Patient’s Release Leads Judge to Attack Mental Health System

A San Diego County Superior Court judge, outraged that a man whom she sent to San Diego Psychiatric Hospital for treatment last week was released the same day, on Monday decried what she called a crisis in the county’s mental health system and vowed to press for improvements.

Judge Laura P. Hammes said the release of Randall Gonzalez, a 23-year-old Poway man whose family says he is schizophrenic and sometimes violent, has convinced her that county mental health officials are “no longer making proper medical decisions. They are making political decisions based on who is the worst of the worst.”

“This is a crisis of monumental proportions for the county,” Hammes said, noting that doctors at San Diego Psychiatric Hospital on Friday gave Gonzalez two bus tokens and a shot of Haldol, an anti-schizophrenic drug, then released him. “We are turning out people who are a danger to others and to themselves. We must get ahold of the situation.”

Hammes’ comments came as the San Diego County Board of Supervisors prepared to reconsider a planned $4.7-million budget cutback that could mean closing most of the 109 beds at the 2-year-old mental hospital and laying off or transferring dozens of workers.

Last month, the board postponed its approval of the proposed budget in hopes of finding other budget-balancing options that would not curtail vital mental health programs. Today, the board is scheduled to take up the issue again.

At a hearing Monday afternoon to decide Gonzalez’s fate, Hammes said she was aware of the board’s impending budget decision. As far as she was concerned, she said, Gonzalez’s case showed that San Diego Psychiatric Hospital’s resources are already stretched too thin.

“Their medical decisions now have to be made not on what is medically appropriate but on what beds are available. That concerns me,” she said. “I will do what I can to get to the board.”

Patrick Stalnaker, a spokesman for county mental health services, said rules about patient confidentiality prevented him from commenting on any particular case. But, he said, if a person was evaluated but not admitted, county doctors must not have found evidence of acute mental illness.

“If someone is screened and is not put into a hospital, then (the doctors) don’t believe they’re acutely psychotic. That’s the bottom line,” Stalnaker said. “We honest to God don’t judge people on whether or not A) we don’t want them or B) there’s politics involved. Those doctors look at every individual and judge. If they’re acutely psychotic, we bend over backwards to get them the care that they need.”

Stalnaker conceded, however, that the hospital is feeling the crunch. With only 75 beds set aside for acute care, he said, the hospital must invariably practice “triage,” turning away those who have more coping skills in order to hold the most seriously ill.

According to Linda Brown, a county public defender who represented Gonzalez in a recent criminal matter, Gonzalez is a victim of budgetary pressures.

“This kid was shoved through the cracks because nobody wants to pay for him,” she said, adding that county doctors “just don’t want the county to foot the bill for what the state should have to do, so they’re lying and saying he’s OK and putting him on the streets.”

According to Gonzalez’s family, he was first diagnosed as schizophrenic when he was 14. Beverly Fraser, Gonzalez’s mother, said she knew something was wrong when her son put his fist through a car window. He later said voices had told him to do it.

In recent years, Fraser said, her son has insisted that he is God. He has also lashed out at Fraser and her husband, Richard, his stepfather. On one occasion, she said, Gonzalez pushed Richard Fraser to the ground and kicked him in the head repeatedly.

In August, 1990, Gonzalez was arrested in the burglary of a neighbor’s home, Fraser said. Last week, the district attorney agreed to have the burglary charge reduced to a misdemeanor and the probation waived on the condition that Gonzalez would be committed to a state mental hospital.

So last Thursday, when a court forensics doctor found Gonzalez to be gravely mentally disabled and dangerous, Hammes ordered that he be committed to Patton State Hospital in San Bernardino.

After no space could immediately be found for him there or at Metropolitan State Hospital in Norwalk, Hammes ordered that Gonzalez be sent to San Diego Psychiatric Hospital. But, Friday morning, Hammes said, county doctors re-evaluated Gonzalez, judged him to be healthy and sent him on his way.

Gonzalez’s mother said that when he showed up at her home Friday night, she called the sheriff and two deputies took him away. The next morning, however, Gonzalez was back, pacing around the back yard and saying he was God. Sheriff’s deputies were summoned again, and this time Gonzalez was taken back to San Diego Psychiatric for another evaluation.

Sometime after the deputies left, Gonzalez walked away without being evaluated, Brown said. And, by 9 p.m. Saturday evening, he was back at his parents’ home. This time after the authorities were called and Gonzalez was picked up, Hammes ordered that Gonzalez be held at San Diego Psychiatric Hospital pending Monday’s hearing.

Determined to avoid a “rerun” of those events this week, Hammes on Monday telephoned Dr. David McWhorter, the hospital’s medical director, and received an assurance, she said, that Gonzalez will be kept at the mental hospital for as long as he exhibits signs of acute mental illness.

But, if Gonzalez appears normal, he will be released, Hammes said McWhorter told her. The doctor promised the judge that this time, however, she will be notified before Gonzalez is set free. And, in the meantime, county conservators will hurry to try to find a place for Gonzalez in a state institution.

Gonzalez’s parents said they were pleased.

“So many times we’ve been to court, and they just release him,” Richard Fraser said, his voice shaking as he took off his glasses to wipe away tears.

“There’s times we’ve been afraid of him,” said his wife.