"CARING" BUREAUCRATS AT WORK AGAIN

"Don't bother me" is the only goal of a bureaucrat.

Two different pictures are emerging of the Napa State Hospital in the wake of a recent scathing federal report detailing problems at the facility. The first is the image portrayed in the U.S. Department of Justice report, which describes a perilously understaffed mental hospital crawling with illegal drug use, poor supervision of suicidal and dangerous residents, and a staff too quick to restrain, medicate and isolate patients - sometimes for hundreds of hours at a stretch.

The second is the view of state mental health officials and many who work and live at the hospital, who say a previously trouble-plagued hospital is changing its ways and shifting focus to the individual needs of each patient. Some of the accusations, they say, have been overblown and taken out of context. "Nobody denies that ugly - and unacceptable - things have happened within the historic walls of the 130-year-old hospital at the mouth of the Napa Valley. "We take issue with some things (from the report)," said Stephen Mayberg, director of the state Department of Mental Health. "But there are other things that we knew and that we are trying to address and we are aggressively addressing."

The Department of Justice is blunt in its findings, detailed as "widespread and systemic deficiencies" in a 23-page letter to Gov. Arnold Schwarzenegger on June 27 that recently became public. Of particular concern, the letter states, the hospital has failed to adequately supervise suicidal patients and protect its general population from patients prone to violence. In one instance cited, staff failed to prevent a patient from hanging himself in December despite previous suicide attempts and warnings from his family that he was despondent and in need of attention. The report cites six suicides at the hospital since 1999, the most recent when a patient hanged himself in a locked bathroom in March.

In another case, a patient was strangled to death in May 2002 by his roommate, who had a history of violence and attacking sleeping patients. "Patient advocates and patients themselves tell us that staff often fail to intervene with violent patients because the staff are afraid," the report states. The report also details allegations that patients have access to marijuana and cocaine and that one patient died of a drug overdose in fall 2004. The federal agency also accused state officials of failing to cooperate with the federal investigation and of repeatedly refusing to allow access to the facility. Eric Holland, a spokesman for the Justice Department, said the agency had no comment beyond the report.

State mental health officials say they are preparing a formal response and that they had been working to cooperate. Kirsten Macintyre, a spokeswoman for the Department of Mental Health, said the hospital had been trying to set up time for federal investigators to pore over thousands of documents and interviews they sought. "The timing of this thing caught us off guard because we were negotiating with them," she said. "We've always been open and believed in transparency."

Mayberg said the state was aware of many of the problems outlined in the report, and already had begun massive staff retraining and a widespread shift in the treatment philosophy at all of the state hospitals, including Napa. They have moved toward a model that emphasizes the individual and seeks to encourage patients to interact, learn new skills and reduce the amount of seclusion, he said. "We've raised the standards. We can't say that we can predict everybody's behavior at this stage but we are building in as many checks and balances to make sure that none of that occurs (again)," Mayberg said. He said many of the problems - and the needed remedies - stem from a shift in recent years in the type of patients who reside at the hospitals to criminals who have "much more propensity toward violence."

About 90 percent of the 4,600 patients in the state hospitals now come through the criminal justice system. Most have committed violent crimes, including murder, and have been found mentally incompetent to stand trial or not guilty by reason of insanity. "There's nothing that can be said to say that we even defend or justify (the deaths and violence)," Mayberg said. "We have a very different population. The folks we are dealing with now bring a whole new set of challenges." In the aftermath of the report, officials also are making an effort to open their doors to journalists and elected officials.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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