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WILL COST TAXPAYERS MILLIONS
With the placement of the California Department of Corrections ("CDC") under receivership by a federal judge in June, 2005, the media has now made the public aware of the abysmal state of medical care in the California prison system. The public also should be made aware of the substandard medical care being provided the mentally ill in California's State Hospital System. As the media has reported, the Department of Justice and the Commission on Human Rights have ongoing investigations underway of allegations of civil rights violations at Atascadero State Hospital ("ASH"), a facility operated by the Department of Mental Health ("DMH") which houses patients such as mentally disordered offenders, those not guilty by reason of insanity, and sexually violent predators. Allegations of substandard medical care at ASH is just one of the issues being investigated, but is probably one of the most important as substandard medical care can result in unnecessary deaths. Poor medical care can also cause unnecessary pain and suffering, and in the long run, will eventually cost the taxpayers unnecessary spending. After all, prevention is almost always more cost effective than delayed repair. In addition to the federal investigation into ASH, the patients themselves have in process a class action lawsuit in federal court. The case could potentially result in the DMH facing the wrath of a federal judge just as happened with the CDC. Could the DMH possibly be placed under a very costly to the taxpayers’ federal receivership? Most of the same contributing components also exist within the DMH. The DMH has a rapidly growing patient population. The State has been unwilling or unable to adequately fund the growth. The infrastructure and resources have not grown commensurate to the patient population growth. The staff shortages are acute. The list goes on. Time and time again throughout history, government operated mental institutions have been exposed as little more than dungeons to warehouse societies mentally ill. The public will rant and rave for a short time, but be unwilling to provide the long-term funding to make real changes. Because of the substandard medical care, the CDC was recently called a dungeon by an expert in the field of corrections. The DMH suffers the same medical care problems and inadequacies as does the CDC, and also has a long history of being compared to medieval dungeons. There are reasons for this. The federal judge placed the blame on management, and praised most of the first level CDC medical care providers. Interestingly, it appears that the same situation also exists at ASH and probably throughout the DMH facilities. Several of the medical doctors employed by the DMH are former CDC doctors. Their official reasons for the move are unknown, however, they are quick to state, "The CDC did not allow me to practice medicine." They elaborate that they were not allowed to provide necessary medical procedures or intervention in a timely manner - if at all. Although contrary to state law, ordered medical treatment was often disallowed by low level custody staff. The double whammy of both management refusing to authorize medical procedures and low level custody staff overriding medical orders was simply too much for these doctors. Most of the same problems also exist within the DMH. It takes approximately six months to have management approve a surgical procedure, and often the DMH management simply will not approve procedures allegedly based upon lack of funding. Lack of funding is simply not a good enough excuse. The United States Supreme Court held in DeShaney v. Winnebago, (1989) 489 U.S. 189, that when a state incarcerates a person that the state has an affirmative duty to provide for that person's basic needs. One of the basic needs listed was medical care. The Supreme Court explained that the rational behind this requirement was based on the principle that when the state involuntarily takes a person into custody, the state has removed that person's ability to care for himself and thus the state has a duty to provide that care. If the state does not provide that care then the person will not receive medical care. Such is the case with both the CDC and the DMH. Those incarcerated by either agency will not receive medical care if the agency refuses to provide such care. This principle underlies the problems presently existing within both agencies. The CDC has now been called to task -- the DMH is next. An example: Approximately two years ago, 65 year old ASH patient Michael Dodele was rushed to a local public hospital with severe chest pains. The first level ASH staff did an exemplary job in dealing with the emergency. What initially appeared to be a heart attack, was eventually diagnosed as something else. The symptoms of a heart attack are shared with several other maladies, and only testing will define the true problem. In this case, Dodele was ultimately diagnosed with a Hiatal Hernia. The treating doctor recommended immediate surgery, but the DMH refused to allow the surgery. Subsequently, 'the first level medical doctors at ASH recommended the surgery be scheduled, again the DMH management refused to authorize the surgery. On July 7, 2005, Dodele began having chest and stomach pains. He laid down in his bed and immediately the pain turned extreme. As before, the first level staff did an exemplary job in their response. The first level ASH doctor made preliminary tests and recommended he be checked out at Twin Cities Hospital in Paso Robles. In the Twin Cities Emergency Room ("ER"), Dodele was observed and tested for approximately four hours, and was then admitted to a regular hospital room (212). Continued testing and monitoring was done until they determined the problem was not cardiac in nature, but was the same old Hiatal Hernia. Again the Twin Cities doctor recommended immediate surgery, and was poised to do the surgery right then and there. The paperwork process was begun, and again the DMH management at ASH refused to authorize the surgery, allegedly stating that they don't have the money and it takes four to six months to get approval. Dodele was then taken back to ASH without his medical condition being repaired. Much like the CDC guard interference with prescribed medication documented by the investigator for the federal court, Dodele reported a similar interference from the ASH Department of Police Services ("DPS") Officers sent to guard him. In a Penal Code Section 832.5 Complaint Dodele is preparing to file, Dodele alleges that at various times during his stay in Room 212 at Twin Cities Hospital, as many as six DPS Officers would congregate in his room for long periods of time drinking coffee and soda pop and eating. When interrupted by the Twin Cities nurse attempting to administer prescribed medication, the DPS Officers denied Dodele his medication, telling the nurse to get out of the room and not come back. The nurse did come back, and she brought an armed hospital security officer who threatened to eject the DPS Officers from the room if they continued to interfere with the administration of prescribed medication. Later, when Dodele attempted to obtain the names of the interfering DPS Officers, they refused to identify themselves and turned their picture Identification Card Badges around facing backwards so their names could not be read. In a non medically related show of defiance to Dodele's civil rights, the DPS Officers refused to allow Dodele a telephone call to his attorney even though their sergeant had previously issued written authorization for this call. Examples such as this one show that the arrogance of some DPS Officers in following the directions of medical professionals, and of their superiors, is no different than what the federal courts documented against CDC officers. Not only should the taxpaying public question how long this man should be forced to suffer, but also the costs of repeated emergency trips and overnight stays to the hospital. Not only does the state have to pay for the medical costs of this trip, but also for around-the-clock security personal to guard the patient. Since the hospital doesn't have a legal leg to stand on, eventually the legal system will force the DMH to provide this surgery, so also legal costs will be added to all the other costs. Therefore, it would appear that all of the costs associated with this medical condition following the first episode are unnecessary costs, which could have been avoided. This situation is typical, and there are over 1500 patients at ASH. How many millions of taxpayer dollars are thus wasted through the prevalent denial of medical care at ASH and probably throughout the DMH? There are many deaths per year as ASH. How many of these deaths were preventable had timely medical care been provided? Tom Watson
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