Why is a public hospital in L.A. restraining psychiatric patients at high rates?

Good morning. It’s Thursday, Oct. 19. I’m Emily Alpert Reyes, a public health reporter for the Los Angeles Times. Here’s what you need to know to start your day.

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Why is a public hospital in L.A. restraining psychiatric patients at high rates?

Strapping down a psychiatric patient is supposed to be a measure of last resort for medical professionals. Federal law forbids hospitals from physically restraining patients unless they need to prevent patients from harming themselves or others — and only after other steps have failed.

So the numbers at L.A. General Medical Center were striking to me and to investigative reporter Ben Poston. The public hospital, which serves some of the poorest and most vulnerable people in L.A. County, has been restraining patients in its locked psychiatric unit at a higher rate than any other inpatient facility in California from 2018 to 2021, federal figures show.

In fact, the restraint rate at L.A. General’s Augustus F. Hawkins Mental Health Center was more than 50 times higher than the national average for inpatient psychiatric facilities, ranking it among the highest in the United States during that time. And the numbers have only grown in recent years, doubling between 2020 and 2021.

We teamed up to look deeper. L.A. General officials said that the high rates are tied to forces beyond their control, including more patients with a history of violence showing up at the hospital and longer waits to transfer patients to more suitable facilities.

“We have not been prepared to handle people at this level of violence,” L.A. General Chief Medical Officer Dr. Brad Spellberg said.

Other facilities are unwilling to take the “difficult” patients that it handles as a publicly run, safety net hospital close to Skid Row and the jails, said officials at the L.A. County Department of Health Services, which operates L.A. General.

L.A. General plainly has challenges, but mental health experts we interviewed questioned its explanations for high rates of restraint. Other safety net hospitals in San Francisco and New York City do not restrain psychiatric patients at anywhere near the same rate as L.A. General.

“It doesn’t make sense to me that patients in L.A. are more seriously psychotic and dangerous than patients at a general hospital in San Francisco,” said USC law professor Elyn Saks, who has studied the use of restraints for decades.

We also asked for numbers. Hospital officials said that assaults on staff had risen dramatically. The county later provided figures that do not show an increase in the average number of attacks each month at the psychiatric unit between mid-2018 and spring 2022.

To explain the high rates of restraint, county officials also pointed to a logistical issue that doesn’t exist at other hospitals: Hawkins, the psychiatric inpatient unit for L.A. General is miles away from the main hospital in Boyle Heights, and all Hawkins patients are restrained on the drive between the two. Hospital officials said restraint was needed to prevent patients from jumping out of moving vehicles or harming staff.

Some mental health experts said it was inappropriate to have a blanket practice of restraining all patients from the psychiatric unit during trips to the main hospital. “It’s traumatizing and it certainly doesn’t help gain a person’s trust,” said Kevin Huckshorn, a mental health nurse and national expert on restraint reduction strategies. She added: “Everybody’s not dangerous.”

Marcelus Laidler, 48, was restrained dozens of times while hospitalized at L.A. General in a medical unit on its main campus. (Such episodes of restraint are not included in the federal data, which only includes psychiatric inpatient units.)

Two years after being discharged, he said he still suffers nightmares about being restrained.

“That hospital is like one bad dream after another,” he said.

Today’s top stories

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Today’s great reads

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How can we make this newsletter more useful? Send comments to essentialcalifornia@latimes.com.

For your downtime

(Scott Feinblatt)

Going out

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And finally ... from our archives

On this day 36 years ago, the stock market crashed as the Dow Jones Industrial Average plunged 508 points (the worst one-day drop ever) in what came to be known as “Black Monday.”

(Los Angeles Times)

On Oct. 19, 1987, bedlam swept Wall Street as the stock market selloff turned into a full-scale panic as the Dow Jones Industrial Average plunged 508 points (the worst one-day drop ever). It became known as “Black Monday.”

Have a great day, from the Essential California team
Emily Alpert Reyes, public health reporter
Elvia Limón, multiplatform editor
Kevinisha Walker, multiplatform editor
Laura Blasey, assistant editor
Karim Doumar, head of newsletters

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