Vacancies at Mental Hospitals a Disaster

Ronald Shelton Jr. called his mother, Lori Moore, of Placerville, from inside Napa State Hospital late on the afternoon of Dec. 3. When they were done chatting, he asked her to have his sister Kelly give him a call.

Ronald, then 27, had been diagnosed with schizophrenia at 18. He ended up in Napa after an assault on his mother.

When Kelly called him back that day, he became distraught during a discussion about where he would live if and when he was released.

“He was crying, he was very emotional, and he didn’t do that very often,” said Moore. “That was a clue.”

According to a recent U.S. Department of Justice report, Shelton had previously attempted suicide. When Kelly got off the phone with her brother, she immediately called the hospital to warn a nurse about Ronald’s state of mind.

“Within 20 minutes of that,” Moore said, “give or take a few minutes in either direction, his roommate found him.” Ronald had hanged himself with a bedsheet. Rushed to a hospital, he died the next day.

Just 3 1/2 months after Shelton killed himself, in late March of this year, another Napa patient suffering from severe mental illness hanged himself. Like Shelton, Norman Freidberg, a 36-year-old native of Long Beach, had tried to take his own life previously, according to lawyers Michael Alder and David Feldman, who have filed negligence complaints against the hospital in each of the cases.

“He hung himself using leather laces he had from his two ankle braces,” Alder said, referring to braces that Freidberg wore for an orthopedic problem. “The laces were to be returned every night to the nurses and were to be given back to him in the morning. There was a note to that effect in his file, but ... the nurses never really followed the instructions on the note and never took the laces from him.”

I had no idea what I was letting myself in for a week ago when I put out a call for information about what goes on behind the walls of the state’s four mental hospitals. Details on those two suicides were only a fraction of what came my way. I got phone calls, letters and e-mails from patients, staff and families.

Some of them praised the work of dedicated employees who put their lives on the line to help a dangerously disturbed population.

Others railed against bureaucratic ineptitude and severe understaffing, or tipped me to the latest horrors.

“As you may know by now,” a psychiatrist at Atascadero State Hospital wrote, “a patient suicided last night at ASH.”

The patient was identified by Atascadero’s executive director, Melvin Hunter, as “Jeffery Fisher, DOB 12-20-63.” He twisted a bedsheet into a rope and hanged himself from his locker.

Hunter identified Fisher as a mentally ill patient transferred from the state Department of Corrections and said there had been no indications of despondency or suicide threats. He said the hospital was investigating the death, which was the first suicide at Atascadero in four years.

I don’t think Hunter’s the problem. He seems to be well-liked and respected by staff. But he and other hospital directors seem to be set up for disaster, with exhausted troops that are overworked and outnumbered.

It’s hard to believe that staffing shortages at the four major state mental hospitals haven’t contributed to nine suicides over a 3 1/2 -year period. And to the escapes, the sexual abuse, the drug trafficking inside the hospitals and numerous attacks by patients on each other and on staff members.

At Atascadero, Hunter told me he’s down roughly 100 nursing positions. Those are budgeted jobs that he hasn’t been able to fill. The hospital is also down 10 each of psychiatrists and psychologists to serve a population that hovers as high as 1,367.

The day of the suicide last week, an Atascadero psychiatrist e-mailed me to say:

“Violence is a way of life [here]. Last night a nurse on Unit 6 was beaten about the face by a patient. She is out of work. Such events occur about every week or two.... Violence upon patients by other patients is never reported and is routine.”

On Sunday, another e-mail informed me that a staffer suffered a fractured rib and an eye injury Saturday night in an attack by a patient.

I was faxed an April letter, signed by 27 Atascadero doctors and sent to state mental health Director Stephen Mayberg, that pleaded for relief from caseloads as high as 106 patients per psychiatrist.

“We are not just concerned about our excessive workload and increased liability,” the letter said. “We are also concerned that the excessive caseloads are violating the civil rights of our patients.... We also believe our working conditions are becoming increasingly dangerous due, in part, to the lack of psychiatrists. As we are stretched thinner and thinner, we are being threatened and attacked at an unprecedented rate.”

Mayberg’s office responded with a letter that acknowledged staffing shortages, promised renewed recruitment efforts, predicted some relief when a new facility opens in Coalinga, and asked psychiatrists to drop their opposition to the use of nurse practitioners and psychologists to help relieve the workload.

As for that last request, many psychiatrists believe it’s a dangerous prescription for the treatment of hard-core sexual predators, the severely mentally ill and patients deemed incompetent to stand trial.

I can’t speak to the vagaries of that argument, but it doesn’t take a PhD to realize you’re asking for trouble when the four-hospital system has 1,000 unfilled positions, as the state mental health director told me last week. State officials keep telling me it’s not a budget problem. They insist they’re just having trouble recruiting employees, during this time of sky-high real estate prices, for difficult jobs that don’t pay the greatest salaries in the industry.

Well, doesn’t that make it a budget problem in the end? Pay a little more to fill those vacancies and maybe there won’t be as many deaths by hanging. The state currently pays psychiatrists a premium of roughly $2,000 a month above the basic state salary scale for psychiatrists to tempt them into the state mental hospitals, but for nurses, the pay differential is only a few hundred dollars.

Pay hikes might be cheaper, in the long run, than the cost of fighting lawsuits and burying the dead.

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Reach the columnist at steve.lopez@latimes.com and read previous columns at www.latimes.com/lopez