestwood’s administrators.

One such meeting is scheduled for today. Wakelee said he plans to ask Crestwood officials for assurance that the hospital has boosted the number of staff members trained in psychiatric care and that it is offering patients the extra programs for which the county is paying.

Robert Sauter, Santa Barbara County’s advocate for patients’ rights, added: “We’d like to know more specifically what their plans are and have some way of monitoring them. They did not have programs in place that we’ve been paying for for one to two years.”

Most mental-health advocates agree that a better long-term solution is to build an acute-care mental-health hospital in Ventura County. They say it is inhumane to ship Ventura County residents far from their families to another county, where monitoring medical and psychiatric care is difficult. Ventura residents who want to visit family members at Crestwood face a 123-mile drive each way.

Those family members, as well as mental-health administrators, praise a bill sponsored by state Assemblyman Tom McClintock (R-Thousand Oaks) that awaits Gov. George Deukmejian’s signature. It would authorize Ventura County to contract with a developer to build a 100-bed hospital for acutely ill mental patients on an 11-acre site on Lewis Road at Camarillo State Hospital.

“There is absolutely a need for this in Ventura County,” said Lou Matthews, the founding president of the Alliance for the Mentally Ill, a countywide advocacy group. “If you had more beds, I don’t think you would have had the suicide of Mary Montgomery,” she added, referring to the 54-year-old woman who jumped out of a Ventura hotel one hour after she visited a mental-health clinic and complained she felt lonely.

Ventura and San Luis Obispo county officials are also helping plan the construction of a 90-bed locked hospital on land owned by Santa Barbara County. The hospital would accept patients from the tri-county area.