Atascadero State Hospital

From the Los Angeles Times

Patient's killing shocks state hospital
Already under pressure to make reforms, the Atascadero facility is now dealing with the death of Lawrence Paul Rael. Another patient has been charged with murder.
By Lee Romney
Los Angeles Times Staff Writer

April 4, 2008

ATASCADERO, CALIF. -- — When Lawrence Paul Rael was involuntarily committed to Atascadero State Hospital 10 years ago, his parents considered the placement appropriate. 

Born prematurely and with a severe hearing loss, Rael had been in and out of mental health facilities from the time he was a child, with a tentative diagnosis of autism. At 18, he molested two boys and was sent to prison and then to Atascadero. 

"We were comfortable with the fact that he was somewhere where he was watched," said Rael's father, Lorenzo, of Rancho Cucamonga. "He was supposedly in a hospital. We thought at least that he wouldn't get hurt."

But early Sunday morning, the slight 37-year-old man was found dead in his bed with a towel around his neck -- the victim of the first homicide in the Central Coast facility's 54-year history. 

On Thursday, fellow patient Richard Earl McKee, 44, was arraigned in San Luis Obispo County Superior Court on one count of murder in Rael's death and one count of assault with a deadly weapon in connection with an attack on another patient. 

The death of Rael, who was well-liked by patients and staff, has deeply shaken the hospital. For the last two years, Atascadero has struggled to transform its approach to patient care under a federal consent judgment that mandated sweeping changes. 

The judgment applies to four of the five state mental hospitals and requires them to address issues of patient safety, over-medication and excessive use of restraints. It also calls for changes aimed at more thoroughly involving patients in their own recovery. 

In the midst of the transition, Atascadero -- like the state's other mental hospitals -- has had to contend with an exodus of experienced staff members to higher-paying prison jobs. An emergency move to raise salaries has eased recruiting woes in recent months but has brought an influx of staff members inexperienced with the criminal mentally ill who populate Atascadero. 

The hospital treats a volatile mix of patients, with hardened predators often housed with more vulnerable residents. 

Staff members have repeatedly complained that pressure from the U.S. Department of Justice to reduce the use of restraints and antipsychotic medications has contributed to an increase in assaults by patients. 

"We can't even protect our patients and that's our job," one psychiatric technician said, adding that one resident greases his face to deflect punches and pads his body by dressing in several shirts and pairs of pants. "They can't exactly get well when they're constantly in fear." 

Meanwhile, staff members contend that increased paperwork requirements have detracted from time spent building the kind of relationships with patients that can defuse violence.

The hospital's executive director, Jon DeMorales, called the death "devastating" and said the hospital is planning a "top to bottom analysis" to find ways to enhance patient safety. 

He said the hospital is considering patient-operated bedroom door locks that could protect them from predators while they sleep, surveillance video cameras, enhanced training and supervision for novice staff, and night-vision goggles to aid in rounds. 

"Our mission is evaluation, treatment and protection," DeMorales said, "and in that last regard we failed." 

DeMorales acknowledged an increase in patient violence on the evening shift in recent months and said administrators were studying the causes. Though the transition to a system of more rigorous documentation has been hard on the staff, DeMorales said, he called it the best path to improved patient care and denied that it had detracted from relationship building. 

Convicted of molesting two girls, McKee arrived from prison at Atascadero in 2005, categorized as a "mentally disordered offender," meaning he had a severe mental illness such as schizophrenia that contributed directly to his criminal behavior. Court records show that when he stopped his medication in prison he had become hostile.

Last year, a hospital spokesman said, his status was changed to "sexually violent predator." Patients said McKee developed a reputation for abusively threatening patients who he believed to be child molesters or homosexuals. 

He was bounced from unit to unit -- housed mostly with other sex offenders, who generally do not suffer from the types of severe mental illness that require intensive psychiatric care. 

Last month, McKee lost a legal appeal challenging his confinement, records show. He became increasingly distraught, abusive and paranoid, patients said. 

"A lot of guys had expressed concern about him," said Bill Langhorne, 51, a fellow patient with McKee and Rael on Atascadero's Unit 22. "He was talking to himself, making threats, pacing up and down, making lists." 

On Saturday, Rael stayed up past midnight watching a vampire movie in the unit's "dayroom" and quietly playing his Game Boy, Langhorne said. About 3 a.m., a staff member heard screams and found McKee assaulting another patient in his bed. McKee was placed in seclusion. But it was not until shortly before 8 a.m. that Rael's battered body was discovered in his room.

DeMorales said logs show that staff members conducted mandatory patient checks every 20 minutes. However, Rael's attorney, San Bernardino deputy public defender Jeff Lowry, questioned how they could have failed to notice Rael's body. More thorough patient checks were in order given McKee's assault on the other patient, he said.

"Staff totally dropped the ball," said a distraught Lowry, who described Rael as "a really nice kid" who had been nicknamed "Shaky" because of a neurological tremor. 

Patients and staff described Rael as "kind," "mild-mannered" and "benign." He loved science-fiction and Stephen King novels, his father said, and hospital records show that he tithed a portion of his meager monthly earnings from his canteen job to a North Carolina televangelist.

"He was everybody's kid brother. He was everybody's nephew," said Ron Barrett, 53, a convicted sex offender who was at Atascadero with Rael until February. "I miss that boy so much already. My heart is broken."

Posted on Sat, Mar. 04, 2006 

Investigation will follow inmate death at Men's Colony
Autopsy planned for prisoner who died Thursday
By Leslie Parrilla

An autopsy is scheduled for Monday on a California Men’s Colony inmate who died Thursday night.

Eric Dewayne Wilson, 35, lived in an area of the prison for inmates who receive mental health services. He had been at CMC since last year on a controlled substance conviction in Los Angeles County and was scheduled to be paroled in 2009.

Prison officials are handling the investigation of his death. They have not released any information surrounding the circumstances. Terry Thornton, a spokeswoman for the California Department of Corrections and Rehabilitation, said only that Wilson was not in his cell when he died.

Richard Rimmer, chief of the state Office of Correctional Safety, said that information about prison deaths or homicides is sometimes withheld because of specifics to the case, but that withholding the most basic information about the circumstances surrounding a death is not standard.

"That’s not a routine practice, to not provide basic information," he said.

Investigations inside prisons can be challenging, said Rimmer.

"You’re dealing with a felon population that isn’t necessarily going to be very cooperative," Rimmer said. "That can present some challenges. It’s a difficult population to interview."

There are also situations when investigators are interviewing a hundred inmates who witnessed a prison fight that led to a death, further complicating an investigation, Rimmer said.

Each prison has an investigations unit that handles homicides or refers them to local law enforcement or the district attorney’s office, Rimmer said. If the death resulted from an officer-involved shooting or deadly force by prison staff, an outside agency would be the appropriate unit to investigate, to avoid a conflict of interest, he said.

In mid-February, two CMC inmates committed suicide in the same mental health services living area where Wilson lived. The suicides are still being investigated.,1,2984878.story

Hospital for Mentally Ill Is Criticized
Napa Valley State is unsafe for patients and doesn't provide them medical or psychiatric care, a U.S. Justice Department report says.
By Steve Hymon
Times Staff Writer

July 27, 2005

Napa Valley State Hospital routinely fails to protect its 1,100 patients from harm and to provide them medical and psychiatric treatment, according to a scathing U.S. Department of Justice report released Tuesday. 

In one case cited in the report, a patient's family phoned the state mental hospital last December to tell nurses that the patient was "despondent, crying and in need of attention." The staff failed to act and the patient was found dead less than an hour later, hanging from a sheet in his room. 

Another patient died of hanging in March. In May, investigators cited the case of a patient who choked to death in the hospital's cafeteria without receiving proper first aid.

"It is difficult to imagine why there was no staff person with sufficient training available to avert a death by choking," they noted. 

The report also alleged that three Napa Valley patients overdosed on amphetamines or cocaine last fall, while three others obtained and used heroin. Furthermore, the report says that a hospital physician testified under oath last year that staff "brings drugs into the facility in exchange for cash."

The report, posted on the Justice Department's website late Tuesday, also said that the state Department of Mental Health had denied federal investigators access to the Northern California facility and to two other state hospitals it wants to investigate: Atascadero on the Central Coast and Patton in San Bernardino County.

"As we repeatedly advised state officials, however, our investigations proceed regardless of whether officials choose to cooperate," wrote Bradley J. Schlozman, an acting assistant attorney general, in the Napa Valley report. 

Officials with the state Department of Mental Health and Napa Valley State Hospital could not be reached for comment Tuesday night.

Much of the report was based on inspections of the hospital this year by the U.S. Centers for Medicare and Medicaid Services and the California Department of Health Services.

The Centers for Medicare and Medicaid Services report found, for example, that one patient had to wait more than two years to get a proper psychiatric evaluation.

The Justice Department and the California Department of Mental Health have been at odds for months over patient care issues at the four major state hospitals.

In February 2004, the Justice Department released the second of two reports on Metropolitan State Hospital in Norwalk. The report alleged that patients were regularly misdiagnosed and wrongly medicated and that the hospital was unsafe for patients.

Four patients have died under questionable circumstances since then, according to Los Angeles County coroner's reports, including an 18-year-old who hanged herself in late May. 

State and federal officials have been negotiating a plan of correction for Metropolitan for months but have reached an impasse. The Justice Department can sue California under the Civil Rights of Institutionalized Persons Act to force changes.

After the investigation of Metropolitan, the Justice Department turned its attention to the other three large state mental hospitals, which serve as the safety net for some of the state's most severely mentally ill. 

Correspondence between the Justice Department and the California Department of Mental Health shows that the state has tried to keep federal officials out of the other three state hospitals until early 2006. 

The letters were obtained by The Times through a request under the California Public Records Act. 

In June 2004, state officials wrote to the federal government, offering to provide patient records to investigators but asking them to avoid visits to the hospitals, saying the visits strained scarce resources. The Justice Department rejected that request in a letter dated Aug. 27.

Feds investigating alleged abuse at Atascadero State Hospital

By Kim Curtis

2:37 p.m. June 27, 2005

SAN FRANCISCO – Federal investigators are looking into allegations of abuse at Atascadero State Hospital. A patients' rights group says the abuse included overmedicating patients, overusing restraints and in one incident, a former staffer who faces criminal charges of having sex with a patient.
A spokesman for the Department of Justice confirmed Monday an investigation by the civil rights division of U.S. Attorney General Office is ongoing, but refused to elaborate.

"The investigation remains active," Eric Holland said.

The hospital, a locked facility near San Luis Obispo, houses and treats California's criminally insane as well as sexually violent predators.

Allegations of abuse by staff at Atascadero made during the last six months include improper use of restraints and misdiagnosing and overmedicating patients, according to Jeff Griffin, an investigator with the Los Angeles-based Citizens Commission on Human Rights who submitted reports to the Justice Department.

"I've got a file drawer full of signed affidavits and complaints," Griffin said.

Hospital spokeswoman Barrie Hafler did not immediately return a call seeking comment about the federal investigation.

In May, Jacqueline Lucille Collins, a psychiatric technician who worked at Atascadero from May 2001 until earlier this month, was charged with two misdemeanor counts of sexual acts with a patient at a state facility. A hospital spokeswoman would not say whether Collins was fired.

The alleged incident took place on Jan. 1 with a sexually violent predator. Men who receive that designation are considered the worst of the state's rapists and child molesters. They are diverted from prison into Atascadero, where they receive involuntary treatment until they are deemed no longer a threat to society.

Collins is scheduled to be arraigned July 14, according to the San Luis Obispo district attorney's office.

Patient John Kreischer, a convicted rapist and child molester who been locked up in prison or at Atascadero since 1987, said sex between offenders and staffers is common.

"It's going on in my unit every day," Kreischer told The Associated Press by phone Monday. "Other staff see it and don't say anything. ... It's unethical and should not happen."

But Kreischer said other aspects of the hospital disturb him more than the sex.

"I was misdiagnosed as depressed, so they prescribed me antidepressants," he said. "When you give me Zoloft and Paxil, it's like rocket fuel."

Kreischer said the drugs made him angry, agitated and aggressive and he got into trouble for punching windows and threatening staff. After three years, a doctor correctly diagnosed him as bipolar, changed his prescription and it was "like night and day."

Patients don't interact directly with a diagnosing psychiatrist, he said.

"The more medicine they can pile on somebody, the more zombie-like they are, then they can deal with them," he said. "I've never seen so much medication in my life."

While Kreischer admits he dropped out of treatment because it was "a farce" – most offenders don't actively participate in Atascadero's program – he thinks if it were run "efficiently and honestly, it would be a hell of a program."

He said he hopes the federal investigation will result in setting up an independent oversight committee for Atascadero "so there's someone checking on their procedures."

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