This Is Nuts--Fix it <i> Now

While leaders dither and pass the buck, the psychiatric emergency room at Los Angeles County-USC Medical Center has degenerated to the point that it resembles St. Mary of Bethlehem, the 18th century London madhouse that gave us the word “bedlam.”

The scenes described in Monday’s Times story about a grand jury investigation into the overcrowded facility make it sound as if lunatics are running the asylum. The story described a place where one patient jumped off a gurney and onto a doctor drawing blood; where a psychotic man attempting to escape crashed through the ceiling into a trauma room; where a young woman who’d been raped cowered in a corner while older male mental patients ogled her.

The grand jury report concludes that the psychiatric ER “creates unsafe conditions for patients, visitors and staff” and recommends that the county come forward with money for extra beds to alleviate the crisis. That money will not be easy to find in a county health care system that teeters on the brink of collapse due to overwhelming deficits. But given the chaos at County-USC, everyone involved had better start looking in new places in the county health department’s $2-billion-plus annual budget. Fast.

Hospital administrators say that in seven years they will open a replacement hospital with a more spacious psychiatric emergency room. Seven years? Another 2,555 days of bedlam? County leaders should have created more space seven years ago , when the Northridge earthquake shuttered County-USC’s main psychiatric ward, cramming everyone from the dangerously delusional to severely depressed teenagers into the hospital’s single, eight-bed psychiatric emergency room.

Ultimately the county will need Gov. Gray Davis’ help. Just as he loosened the red tape manacling power plant manufacturers, he should prod city, county and state bureaucrats to streamline permitting and building code laws that essentially bar counties from using existing facilities to expand psychiatric wards.

Davis should also fund “Assertive Community Treatment” teams, in which police officers and mental health professionals join to ensure that seriously mentally ill people get the counseling, medication and other outpatient treatment they need to lead stable lives. Recent studies have shown that these teams dramatically reduce demand for inpatient psychiatric services. Yet Davis is reportedly balking at the modest $10-million increase for these programs that the Legislature allocated last week.

Given the needed money, such programs will eventually ease the burden on psychiatric emergency rooms statewide. But County-USC needs more beds and better health standards today. If a society is measured by how it treats its most vulnerable, then Los Angeles must be judged harshly for deepening the despair of frightened and fragile people.

“It is nuts, and it’s unacceptable,” the hospital’s chief executive, Roberto Rodriguez, said of conditions at the psychiatric emergency room last week before stepping down from his post. Anyone who disagrees should have his head examined.