California Mental Health: Who Is in Charge?

Tuesday, May 15, 2012

Page 11

SNIPPETS (Column):

California Mental Health: Who Is in Charge?

By MARC HAEFELE

In a short story by Argentine writer Adolfo Bioy Casares, a ward attendant at a suburban mental hospital discovers his employer’s dark secret. The mad doctor running the place has discovered a way to profitably generate electric power from the misery of his patients.

On the basis of accounts of some of California’s state hospitals, those facilities could also be cranking out the kilowatts. A recent Times story chronicles the fate of 52-year-old patient Diane Rodrigues at Norwalk’s Metropolitan State Hospital. It tells of how the staff dithered for five hours after Rodrigues broke her neck before they got her treated. She only lived another six months after that.

The Times cited official reports on the case that “detail serious lapses in medical treatment at the height of a massive court-supported effort to improve care in the state’s mental hospitals.” The hospital’s report on the incident, one of several similar events, was reported to have been severely diluted by hospital officials—including some recommendations that, had they been in place earlier, could have saved the woman’s life. Like making sure her attendant stayed awake, when she did not. Apparently napping on the job was a prerogative at Metropolitan. So was lying about patient outcomes. “Incompetence, fraud and dishonesty” were cited in the investigation report the Times obtained. But no criminal charges will be made, it was reported.

Metropolitan is reportedly one of two troubled state mental hospitals operating under a federal court consent decree due to lengthy histories of grim operational problems. The other is Napa State. Two years ago, a criminally insane patient murdered a woman attendant at Napa; the patient was ruled incompetent to stand trial. This month, a Napa State nurse was found dead hours after his release from jail, where he had been held for having sex with a patient. Another nurse, jailed on the same charge, was released last week after he posted $10,000 bail. How often, you ask, does this sort of thing happen? Is it perhaps mere coincidence that the former director of Napa State, Claude Foulk, was sentenced last year to 248 years in prison for molestation of his own adopted son?

The long, sad history of Los Angeles County’s King Drew Medical Center demonstrates the near-impossibility of hosing out the self-supporting culture of incompetence and corruption that can settle into a medical institution and persist like an antibiotic-proof staph infection. Mediocrity and bad performance standards become a secret religion, sustained by managers and supervisors whose careers they advanced. Is this what is happening at Norwalk and Napa? The answer at King Drew was to literally fire nearly everyone and build a completely new hospital and staff. We don’t even know for sure yet whether that solution was successful.

The Times piece on Metropolitan mentions a clutch of names of the Norwalk staff members involved. I didn’t see one much more important name. It was that of Cliff Allenby, acting director of the state Department of Mental Health Services. You don’t hear much about his department, but it is a big one—$6.4 billion a year with a staff of 12,000. Allenby has only been on hand for 14 months or so. Maybe it is to his credit that you don’t hear that much bad about the other three state mental hospitals. Who knows? But Allenby looks, from his web page, to be a veteran bureaucrat whose career dates back to the current governor’s father with scarcely a trace of mental health or medical experience as such. Certainly with the latest $8 billion budget shortfall increment, that current governor has plenty else on his mind.

But even so, it looks to me to be time for Jerry Brown to find a proactive and vigorous Allenby replacement who can take responsibility for the state’s snake pit hospitals and realize it is his or her job to do something about them.