Flight of mental hospital staff taking a human toll

Two Atascadero State Hospital patients have killed themselves and four others have attempted suicide since early February -- an alarming surge in such incidents at the Central Coast psychiatric facility that comes as it is rapidly losing key staff to more lucrative jobs in the prison system.

Until February, the facility had not had a suicide since August 2005, and the one before that occurred in 2001. Over the last six years, Atascadero has averaged less than one attempted suicide per month.

The recent spate of deaths and injuries occurred in the weeks after hospital administrators severely curtailed admissions for the first time in the institution’s history, concerned that staff shortages were jeopardizing patients’ safety.

Atascadero Executive Director Mel Hunter said he couldn’t directly tie the suicides to the crisis. But he noted that acute staff shortages are clearly eroding care. To keep wards fully staffed, he said, the hospital has had to rely on overtaxed employees working large amounts of overtime.

“The best way to prevent suicides is to spend time with the men, to develop good clinical relationships,” Hunter said. “In an institution running shortages from 52% to 80% on our clinical staff, we are bound to start seeing some bad outcomes.”

The two men who died, Matthew Miller and Roland James, had been sent to Atascadero from the California prison system, where mental health care is so poor that a federal judge ruled it unconstitutional. The court ordered reforms, including steep pay raises for clinicians.

But those reforms have contributed to what one legislator called a “death spiral” at Atascadero as psychiatrists and other clinicians have left the facility for much more lucrative prison jobs.

Staff members had already been leaving the hospital, frustrated by relentless mandatory overtime, increasing assaults by patients and orders by the California Department of Mental Health to dramatically change the treatment philosophy. After the court-ordered prison raises, that trickle became a flood. On Jan. 18, Atascadero administrators closed the hospital to all but the most urgent admissions, saying that safety could not be guaranteed.

The prison system only sends its most severely mentally ill inmates to Atascadero, which seeks to adjust their medication, stabilize them and keep them safe. But in the midst of its crisis, the hospital failed some of its patients.

The recent cluster of suicide attempts began Feb. 4, when staffers discovered a gasping patient who had tried to hang himself from his bedroom locker. He survived without serious injury. Then on Feb. 15, Miller, 52, of Lynwood, killed himself using a similar method.

He was deeply despondent, a cousin who grew up with him said, having learned the previous month that he would be kept at Atascadero rather than paroled. Ron Ward, who grew up watching out for his socially vulnerable cousin, wonders why the hospital was not able to prevent the suicide because it was evident from Miller’s letters that he was distraught. “Maybe they should have watched him better once they told him that,” Ward, 53, said.

The next weekend, a patient overdosed on the antipsychotic drug Seroquel and was hospitalized. Another doused himself in baby oil, wrapped tissue around his body and set himself ablaze, suffering burns.

On the night of March 2, in the same unit where Miller killed himself, James -- a 43-year-old father of four -- hanged himself from his locker with a bedsheet.

A panicked staff member called his mother, Christine James, at her Redding home at 11:30 that night to report that her son had been found without a pulse. Then, concerned about privacy laws, she and other staffers refused to elaborate, leaving the family to call frantically through the night trying to get more information.

Ten days later -- after yet another patient in the same unit unsuccessfully attempted to hang himself -- James was removed from a ventilator. He was brain-dead.

In the weeks before his death, Christine James said, her son seemed to sink into deep despair. He told her he had been placed under intensive monitoring, and then, a few days before he hanged himself, he said the monitoring had been lifted.

“It’s hard to accept. Your kids are supposed to outlive you,” said Christine James, 62. “It’s a mental hospital. I would have thought they would have watched him since they know mental patients are capable of such things.” Suicide attempts sometimes come in copycat clusters, and those determined to die can be difficult to thwart.

Still, staffers are dismayed by what some say is the worst series of patient tragedies in recent memory and believe that the staffing crisis contributed. Staff members say that licensed caregivers are in such demand that they are often required to shift to units where they don’t know the patients. The problems, they say, are compounded by low morale.

“When you have staff who feel defeated, how do you help patients who are basically criminals and feel defeated all the time?” one psychiatrist asked.

Hunter said he is doing what he can to stabilize his hospital. Lockers have been redesigned to eliminate the risk of patients using them to hang themselves. And last week, what Hunter hopes will be the first of an influx of contract psychiatrists began working at the hospital to help plug the 80% vacancy rate. The temporary doctors will earn about $240 per hour -- triple the rate of staff psychiatrists.

Hunter has also been advocating pay parity with the California Department of Corrections and Rehabilitation. The judge in the prison mental health case -- which includes the Department of Mental Health because the hospitals treat some prison inmates -- recently ordered state officials to equalize salaries in the two systems or present an alternative plan in court by April 6.

On Wednesday, after a meeting with Gov. Arnold Schwarzenegger, Department of Mental Health Director Stephen W. Mayberg announced a plan for temporary raises that will increase state pay for psychiatrists to within 5% of prison salaries and pay for other clinicians to within 18% of the prison rate.

“The governor is very concerned about the impact of the exodus of staff on patient safety and staff safety,” Mayberg said.

Psychiatrists at Atascadero responded to the news with skepticism.

“This will slow down the hemorrhage but the patient is still bleeding to death,” said Dr. John Cannell, whose patient load surpasses 100. “The real question to me is whether doctors who have left for corrections will be willing to take a 5% pay cut for the privilege of working at Atascadero State Hospital in its current deteriorating state. I don’t think so.”

Atascadero psychiatrist Michael Lisiak, the hospital’s union steward, urged the federal judge to reject the plan, saying the “crisis will only continue” without pay parity.

The deteriorating conditions at Atascadero and the state’s other mental hospitals underscore how entangled the mental health and criminal justice systems have become. The hospitals increasingly serve mentally ill patients who are either too ill to be tried for crimes they are accused of committing, too sick for the prison system to handle or too dangerous to be paroled.

Many received no mental health care at all until they found themselves in prison, where the care was lacking.

Attorneys who pressed the class-action case that resulted in raises for prison clinicians say they now plan to seek an order from the judge to reopen Atascadero to mentally ill prisoners and to improve care there.

“Even before the deaths, we felt that the situation at Atascadero was very dangerous and very likely to result in harm to patients,” lawyer Michael Bien said.

Assemblyman Sam Blakeslee (R-San Luis Obispo) has held numerous meetings with Atascadero staff members over the last year and faulted the governor for not taking action more promptly.

“We’ve seen the implosion in corrections and what happens when a crisis is allowed to fester,” he said. “There is the potential for a federal takeover, in which case you have no control. I would hope the state of California would have the foresight to appreciate that the same fate could await us in the Department of Mental Health if we don’t prioritize this now.”

lee.romney@latimes.com

scott.gold@latimes.com