Court Doubles County Beds for Mentally Ill : Health Care: Ruling calls for equalization of bed allocations among state’s counties over next three years.

San Diego won a court victory Friday that will more than double the number of hospital beds that the state must provide for the county’s poor, mentally ill residents.

Calling the existing system irrational and unconstitutional, San Diego Superior Court Judge Patricia Gamer ordered the state Department of Mental Health to equalize the bed allocations among all of California’s counties over the next three years.

“Often . . . in their zeal to administer programs, agencies lose sight of reality,” Gamer wrote in her decision. “The law requires agencies to make sense out of what they do.”

Gamer also ordered the state to repay counties that, since 1985, have been financially penalized when they exceeded their bed allocations. This amounts to about $3 million for San Diego County alone.

The ruling will mean better mental health care for the county’s residents, said Areta Crowell, director of mental health programs for the county.

“This will really help San Diego do a better job of treating the mentally ill in San Diego,” Crowell said. “It is recognition of the human plight and the need for the services.”

The county’s allocation of 71 state-hospital beds for the mentally ill will rise to about 190 under the judge’s ruling, Crowell said.

The county uses these beds for caring for people who need long-term confinement, freeing the 75 beds at its mental hospital on Rosecrans Street for people who need short-term hospitalization, she said.

But San Diego County also lost a significant issue in Friday’s ruling.

Gamer refused to rule unconstitutional the state’s existing system of allocating funds for community mental health programs. State funding is not equitable among counties, but the state is moving slowly and rationally toward equity, she said.

This part of her decision removed the threat of losing as much as $15 million a year for counties such as Los Angeles and San Francisco, two of the nine counties that intervened on the state’s side in the suit.

Together, the various pieces of Gamer’s decision provided a framework that pleased counties on both sides of the case and left the state Department of Mental Health as the only clear loser.

If the ruling stands, the department will have to come up with millions of dollars to repay the counties even as the state faces a $12.6-billion budget deficit.

Kassy Perry, assistant director of public affairs at the Department of Mental Health, said the agency would not comment on the decision or its potential effects until it had been studied more thoroughly.

One section that lawyers are puzzling over already is Gamer’s promise to review the state’s financial allocations to counties for mental health in June, 1992, to assure that progress toward equity has been achieved.

“That’s very novel. I’ve never seen that in my years of practice--where the defendant wins, but the judge says, ‘Maybe in the future the defendant may lose,’ ” said Stewart Foreman, attorney for San Francisco in the case. “I don’t know what it means.”

Still, county attorneys who took the state’s side in the case were pleased that Gamer left their clients’ budgets intact.

“If the judge had found the allocations unconstitutional, that could have put us at risk of losing $10 (million) to $15 million just in our county alone in state mental health funding,” San Francisco’s Foreman said. “So that’s a major victory for our community mental health program.”

“The judge understood that all the counties are suffering and tried to balance the hardships,” said Brenda Carlson, attorney for another intervenor, San Mateo County.

The counties that have more than their proportionate share of state hospital beds for the mentally ill will be able to handle cuts in allocations by decreasing the average length of hospital stays and putting more emphasis on community programs, Carlson said.

Other counties joining the state in the suit were Mendocino, Alameda, Contra Costa, Solano, Napa and Marin.

Counties that sided with San Diego in the suit, filed in 1986, were Tulare, Fresno, San Bernardino, Imperial, Stanislaus and Riverside.

An appeal of Gamer’s decision is likely, said Michael B. Poynor, deputy county counsel who handled San Diego’s case. Poynor said the state’s lawyer had said earlier that any ruling against the state would be appealed.

If that occurs, it could take several years for the case to be resolved and the changes the judge ordered to take effect.

The entire matter could become moot, added Crowell, after current budget negotiations in Sacramento are completed. The governor proposed turning mental health programs over to the counties with designated revenue sources. If this is done, it would eliminate population-based differences between counties.

Also, a state budget analyst has since recommended that state-hospital bed allocations be included in the program’s overhaul. This, too, could even out the inequities among counties.

The inequities San Diego and the other counties are challenging are an artifact of the state’s funding system for mental health over the last three decades.

When Proposition 13 took effect in 1978, counties that had liberally used state and federal grants for mental health had those funds considered as part of their base funding allocations. San Diego and smaller counties, which had refused such funds, didn’t. Similarly, counties that had liberally used state-hospital beds had their allocations grandfathered in.

The result has been, for instance, that, although the statewide average for allocations to counties is $26.45 per resident per year, San Diego receives only $19.38. But Los Angeles receives $28.86 and San Francisco $54.42.