Deep budget cuts at Orange County’s biggest psychiatric hospital ravaged patient care, resulting in one unattended patient’s death from a drug overdose, an attempted suicide and a homosexual gang rape of a teen-ager, two former top administrators have charged in lawsuits.
The suits--which also accuse Brea Hospital Neuropsychiatric Center and its corporate parent, Comprehensive Care Corp., of financial improprieties--charge that the hospital has put profits ahead of patient care, an allegation echoed by some leading Orange County psychiatrists.
Charges of poor care and short staffing have dogged two other health facilities owned by CompCare, as the Irvine-based firm is known. The company’s heavily advertised CareUnit centers make it the nation’s biggest operator of hospital-based drug and alcohol treatment programs.
Hospital Cited Twice
State health officials were unaware of the charges leveled at Brea and of the incidents described in the lawsuits, although they say hospitals are required by state regulations to report such extraordinary events. Twice before, the state has cited Brea for failing to make required notifications.
Executives of CompCare deny all the charges and say Brea prides itself on the quality of its care. The hospital, which is licensed and accredited, has been subject to fewer formal complaints to state health officials than some other psychiatric hospitals in Orange County.
Nonetheless, the 142-bed hospital’s reputation remains clouded in Orange County’s psychiatric community.
The Orange County Psychiatric Society said it has received written and oral complaints from patients, families and doctors about Brea. The critics say that patients are kept at Brea for as long as their insurance coverage lasts, that psychiatrists at the hospital play too small a role in patient care and that many patients are overbilled, according to the society’s president, Dr. Irwin I. Rosenfeld.
Members of the society have been concerned “that care might not be up to snuff or might not be meeting ethical standards” at Brea, said Rosenfeld, a Laguna Hills psychiatrist.
CompCare Executive Vice President James P. Carmany, who is in charge of the firm’s hospitals, termed the complaints baseless. Psychiatrists’ criticisms of Brea, he said, may stem from the fact that the hospital was one of the first in Southern California to allow non-physicians--psychologists, counselors and social workers--to play a major role in patient care.
Psychiatrists who practice at Brea say the criticisms are unduly harsh.
“I’ve always had a concern about how corporations in general run things, but I haven’t seen it be real abusive” at Brea Hospital, said Dr. Robert M. Morelli, public relations chairman of the psychiatric society. “The staff is very personable, very good at working with people.”
The suits, filed during the last two years by the hospital’s former acting administrator and its former fiscal director who also contend that they were wrongfully fired, say the alleged problems at Brea stemmed from staff cuts that more than doubled the ratio of patients to staff and from pressure to increase revenues early in 1986, the outset of a three-year business downturn for CompCare.
Reports filed by Brea with the American Hospital Assn. confirm that staff levels were cut, though not as deeply as the suits allege. Between 1983 and 1986, the reports say, the hospital reduced its nursing staff by about 12%, from 51 nurses on an average payroll to 45.
Other medical facilities in Orange County were reducing their staffs at about the same time, but doctors said the cuts at Brea were greater.
In an interview at the hospital, a low-slung array of beige buildings with red Spanish tiled roofs that sits below Brea Canyon, Carmany acknowledged that CompCare had asked its administrators to find ways to cut expenses in 1986.
But he insisted that patient care was not compromised, then or since, by staff reductions.
“We did not, to my knowledge, do anything that would have endangered patients and staff,” Carmany said.
Carmany said the national nursing shortage has prompted CompCare to employ non-licensed personnel in some patient care functions. And he admitted that Brea, like many Southland hospitals, has an ongoing problem maintaining the numbers of registered nurses required by state law.
He said that two areas of care have suffered as a result: patients sometimes get the wrong drugs and the documentation of treatment at times is inadequate.
“We have a problem with RNs, but every hospital in Southern California does,” Carmany said. “But we have never shorted (staff) in that area.”
Yet a suit filed in Orange County Superior Court two years ago by Nancy Dear, Brea’s former top fiscal officer, charges that “massive budget cuts” in early 1986 resulted in staff reductions that “created a dangerous environment for patients and staff,” especially in units where patients required the most intensive care.
According to the lawsuit, inadequate staffing levels led to a series of dangerous--in one case deadly--episodes:
- In violation of hospital policy, a heroin addict who had overdosed during previous stays at Brea was kept in an open unit and allowed out on a pass, with $270 from his personal account. Shortly after his return, he was found dead; there were balloons containing heroin in the toilet in his room.
Based on a review of hospital records, Carmany said “the incident doesn’t come together the way (Dear) describes it.” It would have been the decision of the patient’s physician, not the hospital, to release him on a pass, he added.
- A teen-age boy, housed in a unit of the hospital next to adult patients’ rooms, “was brutally raped by a gang of adult male patients.”
Despite a search of hospital records, Carmany said, “I can’t find anything to substantiate that anything like that occurred.”
- A patient whose doctor had ordered her monitored one-on-one escaped from the hospital’s locked unit and was found alive at a nearby gas station after having slashed her wrists.
Carmany said hospital records of the incident said the woman was on an open unit, not under lock-and-key, and was not receiving one-on-one monitoring.
- In a unit through which teen-age patients would pass to reach the hospital lobby, Dear “personally observed patients having sexual intercourse while other patients stood guard.”
Carmany’s response was that he could find no record of Dear reporting the event.
- Teen-age patients left the hospital unsupervised to drink alcoholic beverages. The suit says Dear also told top hospital administrators of reports that patients were buying and selling drugs.
Although such problems are common in psychiatric hospitals and substance abuse treatment centers, Carmany denied they were an issue at Brea. “If in fact we were improperly staffed, that could be true,” he said. “But we weren’t improperly staffed.”
None of the incidents described in Dear’s lawsuit--including the overdose death and suicide attempt acknowledged by Carmany--was brought to the attention of the California Department of Health Services, according to Jacqueline Lincer, district administrator of the department’s licensing and certification division in Santa Ana.
State health regulations require such “unusual occurrences” to be reported so that the state can order hospitals to correct any lapses they indicate in patient care.
“Especially in a case where a patient suffers harm--like a rape, or an overdose, or a patient elopes from a secure unit--then we’re going to want to know that, because there’s something wrong,” she said.
Division records show that Brea Hospital was cited in 1984 and again in 1985 for failing to report other unusual incidents. After the 1985 incident, administrators pledged to report all future occurrences, inspection reports say.
Carmany said he was unaware of the earlier citations and had not known that later episodes went unreported.
Illegal Practices Alleged
A second suit, filed last June by James Powell, Brea’s former acting administrator and assistant administrator, repeats most of Dear’s charges and adds allegations that Brea and CompCare engaged in illegal and unethical business and medical practices:
- From 1977 to 1983, the suit alleges, Brea paid psychologists and other professionals a $25 fee for every day their patients stayed at the hospital. The suit alleges that Carmany and hospital officials decided to resume the practice in mid-1987 and asked Powell to offer the arrangement to practitioners.
Thomas O’Connor, executive director of the California Psychology Examining Board, said acceptance of such payments would constitute a violation of state law prohibiting kickbacks to medical practitioners.
“The problem with paying a fee for referral is what’s first at hand--the welfare of the patient or the payment of referral fees?” he explained.
Carmany insisted that such fees never were paid. Louis H. Regal, president of the Orange County Psychological Assn., said leaders of his organization had no knowledge of such payments.
- Members of the hospital’s Patient Evaluation Team, which fielded emergency calls from the public and examined patients in the emergency rooms of general hospitals, “were instructed to routinely attempt to convince such persons to admit themselves to a CompCare facility, whether or not they reasonably needed such in-patient treatment,” the lawsuit charges.
Team members, it alleges, also were under orders to take steps to involuntarily commit reluctant patients for 72-hour legal “holds” in CompCare facilities.
According to Carmany, no such directives ever were issued to the team, which has since been reorganized and separated from Brea. Moreover, he said, Powell’s charge ignores the fact that a blanket policy of seeking admissions would bring many people into the hospital who were incapable of paying for their care.
“If they don’t need to be here, we need to be certain of that, because it doesn’t make good sense to put people to bed who don’t need it--both economically for us, because they’re not going to pay, as well as from a service angle,” Carmany said. “You don’t keep your business if you’re doing that.”
Two other CompCare facilities have been sharply criticized by government regulators for shortcomings in staffing and patient care.
Medicaid Payments Halted
The federal government halted Medicare and Medicaid payments to the CareUnit Hospital of St. Louis for several months in 1986 and 1987 after an investigation found that the hospital failed to have registered nurses working on all shifts, that patient care was not properly charted and that some patients did not have personalized treatment plans.
Also in 1986, an investigation of the CareUnit of Jacksonville Beach, Fla., by the Defense Department’s civilian medical program, found “routine use” of drug treatments “without medical necessity” and no justification for the treatment of 25% of the patients in a substance abuse detoxification program, according to a report obtained by The Times through the federal Freedom of Information Act.
Staff members told the investigators that the substance abuse treatment center “was operating on ‘bare bones’ staffing patterns in some of its areas,” the report said.
“The quality of care is mixed,” the investigators concluded, “with some areas of competence and others where there is immediate danger to patient safety.”