While California has all but emptied state hospitals of the noncriminal mentally ill, 4,700 people with schizophrenia and other severe mental disease are housed in privately owned asylums where patient abuse and neglect are all too common.
Although oversight is spotty, the state Department of Health Services has issued 200 citations and fines against 35 of the 45 facilities certified to care for mentally ill people since 1992, the year California began moving the bulk of the last noncriminals out of state hospitals. Eight homes amassed half those citations.
Nevertheless, counties trying to save money by avoiding the high cost of state hospitals rely on the private locked facilities to care for ever more troubled people. At some, workers lack training to handle tough patients and can be paid as little as $6.50 an hour, less than teenagers who bag groceries.
Violations have included open sewage near patients and tap water that was too hot; staff failure to stop residents from harming themselves or attacking others; and workers assaulting and sexually abusing people under their care.
In addition, since 1992, citations and fines have been issued in the deaths of 23 patients. There have been six suicides and a homicide. Several other deaths were attributed to staff neglect.
One of those who died was James Foley.
At least operators at Skyview Memorial Lawn in Vallejo thought that was his name when they spread his ashes in a rose garden, with no marker. For many of the 27 years he spent in state hospitals, private sanitariums and jails, authorities believed that he was Edward Heath, though he used other names too.
He had no known next of kin. His parents died when he was an infant. He was raised in foster homes in San Francisco and dropped out of school in the ninth grade. A chronic schizophrenic, he died at a Vallejo nursing home in January of fecal impaction, after complaining of pain for two weeks.
Simple Economics Sway Placements
"This was not a rocket science medical problem," said Dr. Jerome Lackner, who was chief health officer for California during Gov. Jerry Brown's administration and read Foley's file at The Times' request. "The remedies are small and not expensive. It requires that you care, and that you have an ability to add two and two to get four in terms of the diagnosis."
When California was paying the tab, people like Foley would have been confined to state institutions, probably for life. Counties can keep patients in state hospitals now. But they must pay $130,000 per patient a year--more than three times the cost of a bed in most privately run wards.
So simple economics lead counties to place their most severely ill patients in private facilities licensed by the state.
Despite the reliance on such operations, state officials cannot say for sure how many mentally ill people are housed in California's 1,425 licensed nursing homes. Estimates range from 7,000 to more than 10,000.
Among those homes are 45 locked, long-term facilities that have state-certified treatment programs and house about 4,700. The Department of Mental Health certification means that the owners offer some specialized therapy. In exchange, they receive the going state rate for housing indigents in nursing homes--about $90-$95 a day per patient--plus an extra $5.72 per patient per day, an amount that has not changed since 1985.
Ten of the 45 specially certified treatment facilities have received no citations since 1992. But eight have a combined 111 citations.
"I wonder why some of those places are still open," Dr. Richard Elpers, past mental health director in Orange and Los Angeles counties, said after reviewing the citations at The Times' request. "I think this is the tip of the iceberg."
'I Don't Have Any Excuses'
View Heights Convalescent Hospital in South-Central Los Angeles has received the most citations, 26, including sanctions for three deaths and an incident last year in which a staff member had sex with a patient, promising money and cigarettes in exchange.
"I don't have any excuses for anything that happened," said View Heights' administrator, David Elliot. He said the 163-bed facility has improved in the year since he arrived. But he also described a job that is not easy.
"This facility has a lot of tough people," he said of the patients. At the same time, county funding allows the facility to pay its nursing assistants only $6.50 to $6.80 an hour, he said, while counselors receive $8 to $10 an hour.
"We've been trying to get more [county money] so we can hire more people," Elliot said.
Although some facilities pay more than View Heights, wages and training at private homes still lag behind those at state hospitals. At the hospitals, psychiatric technicians must have passed an 18-month college course and are paid as much as $20 an hour. That's more than some nurses are paid at private facilities.
