Troubles Continue at State Mental Hospital in Norwalk

A state mental hospital in Norwalk targeted in a federal investigation for lapses in patient care has encountered new troubles in recent weeks as five teens fled, an adult patient tried to sexually assault a nurse, and a woman died early Friday after hanging herself at the hospital May 27.

The latest problems, confirmed by state officials last week, follow a tumultuous three years at Metropolitan State Hospital, where several previous instances of rape, patients running away and other dangerous behavior have been noted by state and federal inspectors.

Last year, three patients died after trying to harm themselves or others, although the state determined that the hospital did not violate rules in two of the deaths.

Metropolitan houses some of the most severely mentally ill adults and youths in the region, and it is not unusual for patients to hurt themselves or other people in such settings. But inspectors have repeatedly found that the hospital isn’t doing enough to stop them.

Officials with the state Department of Mental Health say they are taking the incidents seriously and are engaged in a systematic overhaul of the hospital’s treatments and programs.

“I don’t think there is any number [of incidents] that is acceptable, but we have to keep continuing to work on it,” said Cindy Radavsky, assistant deputy director of long-term care services for the Mental Health Department, which runs California’s four hospitals for the mentally ill.

William G. Silva, who has been the hospital’s director for 18 years, could not be reached for comment. A spokeswoman referred calls to the state Mental Health Department.

The latest events, confirmed by Radavsky and hospital employees, began last month, when three teenage girls, ages 16 and 17, overpowered a nurse in a locked ward, cut phone lines and stole the staffer’s keys, which they used to flee the hospital compound.

The next night, one of the girls returned to the hospital and, with two other teenage girls, overpowered a nurse and stole her keys, then fled again.

Three of the five girls never returned to Metropolitan and have been officially discharged from the hospital because they were gone for more than 10 days, said Department of Mental Health officials, who added that local authorities had been contacted.

The whereabouts of the girls remained unknown Sunday.

Lt. Alma Espinoza, a watch commander at the Los Angeles County Sheriff’s Department substation in Norwalk, said Sunday that she was unaware of the missing girls but that it was possible other officials in the station had been contacted by Metropolitan.

A few days after the girls fled, eight patients at Metropolitan were found with marijuana they said they’d bought on hospital grounds, although only two of the patients tested positive for use, Radavsky said.

On May 27, 18-year-old Maria Garcia hanged herself. The patient had been seen during a routine staff check at 5:45 that evening, but when staffers returned 10 minutes later, they found her unconscious and began efforts to resuscitate her, according to state mental health officials.

Garcia was taken to Los Angeles Community Hospital in Norwalk. After surviving for a time on life support, she died early Friday.

The day after the hanging, an adult male patient tried to sexually assault a nurse, who was shaken but able to complete her shift, state officials said.

The recent incidents are not isolated, according to inspection reports and other records obtained by The Times.

Based on a visit to the hospital in July 2002 and the examination of hundreds of pages of patient records, the federal Department of Justice issued two investigate reports on Metropolitan. The first, in May 2003, was on the care of juveniles and the second, in February 2004, was on adult care.

Metropolitan has about 650 patients, including approximately 50 who are under the age of 18. Many of the patients have been committed there by criminal or civil courts and are suicidal, schizophrenic or suffer from other maladies that make it difficult to control their impulses.

Both federal reports alleged that the hospital routinely failed to protect patients, many of whom were misdiagnosed and given improper medications.

“In summary, Metropolitan’s treatment planning for its adult patients substantially departs from generally accepted professional standards of care,” the 2004 report stated.

The investigation of Metropolitan’s adult care found that from April 1, 2001, to March 31, 2002, there were 475 patient-against-patient assaults, 310 incidents in which patients hurt themselves and 304 accidental injuries.

The Justice Department and the state Department of Mental Health have been negotiating for months over a plan of correction. If the Justice Department is not satisfied with fixes to the hospital, it can sue the state to force changes.

Eric Holland, a spokesman for the Justice Department’s civil rights division, said this week that he could not comment on the latest episodes at Metropolitan, or on what follow-up actions are underway.

Mental health experts said the conditions at Metropolitan could partly be a reflection of systemwide breakdowns in care for the mentally ill.

Dr. E. Fuller Torrey, president of the Treatment Advocacy Center in Arlington, Va., and the author of “Surviving Schizophrenia,” said funding is getting increasingly scarce, there is little continuity in care, and facilities such as Metropolitan find themselves treating the “sickest of the sick.”

“But deaths shouldn’t happen very often,” Torrey said. “I can’t say that a coincidence of bad events isn’t possible, but when you have a series of deaths like that it suggests that the quality of care on the wards is not good and the staffing is either insufficient or they’re sleeping on the job.”

In more than two dozen visits to the hospital in 2004, officials with state Department of Health Services found that Metropolitan’s staff failed to stop patients from attacking or raping one another, harming themselves with potentially dangerous objects or fleeing, according to documents obtained by The Times under the California Public Records Act. (The Health Services Department inspects the hospital and the Mental Health Department runs it.)

The health department’s inspections were triggered by reports from the hospital to the agency, or by complaints from staff members, patients or anonymous sources.

In almost every instance, inspectors concluded that the hospital had fallen short in some way.

For example, in January 2004, a male patient attempted to rape a female patient in the hospital’s sickbay, in a room with two other patients. “The facility failed to protect Patient 1, who was unsupervised and asleep in the sickroom, from harm,” wrote Dorothy Crawford, a state inspector.

Also that month, in a room near the hospital’s treatment center, a female patient was sexually assaulted and forced to perform oral sex on a male patient who had been transferred to Metropolitan from Los Angeles County Jail.

In Feb. 4, hospital police found a patient smoking marijuana in a courtyard at Metropolitan. The patient told hospital police: “A guy named [redacted] who drives a white truck sells us cocaine and pot. He used to be a patient and he sells drugs to a lot of people here.”

The patient subsequently attacked and injured two hospital police officers, and was later taken to the county’s Twin Towers jail in Los Angeles.

In April, state inspector Naomi Russell reported that a hospital staffer had told a patient, “I am going to beat the [expletive] out of you if you don’t come to get your treatment.”

Russell also wrote that the staffer had been accused of abusing a patient in August 2003 and then received a transfer to another unit.

On Aug. 18, a male patient diagnosed as being bipolar and antisocial with psychotic features walked out the hospital’s back gate, which was supposed to be staffed by guards.

He wasn’t found until Aug. 22, when he was picked by Metropolitan staff at County-USC Medical Center, about 15 miles from Norwalk.

Separately, The Times has confirmed that three of the hospital’s patients died last year after abusing themselves or others:

* In February 2004, eight days after the Justice Department issued its second report, 42-year-old Clifton Washington tied a scarf around his neck and hanged himself from a bar over a window in his room, according to an autopsy report from the Los Angeles County coroner.

* In July 2004, 52-year-old Julia Rodriguez died of a small-bowel perforation at Los Angeles Community Hospital after she swallowed two quarters at Metropolitan.

Rodriguez had a history of such behavior. She was at the community hospital for 14 hours but never underwent surgery, which probably would have saved her life, coroner consultant Dr. Denis Clement Astarita said in the autopsy report.

* In October 2004, 39-year-old Richard Allen Callender was tackled by Metropolitan staff after he attacked another patient and a nurses station with a chair.

He stopped breathing and died 65 minutes later. The coroner ruled his death was probably due to suffocation “following restraint and other unestablished factors.”

The state health department determined that the hospital was not at fault in the first two deaths. It is investigating the third.

In 2004, there were 1,416 incidents of self-injurious behavior -- including suicide threats -- in the four state hospitals. There were 72 suicide attempts statewide, three of which were successful.

Radavsky said that the state is working to resolve the Justice Department’s concerns, but also that the Mental Health Department does not agree with all of the federal findings.

She also said that Metropolitan has met state licensing standards and that incidents of mental patients harming themselves are quite common.

In addition, after the Justice Department findings, the Department of Mental Health hired two mental health contractors at an annual cost of $1 million to help oversee changes at Metropolitan.

“I think it’s still pretty bad there,” said Pamila Lew, a staff attorney for Protection & Advocacy, a nonprofit group that provides legal help to people with disabilities.

Lew cited the level of violence at the hospital as a continuing problem and said that it often seems as if each patient needs his own advocate to ensure proper treatment at Metropolitan.

“From what I’ve seen, there are some overarching reforms going on there,” Lew said.

“You can have better paperwork and procedures, but if it isn’t improving the quality of life for patients, it’s kind of for naught.”