Rash of Suicides Rocks Veterans Psychiatric Unit

Four patients have committed suicide in 13 months in the psychiatric unit of the Veterans Affairs Medical Center in Long Beach and a fifth shot himself to death after he was granted an early release, a suicide rate that experts said is unusually high.

The unit’s 30-bed locked ward, where some of the most unstable patients are held and where two of the deaths occurred, was ordered temporarily shut down Friday by hospital administrators who cited a shortage of skilled psychiatric nurses.

Although hospital officials said the closure was unrelated to the deaths, they said they will concentrate on recruiting new nurses and retraining those on staff until the unit reopens July 1.

Several psychiatric experts said suicides in a hospital setting are rare, particularly in a locked ward, where suicidal, homicidal, violent and gravely disabled patients are supposed to be kept under constant or near-constant observation.

“Most patients do not commit suicide when they are in the hospital. That’s one of the reasons you put them there, to prevent it,” said Dr. R. W. Burgoyne, medical director of the Los Angeles County Department of Mental Health. “To have that many suicides clustered is an unusual chain of events. It does happen, but when one does have a series, one is really obliged to look and see what’s going on.”

The medical inspector at the Department of Veterans Affairs in Washington--where all VA hospital suicides and attempts must be reported--said no investigation is planned. The state and county have no jurisdiction over veterans hospitals.

“The volume at that hospital is fairly heavy and they don’t consider those figures high, considering the workload,” said spokeswoman Donna St. John.

The 75-bed psychiatric unit, which includes the locked ward, is the second-largest of five veterans facilities in Southern California. The psychiatric ward, which like the 1,368-bed veteran’s hospital is affiliated with the UC Irvine Medical Center, treated 35,450 patients last year.

But several of the hospital’s psychiatric nurses who spoke on the condition of anonymity said the unit is in turmoil. They said suicidal patients are not kept safe, patients have been released without full psychiatric evaluation and patients considered dangerous to themselves or others escape an average of once a month.

“Nobody should ever die from suicide on a locked psychiatric unit. When they are turned over to us, we are to keep them safe,” a psychiatric nurse at the hospital said. “They are our responsibility as much as if they were 6 months old.”

“I felt it was the responsibility of the military to help him,” said Millie Carota of Santa Ana, whose husband was one of the five who died. “He needed help. At the very least, they should have kept him from killing himself.”

Coroner’s records, city health department files and interviews with patients’ families and hospital staff members detail the circumstances of the five suicides between March, 1989, and this past April:

John Carota, a 66-year-old World War II veteran diagnosed as suicidal, was brought to the VA hospital for outpatient treatment March 22, 1989, and put on “constant watch” status, according to hospital records and nurses. The hospital staff lost track of him for 15 minutes and he jumped off the roof, plunging three flights to his death, records show.

Michael P. Dowling, 41, was housed in the hospital’s open psychiatric ward, which is monitored less rigorously than the locked ward. He had not been assessed as suicidal, nurses said, when he hanged himself on the ward April 6, 1989. He suffered extensive brain damage and died nine months later from complications that the death certificate linked to “suicide attempt by hanging.”

William J. Merzenick, 31, depressed over the breakup of his marriage, was taken to the VA emergency room for suicidal behavior July 13, according to nurses and the Riverside County coroner’s office. He was put on a three-day hold but released as safe before the hold expired, two nurses said. His landlord found him a few days later on the bed of his Desert Hot Springs home. Merzenick had shot himself in the head with a 12-gauge shotgun, the coroner’s office said. A suicide note was written on the back of a photograph of his wife. The coroner’s report said Merzenick was upset because he had been refused admission for treatment at a VA hospital.

Richard A. Silas, 39, was housed in the hospital’s locked psychiatric ward the afternoon of Dec. 9, 1989, when nurses were securing patient rooms to cloister them in a day room where they could be watched. Silas was locked inside his room rather than outside, several nurses said. He hanged himself with his bed sheets in the bathroom, according to Los Angeles County coroner’s records.

Geraldo Cruz, a 27-year-old active-duty sailor, had twice tried to kill himself before he was admitted to the Long Beach VA hospital last month, his family said. He was seeing demons and hallucinating when he was put in the hospital’s locked ward, according to his uncle, Jose Simon. On April 17, Cruz was found in the bathroom of his hospital room, hanging by the laces of his combat boots. Several nurses at the hospital said the boots and the laces should be taken from a patient with a history of suicidal behavior.

Comparisons with other veterans hospitals with similar patient loads show a remarkably lower incidence of suicide during the same time period: One suicide was reported at a Brooklyn, N.Y., facility and none was reported at hospitals in Gainesville, Fla., and Minneapolis.

All five state-run mental hospitals in California recorded only three patient suicides in 1987 and two in 1988, officials at the state Department of Health Services said.

However, VA spokeswoman St. John disputed such comparisons as unfair. “You need to know the circumstances surrounding each case,” she said. “Just looking at the numbers is not an indicator of a problem.”

Dean R. Stordahl, the Long Beach hospital’s director, said in a written statement that patient care is a high priority at the hospital. He attributed the unit’s closure to a lack of skilled psychiatric nurses brought on by a nursing shortage in Southern California, a 13% turnover in his psychiatric nursing staff and a need to paint and upgrade the ward.

“Based on an assessment of recent staff turnover, an insufficient number of staff at the appropriate skill level and the need for upgrading the physical plant, it was decided that (the locked ward will) be closed temporarily,” Stordahl said. “(Because) qualified psychiatric nurses are difficult to recruit . . . management has opted for an intensive educational effort of staff,” he said.

Stordahl acknowledged there have been four suicides in the hospital and seven escapes from the locked ward since the beginning of 1989. But he would not discuss the circumstances or answer questions about the patient who killed himself in his home after allegedly being refused treatment.

Stordahl said the hospital abides by criteria established by the Joint Commission on the Accreditation of Health Care Organizations.

But the commission, a private nonprofit accrediting body that inspects 1,800 hospitals nationwide, put the Long Beach VA Hospital on probationary status in February and gave the administration six months to come into compliance with the commission’s regulations, spokeswoman Pamela Schumacher said.

Hospital spokesman Gabriel Perez said none of the commission’s concerns dealt with the psychiatric unit, and the commission said it does not make public its findings.

The locked ward stopped admitting new patients last week and closed at 4 p.m. Friday. Five remaining patients were transferred elsewhere.

Of 30,000 suicides reported each year in the United States, only 1% occur in psychiatric units, said Dr. Robert Litman, clinical professor of psychiatry at UCLA and co-founder of the Suicide Prevention Center of Los Angeles, where he was chief psychiatrist for 30 years.

“That’s a lot, that’s an awful lot,” Sam Heilig, a clinical social worker specializing in suicides and the former executive director of the Suicide Prevention Center in Los Angeles, said of the number of suicides at the Long Beach facility. “An untoward number of suicides in a hospital or institution reflects something is going on with the institution. It’s troubled.”

Meanwhile, family members struggle with the losses.

“How could it be possible for anyone to be in the bathroom as long as it takes to kill yourself and not be noticed?” said Jose Simon, who traveled from the Philippines to help Cruz, his nephew, and escorted him home in a coffin. “He was neglected. There was a change in shift at 2:30 p.m. and at 2:30 p.m. they forgot about Jerry.”

Millie Carota, 69, who was married to John Carota for 44 years, has filed a claim with the VA over her husband’s death, the first step toward a lawsuit, said attorney M. Teresa Peel.

Carota said her husband never recovered from combat duty as a World War II Marine who picked up a Japanese helmet in the field and inadvertently put his hands in brain matter. “He never felt he could get his hands clean,” she said.

Carota’s death came only three months after he suffered a mental breakdown and was wheeled into the Long Beach VA emergency room on a gurney, his widow said. She said she waited three hours to see him, only to discover he had walked out of the hospital without the staff noticing. Long Beach police found him around midnight in a downtown coffee shop, she said.

The next time they lost track of him, she said, her husband leaped to his death.