The $388-million facility sprawled on the desolate outskirts of this Central Valley town was intended to answer a pressing problem: what to do with hundreds of repeat pedophiles and rapists in California who have served their prison terms but are deemed too risky for release.
This was to be a hospital dedicated primarily to such “sexually violent predators,” who can be lawfully detained for mental health treatment.
It was the first state mental hospital built in more than half a century, and few amenities were spared. Shiny keyboards and drum sets now grace private music rooms. Woodworking and printing studios resemble professional shops. A Native American sweat lodge is in the works.
Treatment, however, is in short supply.
Despite vigorous recruiting efforts, not enough nurses, doctors and technicians want to work at this remote outpost. As a result, six months after the 1,500-bed hospital opened to the speeches of lawmakers, only about 170 patients have moved in. More than 400 sexually violent predators await transfer from Atascadero State Hospital near San Luis Obispo.
And hundreds of other beds, which could be filled with patients with other mental disorders, remain unoccupied in a system that otherwise is badly overcrowded.
The largely empty Coalinga State Hospital embodies twin problems of the state’s mental health system: its struggle to hire licensed staffers and its difficulty accommodating sexual offenders, who some experts say don’t fit conventional definitions of mental illness.
Now, scores of patients are being housed in a facility that does not act much like a hospital. In most housing units here, patients are supervised largely by a skeletal crew of hospital police officers -- not the clinical teams of licensed caregivers required at the other four California state mental hospitals.
The problem is complex. The state can’t incarcerate people beyond their prison terms; it is unconstitutional. But it can, by virtue of a 1995 state law, keep these offenders as patients.
But the state can’t make around-the-clock care available without people to provide it. Moreover, it can’t force therapy on patients. In fact, historically, 80% of sexual offenders have refused it.
“What they’ve done is to create what they hope is a legal situation for warehousing” patients, said Ted Donaldson, a psychologist who often testifies for the defense in sexual predator cases.
“Most of these people don’t have a qualifying mental illness,” he added. “They’re bad people and we don’t like them very well, but you can’t civilly commit people because you don’t like them.”
Even some patients distrustful of therapy complain about the lack of professional care.
“The state of California spent all this money on a 1,500-bed facility and they don’t have enough staff to staff it,” said Luther Evans, 56, a convicted rapist who is in one of the two licensed treatment units for a medical problem and wants to stay there. “They’re disguising what they’re supposed to be doing in here.”
Last summer, the state Department of Mental Health secured a change in California law, suspending for six years the state’s obligation to provide licensed care by nurses and psychiatric technicians in 30 of 32 housing units at Coalinga. It was an unprecedented exemption for a California mental hospital.
The two units that have been licensed for treatment handle patients who are medically infirm or suffer from psychoses that require medication.
John Rodriguez, deputy director of the Department of Mental Health, acknowledged that the state has made “slow” progress recruiting licensed staff for the Coalinga facility. But he said the legal change was a cost-saving measure because most sex offenders “don’t need the very expensive and staff-intensive 24-hour nursing” that those with mental illnesses such as schizophrenia do.
California is not reneging on its treatment obligations, he said, because therapy targeting the men’s sexual urges is available, on a small scale for now, in the central portion of the facility away from the housing units. The new law requires that patients be offered a chance for treatment monthly.
Under the 1995 law, sex offenders with at least two victims and continued predatory urges were defined as mentally ill.
Courts have since ruled that detaining offenders for treatment was constitutional only because it was therapeutic -- not punitive. The state offers a five-phase therapy regimen that tries to teach them to empathize with their victims and suppress their sexual urges.
But the vast majority refuse to participate beyond the first phase because anything they say can be used against them in jury trials held every two years to determine whether to keep them locked up. Nine of 171 patients at Coalinga have gone beyond that phase.
Former Rep. James Rogan, who co-wrote the sexually violent predator law as an assemblyman from Glendale, said prosecutors seem satisfied the law is working. Its primary purpose, Rogan said, was to ensure that sexually violent predators stayed out of the community.
“The implied secondary purpose, of course -- where there’s any mental health need -- was to try to have the resources to do whatever degree of rehabilitation can be done through medicine and psychiatric help,” he said. “I regret that it’s not happening.”
The efficacy of treatment for these inmates is a matter of professional debate, as is whether the men have a true psychiatric disorder. They have nevertheless been channeled into an increasingly crowded state mental hospital system. At Atascadero, they have clashed with severely mentally ill patients, exploiting them for sex, drugs and money.
Planned since 1998, Coalinga presents its own set of problems. Hospital documents show that the initial staffing plan last July was for two officers -- and no professional caregivers -- to monitor each unlicensed, 50-patient unit around the clock. After officers protested, the plan was changed to include at least one psychiatric technician.
The officers -- relatively poorly paid and untrained as caregivers -- have been directed to attend to patients’ needs by passing out shaving kits, monitoring showers and writing reports on aggressive outbursts
At the other four state mental hospitals in California, such officers investigate crimes and respond to disturbances. Patients are monitored by nurses and psychiatric technicians at ratios of at least one licensed staffer to six patients.
“The officers weren’t expecting to be on a unit baby-sitting these guys,” said Officer Bill Muse, Coalinga’s representative for the Hospital Police Assn. of California and a former Atascadero officer.
“They were under the assumption that they were going to be doing police work,” he added.
So far, only the best-behaved patients have been moved to Coalinga, but some already have been caught with illegal drugs and homemade alcohol known as pruno, officers said.
“The patients are getting jacked up,” Muse said, “and something’s going to happen.”
Just two units at Coalinga are licensed for treatment, and they are almost full already. Hospital spokesman Tom Hunt, who spends much of his time seeking recruits at job fairs and vocational schools, said the hospital can seek to have more units licensed as needed.
But attracting skilled staff may continue to be difficult. Coalinga is not just off the beaten path; its jobs are often demanding and not that high-paying.
“The problem is going to be if they can’t find the staff and people want the treatment and they can’t get it,” said Daniel Brzovic, associate managing attorney for Protection & Advocacy Inc., a state contractor that advocates for mental patients’ rights. “Then I don’t see any justification for the hospitalization.”
Several patients said they were relieved to be away from Atascadero, where tensions with treatment staff erupted often.
“They treat you pretty decent here,” said Anthony Iannalfo, 63, a three-time convicted rapist who committed his last offense 24 years ago and has declined formal treatment because so few patients have won release that way. “The officers, they seldom come out of the office, but when we ask them for something, they do it right away -- when you need your hall card or you want to shave.”
Though Iannalfo refuses to go beyond the first phase of treatment, he is taking a depression management class and has signed up for “relapse prevention.”
But the shortage of licensed staff members underscores these patients’ strange brand of purgatory. A group in one unlicensed unit spends time building model motorcycles with paper, string, straws and the foil from potato chip bags.
For now, as patients move into unlicensed dorms with names such as Catalina and Pebble Beach, critics say California’s sexually violent predator program looks more like upscale incarceration. The men mostly peruse things in the library, work out in the gleaming gym and choose from classes such as computers, history and art. A woodworking shop sits unused since a teacher recruited last fall left.
“We’ve been saying all along that this isn’t about treatment,” Jean Matulis, a Pacific Grove defense attorney, said of the state’s suspension of licensed care in most housing units. “This just confirms that.”