Attack Reflects Rising Crisis in Psychiatric Care

Just hours after the financially strapped San Diego County Psychiatric Hospital stopped admitting patients this week, a former patient, apparently determined to continue his treatment, scrambled over a 20-foot hospital wall, attacked two male nurses with a pipe and pleaded with hospital staff members to let him in, authorities confirmed Thursday.

“He said, ‘I want to go to the hospital. Don’t send me to jail.’ He was mumbling and saying Jesus Christ made him do what he did,” said one hospital employee who said he helped restrain the man Wednesday night. “It was his way of getting in. He was extremely disappointed when we said we would not admit him.”

Police said John David Mallen, 22, leaped from the wall into a hospital recreation yard at about 6:30 p.m. Wednesday and began hitting Natoa Dorn, a nurse, with a large metal pipe. Another nurse, Abel Barrios, helped Dorn restrain Mallen, who was later arrested and jailed on suspicion of battery and burglary. Neither man was seriously hurt.

On Thursday, Mallen was under psychiatric observation at the downtown County Jail.

According to another hospital employee, who asked that her name not be used for fear of reprisals from hospital management, Mallen had been discharged from the hospital six weeks ago after three months of treatment. During the last week, the source said, Mallen had tried to re-enter the hospital through a back door, but had been told to go to the voluntary treatment entrance. He apparently never went, the source said.

“He was told, ‘You have to come around and have to be reassessed. But, since you were recently discharged, it’s unlikely you’re going to be admitted,’ ” she said. “He went and decided a lead pipe would be the answer.”

The alleged break-in came one day after the County Board of Supervisors voted to cut $3.7 million from the hospital’s budget, thus halting the admission of any new patients to the facility. If Mallen had sought voluntary treatment at the hospital Wednesday and had been found to be gravely mentally disabled, hospital officials would have had to seek a place for him in a private hospital, officials said.

A hospital spokesman said confidentiality statutes prevented him from confirming or denying whether Mallen is a former patient. Patrick Stalnaker, a spokesman for county mental health services, said he believes the bizarre incident was unrelated to the cutbacks, that will eventually close 45 of the facility’s 75 acute-care beds.

“It’s interesting, the coincidental timing,” Stalnaker said. “But I think this is a freak occurrence. I honestly do.”

But some hospital employees said that Mallen’s outburst illustrates the consequences of recent budgetary trims. Under the recent cuts, the hospital will have just 30 beds to serve acutely ill patients in crisis in San Diego County. In addition, the county will contract with private hospitals for 20 more beds--a decision that county doctors have criticized, saying that private hospitals are not ready or willing to handle their most difficult, violent patients.

“The irony of it is that, by coincidence, just one day after (the board voted to fund more contract hospital beds), we have a patient so extreme that he would climb into our hospital to attack somebody,” said Dr. David A. Schein, a psychiatrist who has run the hospital’s emergency unit for six years.

“We cannot emphasize enough the seriousness of patients that we have to deal with,” Schein said. “Now not only do we have violent patients in the hospital. Now they’re climbing over the walls from the outside. We are concerned whether private hospitals will be able to deal with that.”

San Diego County’s recent mental health budget cuts are compounded by reductions in state support for mental health services. For years, mental health workers and relatives of patients have protested that too little state money is allocated to care for the mentally ill.

The picture was expected to improve somewhat following a move by the Legislature earlier this year to shift funding and responsibility for mental health programs from the state to the counties. Also, mental health programs are expected to receive more revenue from a half-cent state sales tax increase and higher vehicle license fees. However, neither of those changes will take effect until next year.

For the current fiscal year, counties will maintain existing programs at the same or reduced levels, and the state mental health budget will remain at about $760 million.

San Diego County is also chafing under what officials say is an inequitable distribution of state hospital beds for long-term patients. Relatively few such beds are reserved for San Diego County patients--a total of 71, or fewer than three beds per 100,000 population. Los Angeles County, by contrast, has access to 1,080 beds, or 12 per 100,000 residents.

Dozens of county hospital beds meant for acute patients are now occupied by long-term patients awaiting placement in a state bed. Now that acute beds are being closed, officials say some of those patients may be transferred to private hospital beds to continue their wait.

According to Schein, however, the county’s contract with private hospitals does not require them to accept patients the county refers to them. It also includes a clause, he said, that allows the private hospital to return a patient to county care if that patient becomes disruptive.

If Mallen had not been arrested, another hospital employee said, he “would have been one of the first patients we would attempt to place in a contract bed. Can you imagine what kind of reception he would have gotten?”

Stalnaker acknowledged that, in the past, the county psychiatric hospital has received calls from private hospitals saying, “We can’t handle a person, can we send them to you?’ That has always been a role we have played. . . . But we have confidence that these folks will be able to take these patients and do a good job.”

Stalnaker said hospital administrators plan to formally commend Barrios and Dorn, the two nurses who subdued Mallen, for their professionalism.

“Their major concern was to protect the patients. They jumped in the face of a very dangerous situation. They did what they had to do,” Stalnaker said. “That is, we feel, above and beyond the call of duty.”

Times staff writer William Trombley contributed to this report.