Judge Considers Ordering State to Treat Mental Patient

A San Diego County Superior Court judge, concerned that severely mentally ill San Diegans often wait months for a place in state hospitals, sought Monday to order the state’s top mental health official to treat a 23-year-old Poway man or face a contempt citation.

At an unusual hearing punctuated by outbursts from the patient whose future was at stake, Judge Laura P. Hammes asked county counsel to prepare legal papers ordering the state director of mental health to begin treating one--and possibly dozens--of area patients within 30 days.

Hammes said the papers, which she will consider signing later this month, also should specify that, if the director, Dr. William (Bud) Mayer, does not comply with her order, he should be required to “show why (he) should not be held in contempt of court.”

“This is definitely a crisis,” said Hammes, whose action was prompted by the case of Randall Gonzalez, a schizophrenic man who believes he is God. Hammes lamented that Gonzalez is in a “holding pattern” at the San Diego County Psychiatric Hospital as he waits for a bed in a locked, state facility. “We’re at a spot now where we cannot allow this to go on.”

Hammes’ action came one day before the County Board of Supervisors is scheduled to consider final approval of a budget that would close all but 30 of the county psychiatric hospital’s 75 acute-care beds. Already, hospital officials say, dozens of those beds are occupied by chronic patients like Gonzalez who are awaiting placement in state facilities.

“We have no places for new patients,” Hammes said. “For a population of 2.5 million people, to have only 30 (county hospital) beds is absolutely insane. We must have more beds.”

In addition, Hammes noted that despite continuing litigation to make allocation more equitable, there are relatively few state hospital beds reserved for San Diego County patients--a total of 71, or fewer than three per 100,000 population. Los Angeles County, by contrast, has access to 1,080 beds, or 12 per 100,000 residents.

In July, county mental health officials formally requested an additional 35 beds in state facilities--or a total of 106. Last week, they received a letter from Mayer, the state director, denying the request.

As a result, mental health officials told Hammes on Monday, dozens of chronically ill patients are occupying precious space at the county psychiatric hospital--sleeping in beds that are meant for short-term patients in crisis.

“At the present time, from my caseload, we have patients who have been waiting as long as a year and a half to two years” for a state hospital bed, said Kenneth Naysmith, a psychologist at the county hospital. For Gonzalez to be placed more promptly, Naysmith said, “something exceptional would have to be done.”

During the hearing, Gonzalez shifted awkwardly in his leather ankle and wrist restraints. More than once he giggled aloud, and, when he spoke, his speech was slurred--a side effect of the anti-schizophrenic medication he is taking.

“You know what the punishment is for that? It’s called damnation,” he had announced just before the hearing began. It was not immediately clear to whom he was talking. “Purgatory. Hell. Not good hell, bad hell.”

“I’ll say this,” he continued. “You’ll die in hell. Whether it looks like hell or not. You’ll die in hell. I agree. I agree.”

Deputy County Counsel Susan B. Ramsay said she will draft the order Hammes requested by Sept. 30. At Hammes’ suggestion, she will consider asking Mayer to begin treating not just Gonzalez, but more than 20 other county patients as well who await state hospital beds.

“They all should be going. That’s the whole problem,” Ramsay said. “We don’t have any teeth. We can’t force state hospitals to take them.”

Meanwhile, one county official said he had very little hope that Hammes’ order would get results.

“You know where she’s going to get?” said Patrick Stalnaker, a spokesman for county mental health services. “She’ll probably get as far as we have, which is nowhere.”

Lauren Wonder, a spokesman for the state Department of Mental Health, said Mayer and his legal advisers would have no comment until they have received Hammes’ order.

Gonzalez’s case made headlines last week after Hammes found him to be gravely disabled and ordered him 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 sent Gonzalez to San Diego County Psychiatric Hospital for treatment.

Hammes was outraged to find that, a few hours later, Gonzalez received two bus tokens and a shot of the anti-schizophrenic drug Haldol and was released. Eventually, after Gonzalez threatened his parents and was repeatedly picked up by sheriff’s deputies, Hammes again ordered the county hospital to hold him.

But at a hearing last week, Hammes said county mental health officials had told her they could not continue to hold Gonzalez if he stopped exhibiting acute symptoms of mental illness. For the time being, he continues to be held at the county hospital, where administrators have promised to alert Hammes if they decide to release him again.

On Monday, Gonzalez’s mother, Beverly Fraser, sat in the courtroom and waved at her son. She continues to hope that a state bed will be found for him, she said. But for now, she is grateful for even the temporary care he is receiving at the county hospital.

“I know he’s safe,” she said.