Mental Facility Criticized

A U.S. Department of Justice investigation has found significant and wide-ranging problems with the care of the mentally ill children and teenagers at Metropolitan State Hospital in Norwalk, including wrong diagnoses, improper medication and not enough protection from other patients.

Although the report praised some aspects of the sprawling hospital’s treatment programs for young people, overall it gave a scathing assessment of a facility that investigators say is fostering despair and hopelessness. Metropolitan serves about 730 patients, including about 100 between the ages of 10 and 17.

Insufficient supervision of patients creates a poor environment, the report said, and may have contributed to repeated suicide attempts by one patient and possible sexual coercion between underage patients.

In addition, slow procedures often leave patients languishing in the hospital for months longer than they should, compounding their psychiatric distress, the investigation found.

The report often focused on how doctors diagnosed disorders the patients did not have, gave them the wrong medicines and routinely failed to identify the actual problems. In one instance, an overweight patient was diagnosed as being potentially anorexic, although such a diagnosis was not clinically possible, according to the report, which was released on the Internet last week.

Officials at the hospital declined to comment Thursday and referred all questions to the state Department of Mental Health, which operates the facility.

“In some areas I was surprised, in others I was not,” said John Rodriguez, the deputy director of long-term care for the state’s Department of Mental Health. “While we could quibble over a few details, to be honest we find the bulk of the report on point.”

He said some improvements had already been made since federal officials told the state about some early findings last summer. He cited statistics showing that the use of physical restraints has dramatically dropped in the last year and that there are more one-on-one therapy sessions for patients.

The U.S. Department of Justice did not return phone calls seeking elaboration on aspects of the report.

The federal investigation was launched in June 2002 after years of complaints from patient advocates about alleged abuses at the facility. A second report on Metropolitan’s adult programs is also being prepared, but no release date has been set.

Metropolitan, which is ringed with barbed-wire fences, is one of four state hospitals for the mentally ill. Children are sent to Metropolitan by counties and the courts, most often when there is no other foster home or group home that will admit the children, many of whom tend to be physically aggressive.

The report found that hospital administrators did not take enough steps to reduce risks to patients. One example cited was a patient who tried to commit suicide by tying a shoelace through an opening on the underside of her bed and strangling herself. She failed and tried to commit suicide by the same method four months later, again failing.

Recreational facilities are in bad shape and young patients often amuse themselves with violent video games, the investigators say.

According to the Justice Department, insufficient evaluations and treatments make it hard for a child to improve and leave Metropolitan.

The report included dozens of recommendations for ways the facility could come into compliance with the federal Civil Rights of Institutionalized Persons Act and avoid a U.S. lawsuit against the state. Those include reviewing psychiatrists’ competence in reviewing cases, improving nurses’ training and increasing the frequency of staff meetings about a patient.

Jim Preis, an attorney with Mental Health Advocacy Services in Los Angeles, said the real issue is that many of the children at Metropolitan have histories of being mistreated elsewhere and react by becoming overly aggressive.

The report highlights “that nothing is being done, so the kids are doomed to” having to stay at Metropolitan, Preis said. “The staff doesn’t have the training and the capabilities to provide the type of services these cases need.”

Pamela Lew, an attorney with Protection and Advocacy, a group that represents mentally ill people, said she was pleased the report focused on delays in getting youngsters out of the hospital.

“When you go there and meet some of the children and adults you wonder, ‘Why is this person here?’ ” she said. “It is so clear that in a few instances it’s just a matter of some additional resources and sometimes, fairly simple solutions that would help them leave.”

Counties are charged $120,000 to $150,000 per patient each year.

On Thursday, Los Angeles County mental health officials said they had not seen the report, but would ask for reforms at the facility, if necessary.

“We have a responsibility to these kids, No. 1; and No. 2, we spend a great deal of money in order to have those services provided,” said Rod Shaner, medical director at the Los Angeles County Department of Mental Health.

Some counties place children at Metropolitan only as a last resort, said Maria Marquez, the mental health services manager for Riverside County.

“Some issues that they deal with [at Metropolitan] are endemic to the size of the facility and the level of acuity of their patients,” she said. “They have a tough job. Is there room for improvement? I don’t think any large facility would say there isn’t room.”