Hospital Shackled Mentally Ill Man for 6 Days : Health Care: Psychiatrist wouldn’t admit patient, so he was restrained in Palomar Medical Center’s emergency room until health advocate intervened.

A 39-year-old mentally ill man was shackled on an emergency room gurney for most of six days last month at Palomar Medical Center, because the attending psychiatrist wouldn’t authorize his admission to a psychiatric bed at the hospital, the county’s patient advocate for the mentally ill said Friday.

It was only after the patient advocate appealed to county mental health and state licensing officials on Oct. 16 and 17 that the man was placed in an appropriate medical environment.

“I couldn’t believe this, and I was very fearful for him,” said patient advocate Richard Danford. “I’ve worked in mental health for 13 years and this guy just looked terrible. He was in real bad shape, and I wanted something to be done about it.”

Yet, if it hadn’t been for a state law requiring a legal hearing for any mental patient held involuntarily beyond 72 hours, Danford might not have learned about the man’s plight at all, he said.

He reported the situation to the state attorney general’s office as suspected abuse of a dependent adult, and state health care licensing officials were also called in.

The San Diego inspector, Eleanor Bray, found Palomar to be in violation of state codes requiring that involuntary mental patients be kept in the least restrictive, and most therapeutically beneficial, environment.

The man’s hands and feet were kept bound in leather restraints without the psychiatrist’s written authorization, Bray found. “There is no documentation in the emergency room record that alternative methods were considered,” her inspection report said.

He was walked to the bathroom only five times over six days, his medical record indicated. The “may have contributed to the subsequent development of a pseudoileus,” Bray reported.

A pseudoileus is a form of severe constipation. Psychiatric medication can also cause the condition.

The man, who had been previously hospitalized at Palomar for paranoid schizophrenia, was brought to the hospital by police about 3 a.m. Oct. 11 because he allegedly had threatened his father with a knife.

A psychiatrist on Palomar’s staff declined to authorize the man’s admission to the hospital, however, because he “was too potentially dangerous and they had a sensitive milieu” in the psychiatric unit, Danford said he was told later at a hearing.

Danford said he learned elsewhere that another “justification for not admitting him to Palomar was that this guy abused the system.” He had been hospitalized at Palomar for schizophrenia at least twice before.

The doctor’s refusal to admit the man stuck the emergency room with him. He had already been legally determined to be dangerous to himself or others, a step that authorizes involuntary detention for up to 72 hours, so he could not be released under state law.

“Here they had assessed this guy, put him on hold and then one of their own doctors refuses to admit him,” Danford said.

After the 72-hour hold expired, the hospital again certified the man for another 14-day involuntary detention, but he still was left in the emergency room.

The Palomar psychiatrist wanted the man taken to the county’s adult mental health hospital on Rosecrans Street, Danford said. However, the man was eligible for Medi-Cal coverage. This put him at the bottom of the list for getting into the overburdened county hospital, since its 62 beds are reserved for people who have no coverage at all.

After Danford entered the case on Oct. 16, he asked county hospital officials to admit him for humanitarian reasons. They did so after first returning the man to Palomar for medical treatment for the suspected pseudoileus.

“He’s (at the county hospital) now,” Danford said. “He’s walking around and he’s not in restraints and he’s doing OK.”

Palomar officials would not comment on the case, except to say that they had no evidence the patient was ever in a life-threatening situation. Communications director Alain Jourdier denied that Palomar has the facilities to treat dangerous patients.

But the state inspection report notes that “a seclusion room was available on the facility’s psychiatric unit.”

At the time of the incident, Palomar had specific certification from the county as a facility authorized to take involuntary mentally ill people brought there by police, said county mental health spokesman Patrick Stalnaker.

Since last month’s incident, Palomar has asked to have the designation removed, Stalnaker said.

Danford said the incident at Palomar puzzled him, since the hospital’s psychiatric unit is known as one of the better facilities in the whole county.”

It was the doctor’s adamant refusal to admit the man to a psychiatric facility that had plenty of room for him that was the problem, he said.

“The emergency room staff and the mental health staff expressed to me a good deal of frustration about the quality of care this man got,” Danford said.

The state inspection report noted that an inspection at Palomar last March had also found that its emergency room had no policies to ensure that mentally ill patients would not be held there beyond 24 hours.