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2 Psychiatric Facilities Criticized

Escapes, assaults and patient-care violations are reported at the L.A. County institutions.

March 07, 2003|Charles Ornstein | Times Staff Writer

Los Angeles County is paying millions of dollars to house seriously mentally ill patients at two locked psychiatric facilities beset by escapes, assaults and patient-care violations, according to records and interviews with county officials.

Last year alone, at least 50 residents escaped or attempted to flee from the Foothill and Sylmar health and rehabilitation centers in Sylmar, according to the county Department of Mental Health. In the fall, one Foothill escapee was arrested on suspicion of battery after two weeks on the lam.

Earlier this year, a Sylmar employee had sex with a 23-year-old female patient, prompting his dismissal and a county investigation. Patients also assaulted other patients at each facility, leading to one arrest.

Partly because of the pattern of escapes and assaults, L.A. County has stepped up oversight of the privately owned centers and prepared contingency plans to move patients if problems persist.

"Since last November, we've had somebody there just to make sure that a disaster of immense proportions is ... not taking place," said Marvin Southard, director of the county Department of Mental Health.

On Thursday, the county and state launched surprise inspections of Sylmar and Foothill, in part because of inquiries by The Times about conditions there, Southard said.

Robert Sherman, an attorney for the facilities' owner, Golden State Health Centers Inc., said both centers have "a record of success" over many years despite occasional complaints.

"We do a tremendous job with the patient population, and the county recognizes it each time they renew a contract," he said.

Inspectors for the county, which has contracted with the centers since 1987, have consistently documented assaults and other deficiencies there since at least 1998. During those five years, the county has paid Sherman Oaks-based Golden State nearly $41 million, including $8.9 million in the fiscal year ending in June.

In June and again in December, the Board of Supervisors extended the county's contract with Sylmar and Foothill for six months instead of the usual three years because of recent problems cited by county inspectors.

In an October memorandum recommending the latest extension, directors of the departments of Mental Health and Health Services wrote that it "is troubling ... that problems, especially in the area of staffing and supervision, show no improvement over the past year."

But the department directors recommended against canceling the contract outright in view of the "poor impulse control and extreme sexual acting-out behaviors" characteristic of such seriously ill patients.

Among the violations and penalties listed in an attachment to the memo was a $3,000 fine by the state in September against Foothill for failing to protect a 33-year-old female patient from being raped by a male patient.

The citation quoted the woman as telling investigators: "I tried to stop him but he would not. I cried for help but no one came." The man was arrested.

A hearing officer with the California Department of Health Services upheld the fine in November. Foothill has appealed.

'A Short Leash'

In a recent interview, Supervisor Zev Yaroslavsky, whose district includes the centers, defended the contract extension. "I think that the county acted responsibly in keeping them on a short leash and determining exactly what ... the seriousness of the problem is," he said.

In fact, nearly all facilities treating seriously mentally ill patients have some problems with escapes, assaults or patient-care violations. It is the number and degree of deficiencies at Foothill and Sylmar that concern authorities.

The two centers, which stand beside each other on Foothill Boulevard, are among 12 centers in Los Angeles County called Institutions for Mental Disease. The facilities are essentially state-licensed nursing homes for psychiatric patients, less restrictive than acute-care hospitals but more so than unlocked group homes. Patients are confined inside but are able to move about the facilities and sometimes are allowed out on passes.

'Close Supervision'

Such centers house patients who, because of such illnesses as schizophrenia or bipolar disorder, need close supervision. Demand has increased markedly as state hospitals have emptied their mental wards.

Sylmar and Foothill collectively house about 400 patients at a time -- 180 placed by L.A. County and the rest by the state, other counties and the U.S. Department of Veterans Affairs.

Some patients have been committed by conservators; others have been diverted from the judicial system after committing minor crimes. A minority, placed by the state and housed under tighter security, have been found not guilty of serious crimes, including murder, by reason of insanity.

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