Poor Care Reported at Mental Facility

Mentally ill adults at Metropolitan State Hospital in Norwalk were often misdiagnosed, over-medicated and improperly restrained for weeks at a time, according to a newly released U.S. Department of Justice investigation.

In one case, investigators found that no treatment was offered to an 18-year-old patient who had been sexually abused and neglected since she was 2. The report stated this “constitutes a substantial departure from generally accepted professional standards of care.”

Another patient was kept in walking restraints 24 hours a day for a month -- one of several examples of what investigators concluded were excessive measures that were not justified in patient charts.

The report includes dozens of instances when care was determined to be lacking. From April 2001 to March 2002, there were 475 patient-on-patient assaults, the study found. In another instance, a female patient gained access to the employees’ cafeteria, where she broke a glass and swallowed bits of it.

The conclusions come a year after the Justice Department found similar problems with the facility’s treatment of children and teenagers. The investigations were launched in 2002 after years of complaints from families and patient advocates about the state-run facility.

Metropolitan typically houses from 800 to 900 patients at its sprawling facility behind barbed wire.

Most of them are adults who were committed to the facility by civil courts, sentenced to the hospital for criminal wrongdoing or placed there by counties across the state.

The state Department of Mental Health, which runs Metropolitan, has until early May to file a response to the report, at which time state and federal officials will begin deciding on how to fix the problems.

If those negotiations fail, the Justice Department can try to force improvements by suing the state under the Civil Rights of Institutionalized Persons Act.

The report’s findings are based on visits that Justice Department investigators made to Metropolitan in June and July 2002.

Catherine Bernarding, a Metropolitan hospital spokeswoman, declined to comment on the latest findings and referred all calls to the state Department of Mental Health.

John Rodriguez, deputy director of long-term care with the department, said the new report “didn’t raise any new issues that we hadn’t been aware of from the [earlier] children’s report. We don’t agree with everything.... I do believe that there are enough issues that are on point.”

He said the state has hired a consultant to fix problems at the facility. The hospital also is working on a new program in which patients work with doctors to find better ways to rejoin the community after they are released, Rodriguez added.

Federal officials declined to comment on the report, but a Justice Department official who would speak only on the condition of anonymity said there was anecdotal evidence that the hospital is making the necessary fixes -- but no firm proof.

The official added that investigators told Metropolitan officials about specific problems when they visited the hospital, to give officials there a chance to fix problems that put patients’ lives in jeopardy.

The care of the mentally ill in large institutional settings has long been controversial. Critics often have decried what they call a cookie-cutter approach to treating patients with unique illnesses, histories and reactions to powerful medications.

Many of the problems found at Metropolitan speak to those issues:

* Improper use of medications. Specifically, the report stated that “Metropolitan’s psychiatrists often appear to be confused as to which medications are associated with particular side effects.”

* Patient record-keeping. One patient’s records stated that the patient had never been arrested and -- quite to the contrary -- that the patient also had prior convictions for beating a police officer and assault with a deadly weapon.

* Discharge procedures. “Preparation for discharge while in the hospital appears to be almost nonexistent,” the report stated.

Rodriguez said he is concerned that the report gives a narrow picture of life in a large institution.

“I don’t believe we have large systemic problems that are putting patients in jeopardy,” he said, “but you can always do a better job, and weed out bad employees or processes if that’s what is causing it.”

Los Angeles County pays Metropolitan to house about 325 patients, most of whom are adults, said Dr. Rod Shaner, medical director of the Los Angeles County Department of Mental Health. He said the department regularly monitors the well-being of patients at the hospital.

“I think there’s a sense the staff at Metropolitan Hospital is in the process of making significant changes, and there is evidence that they are doing everything they can to move in the right direction,” Shaner said.

“For those of us who have worked in those settings there are great challenges, but there are also responsibilities to provide a good level of care.”

Pamila Lew, a staff attorney with Protection and Advocacy, a group that represents patients at the hospital, said she has concerns about the pace of change at Metropolitan. She would like the public to have a voice in fixing the hospital.

“We’re happy they did the report, but in terms of monitoring progress and giving input, it has been difficult,” she said.

In response to the Justice Department findings, the state Senate budget subcommittee will hold a hearing on problems at Metropolitan on March 22 in Sacramento, said Suzanne Wierbinski, chief of staff for state Sen. Martha Escutia (D-Whittier). The hospital is in her district.