Crackdown Widens in Patients’ Deaths

Los Angeles County mental health officials have expanded their crackdown against psychiatric hospitals that allegedly referred mentally ill patients to unsafe and unsanitary boarding houses.

The county Department of Mental Health is asking the Board of Supervisors to end the contract between the local Medi-Cal mental health plan and City of Angels Medical Center-Ingleside, which allegedly made improper referrals.

Hospital lawyers say that the decision would effectively take away the hospital’s ability to treat indigent psychiatric patients who are covered by Medi-Cal.

The county says that City of Angels discharged patients to an unlicensed boardinghouse in the San Gabriel Valley. Five residents there died earlier this year: Three suffered drug overdoses, and drugs played a role in a fourth death, according to coroner’s findings.

County mental health officials say that the hospital should have known about the poor conditions at the unlicensed facility. The hospital disputes that contention and maintains that patients have the right to decide where to live when they are released.

The Board of Supervisors is expected next week to consider the proposed termination of City of Angels’ contract.

In August, in response to the same allegations, the Mental Health Department stripped the hospital of its ability to detain and treat mentally ill patients against their will.

City of Angels has sued the county, but has so far been unable to persuade a judge to overturn the sanction.

The county’s actions “are in total disregard for the needs of the psychiatric patients and ignore the clear fact that these patients will have no other immediate resource for treatment,� hospital lawyer Jill Curb said in a statement.

David Meyer, deputy director of the Mental Health Department, said: “They can whine all they want, but that’s not going to change what they did and the danger it presents to people who can’t care for themselves.�

Meanwhile, the county has also sent a warning letter to Los Angeles Metropolitan Medical Center because it also allegedly discharged patients to the San Gabriel Valley home whose residents died. The medical center was placed on probation for six months related to its ability to keep mentally ill patients against their will.

The discipline meted out to Metropolitan was substantially lighter than that imposed on City of Angels and Hollywood Community Hospital of Van Nuys, which faced similar allegations. The Van Nuys facility was also stripped of its ability to keep mentally ill patients against their will, and it has also sued the county.

Rather than fighting the allegations, Los Angeles Metropolitan agreed to change its practices. In August, the hospital agreed to the county’s demands and fired six employees who had done mental health evaluations at the San Gabriel Valley boardinghouse.

The firings reduced the staff of 12 clinicians by half, but the medical center’s chief executive, Marc Furstman, said they were necessary.

“The reality is that the conditions at these facilities were very, very bad,� he said. “If clinicians go out [to a facility] and notice that conditions are not up to par, they are required to report that.�

Furstman said the hospital has a system in place in which clinicians must fill out a form on every facility they visit to determine if it’s clean and safe.

“Any time you’ve got a situation where people are dying, it’s a very difficult situation for everybody,� he said. “But ... we think we’ve got a system in place now to try to keep this kind of thing from happening in the future.�

Frank Peck, one of the fired clinicians, said the terminations amounted to scapegoating.

“Our only crime is that at one time or another we happened to see a patient at these facilities,� Peck said.

“Our job is to do emergency psychiatric evaluations. We don’t have control over where we go; we don’t discharge patients back into the community,� he said.