State Mental Facility Probed

The U.S. Department of Justice is investigating possible civil rights abuses at Metropolitan State Hospital in Norwalk, a sprawling facility that for years has been the subject of complaints about excessive use of restraints and drugs to control child and adult mental patients.

Federal investigators arrived last week at Metropolitan, which houses disturbed felons from state prison and is the last state hospital to treat mentally ill children.

Justice Department officials in Washington did not return calls for comment, and the precise target of their investigation is not known.

Hospital spokesman Catherine Bernarding and others confirmed the existence of the federal investigation. It is the third recent federal civil rights investigation into the treatment of mentally ill people in Los Angeles County. Investigators are also examining mental health care in the county’s jails and probation department, which runs county probation camps and juvenile hall.

Allegations of excessive restraints and medicating of patients have dogged the 1,041-bed Metropolitan hospital for years. They rose sharply in 1997, when the state shuttered Camarillo State Hospital and moved the children who had been housed there to Metropolitan. The combination of children as young as 11 and an increasing number of disturbed inmates from state prisons has alarmed advocates for the mentally ill.

The 803 patients include 370 prison inmates, housed behind razor wire and guard towers on the opposite side of the 162-acre facility from the 101 children, ages 11 to 18.

“They’ve turned it into much more of a prison-like facility,” said James Preis of Mental Health Advocates. “It seems more like a holding tank rather than a treatment facility.”

Bernarding, the hospital spokeswoman, disagreed sharply with that assessment. “Patients are being actively treated and we’re seeing good results,” she said. “The program compares very favorably to any other program that treats patients that are this seriously ill.”

Bernarding said new procedures have decreased the use of restraints on patients in the adolescent ward by 66% between 1999 and this year. Five-point restraints--which bind a patient to a bed--were used 127 times in May and 69 times in June, she said. Restraints are used only in emergencies, she added, and the adolescent program is trying to move toward a no-restraint policy.

On the medication issue, Bernarding said that most patients in the hospital were on medication before arriving at Metropolitan. The use of medication is carefully overseen by physicians, she said, adding that “medication has been shown to be extremely effective at treating most mental illness.” Of the 101 children at Metropolitan, nearly all are on some form of medication, Bernarding said. On average, children at Metropolitan have been rejected from 15 prior placements, such as foster homes or group homes.

The federal investigation set off an immediate reaction among the facility’s 1,800 staff members.

An unsigned, five-page packet entitled “How to Survive a USDOJ Survey” has been circulated at the hospital. It advises staff to answer questions from federal investigators “directly and honestly, but ... do not volunteer any information beyond what is specifically requested.” The documents also direct those interviewed to tell supervisors what questions were asked and warns them that investigators may try to trick them into confirming allegations against the facility.

“Think first before answering,” the document says, “and then answer the specific question honestly, nothing more.”

It states that federal investigators are expected to look at a wide range of issues, from use of medications and restraints to staff training.

Bernarding said Tuesday that the document was not official and had limited circulation. She added that the administration halted its circulation and directed staff to disregard it but could not identify who wrote it.

Although some mental health advocates have long complained about Metropolitan, some say that many of the hospital’s problems stem from the troubled overall state of California’s mental health system and are not unique to the Norwalk facility.

The dwindling number of state hospitals and community clinics means more mentally ill people end up untreated, coming to the government’s attention only when they commit crimes and end up in jail, advocates and mental health officials say. Then those patients are channeled to hospitals like Metropolitan.

“We don’t pay to treat them up front and then they go to jail and come in, more expensive, through the back door,” said Carla Jacobs, a Los Angeles County mental health commissioner.

Jacobs said that although she is not intimately familiar with the operations at Metropolitan, she does not think the problems are with its staff.

“I do not think you’re going to find a bunch of Nurse Ratchets running around,” she said, in a reference to the abusive enforcer at a mental hospital in the novel and movie “One Flew Over the Cuckoo’s Nest.”

Over the last five years, state regulators have cited Metropolitan for a number of violations, ranging from failure to fully supervise suicidal patients to improper use of restraints. The greatest number of citations were issued from 1997 and 1998, when the hospital underwent a regular inspection as it was struggling to deal with an influx of children from Camarillo State Hospital.

In 1998, for example, state inspectors found that four of eight patients tied down to beds had developed untreated lesions. They also cited the hospital for tying one patient to his bed for 10 years without providing a plan for how he could correct his behavior and get out of the restraints. Last year the hospital was cited again for restraining a man after he flushed a profanity-laced note from his roommates down the toilet.

Pamila Lew, an attorney for Protection and Advocacy, which represents the mentally ill, said her organization hired an expert to review the files of a woman who has been restrained “on a daily basis” for several years at Metropolitan. Lew said the expert concluded that the restraints were being used to modify the patient’s behavior rather than to protect her, staff members or other patients.

“Generally, restraints and seclusion should only be used when someone’s about to lash out,” she said. “They use the restraints as punishment.”

Lew and other advocates said another part of the problem is the influx of state prisoners into the hospital. The passage of a law requiring sexually violent predators to be housed in psychiatric hospitals after serving their jail sentences has pushed other types of criminal offenders into Metropolitan from the state’s three other psychiatric hospitals.

“They have increasing numbers of people who are coming from the criminal justice system,” Lew said. “It’s unfortunate for everyone there, because it’s unclear what their purpose is.”