.How Finances Trumped Treatment for the Mentally Ill

A Psychiatric Emergency in Contra Costa County — Part Two

After months of collaboration between mental health commissioners, patient advocates, and hospital workers, a proposal to re-use an empty hospital ward to remove children from Contra Costa County’s violent and chaotic psychiatric facility was summarily squelched in 2016 by the hospital’s finance chief.

The empty ward known as “4-D” seemed to offer a promising solution to the growing problem at the county’s Psychiatric Emergency Services department — a crowded and dangerous facility that houses adults and children together. A feasibility report prepared by the chief of the children’s program, Vern Wallace, showed potential budgetary savings for the hospital by opening a new impatient ward for behaviorally troubled youth.

“We were all excited about the prospect of opening a new inpatient facility in 4-D,” former Mental Health Commissioner Kathi McLaughlin said. “The children’s program chief felt like he had the support of the administration and he worked with children’s advocates, mental health advocates, hospital staff and various committees. It looked good.”

But with little ceremony or public explanation, hospital finance Chief Patrick Godley declared Wallace’s report was not feasible, and killed the project.

Now, four years later, the overcrowded psych ward has become more dysfunctional and more violent. Instead of creating a safe harbor for troubled and pained minds, the facility breeds aggression, chaos and violence. Traumatized young people experiencing debilitating anxiety and severe depression are just as likely to have their symptoms aggravated in the chaotic facility, rather than soothed.

Psychiatric Emergency Services saw a 68 percent rise in aggressive incidents during 2019, including physical violence and property damage, according to statistics recently released by the county. Meanwhile, a grand jury report last year warned of serious unresolved issues at the facility: overcrowding, chaos, violence, staffing shortages, little to no access for families, patients regularly sleeping on the hallway floors, and emotionally vulnerable children sharing hallways and waiting areas with volatile adults.

Wallace had examined two potential options for separating juvenile patients from adults — one for a 20-bed facility and the other for 10 beds. According to his report, start-up costs such as retrofitting, supplies, and durable goods would have been paid for through the Mental Health Services Act. Consequently, the report claimed that the ward would have saved the county money provided that its unused beds were leased out to public hospitals from nearby counties, which also are experiencing an acute shortage of inpatient beds for children and adolescents.

Wallace had generated interest in potential bed leases from the counties of San Francisco, San Mateo, Alameda and Marin as well as Kaiser Hospital. Wallace estimated that full occupancy for a 10-bed program would have saved the county $1.7 million per year, including savings from Contra Costa County no longer having to lease roughly five inpatient beds daily in other counties. Even at 85 percent capacity, Wallace projected the county would save money.

Godley was not impressed. He said there were no contracts in place for bed leases and that Wallace’s report underestimated the hospital’s staffing requirements. He also asserted that the county’s need for inpatient beds was simply not high enough to justify the risk of opening a children and adolescent’s ward. “It was more like bar room talk,” Godley said of Wallace’s report. “Once I saw it, I gave it like two minutes of evaluation and ended it.”

The exact reasons that Godley killed the project are not entirely clear. He did not write an evaluation of Wallace’s report so there is no formal rationalization for his opinion that the proposed plan was unsalvageable.

Dr. Scott Zeller, the chair of the National Coalition on Psychiatric Emergencies and a consultant who has helped develop more than 20 psychiatric crisis stabilization units, described Godley’s response to Wallace’s proposal as not unusual.

“All the hospitals I go to, inevitably there’s one administrator that uses the same tired Field of Dreams reference: ‘I’m worried if you build it, they will come.'” Zeller said. “Meaning ‘we don’t want too many of those people on our campus.’ Guess what, they’re already here, and you’re just stacking them in the back room. What we’ve shown if you improve the system, there’s rarely unwanted inquiries. Instead you’re providing much better service and finding alternatives for these folks, which benefits everybody.”

Godley claimed there were no contracts to lease beds in place, but Zeller noted that no hospital is going to lease beds in a project that is years away from opening its doors. McLaughlin said Godley’s other stated objections to the plan seemed more like fixable details than deal-killers.

Even Godley himself admitted at a 2017 Mental Health Commission meeting that the plan would be worth considering if the cost of staffing was shared. “Yes, if our county can partner or get another county to commit, we can reconsider the possibility,” he said.

But instead of exploring further options for the empty hospital wing, or continuing to seek out partners for an inpatient facility in 4-D, Godley shut the effort down. And then he took steps to push Wallace out and gain greater control of the Mental Health Commission, which had supported the therapist’s plan.

In an April 26, 2016 email that Godley wrote to Hospital Director William Walker, he laid out a plan that could be interpreted as retaliatory toward Wallace and the Mental Health Commission. “Find a new ‘chief deputy.’ Layer over Vern and side line him.”

In the same email, Godley also laid out a plan to restructure the Mental Health Commission, which by some accounts, had become dysfunctional. “Meet with CCounsel [County Council]. Validate what we can or cannot do to develop a more functional Commission. Sell it to the Board. Maybe have only the CAO [County Administrator’s Office] or HSD [Health Services Director] screen and make recommendations to the Board for appointment.”

The result of the project’s cancellation was that the Mental Health Commission and various sub-committees never again discussed Wallace’s proposal to move children and adolescents into a safer ward. Nor did they ever discuss any new proposals to move minors out of Psychiatric Emergency Services.

“Anytime the children and adolescents were brought up, we were told ‘hospital staff was working on it,'” McLaughlin said. “Then we were patted on the head and told what a good job we were doing. It was bullshit.”

Hospital administrators have since put forward three options for remodeling Psychiatric Emergency Services. Yet none of the options removes the children and adolescents from the obsolete, windowless facility.

“I hope it isn’t another red herring,” McLaughlin said. “I would rather see the children moved to someplace healthy and safe.”

Godley has no medical or psychiatric training, and is not even a Contra Costa County employee. Rather, he is an accountant whose firm contracts with the county for an undisclosed amount.

He also seems to have an apparent lack of empathy for the kinds of patients and families served by Psychiatric Emergency Services. That attitude was on display in an unrelated 2016 email in which Godley appeared to mock the mother of a boy who suffered from severe psychosis. In a Jan. 2, 2016 San Jose Mercury story about a shortage of emergency beds for children experiencing psychiatric crisis, Alison Morantz, a Stanford law professor, referred to her son by using the affectionate term “polka-dotted swan.” Godley emailed the story, along with a snide comment about the pet name, to then Hospital Services Director William Walker. In a recent interview, Godley described the email as “just a joke.”

Despite his attitude, Godley does have substantial influence throughout the hospital. Even Health Services Director Anna Roth, Godley’s superior, defers to him as “Mr. Godley.” Many committee members and hospital employees claim new projects must first have Godley’s approval or they don’t happen.

Some county officials credit the dapper Godley as being a miracle worker when it comes to finding money for popular hospital programs. He is valued by the Board of Supervisors for staunchly holding the line on hospital spending, which is critical for Contra Costa Health Services because the hospital is always operating at a financial loss.

Psychiatric Emergency Services is the last stop in the county for people suffering mental health crises and Godley is largely credited with keeping its doors open. “He has done some amazing things in terms of finding money for important projects,” Supervisor John Gioia said. “There are a lot of people who are very grateful for the work he’s done.”

When Godley killed Wallace’s proposal to open 4-D as a children and adolescents inpatient ward, he may well have saved the county money. But at what cost?

Answering that question is difficult due to the reluctance of hospital officials to provide the public with information, even as conditions for children and adolescents at the facility have worsened.

With regard to the proposal that Godley suppressed, the county’s most recent civil grand jury report recommended that “The Board of Supervisors should consider directing Contra Costa Health Services to investigate the use of the Medical Center’s vacant wing (4D) as a temporary holding area for children and adolescents waiting for long-term placement in other facilities by December 31, 2019.” Yet the administration’s response was so terse it bordered on petulant. “The recommendation will not be implemented due to regulatory restrictions.” Despite repeated requests from the East Bay Express to spokesmen, administrators, and Godley, no one in the hospital administration could identify what those “regulatory restrictions” are.

A more serious issue is that the hospital has refused to disclose how often it uses mechanical restraints on patients in Psychiatric Emergency Services. With a 68 percent increase in aggression, there is likely a corresponding rise in the use of mechanical restraints.

When used on children, restraints can be particularly dangerous. According to a 2017 story published in Psychiatric Annals, 140 U.S. patients died during the 1990s while being subjected to mechanical restraint. Many of the victims were children who were asphyxiated by chest compression or by being left in a fatal position.

When mechanical restraints are used, health officials are required by state law to monitor and record blood pressure, respiratory rates, and length of time in restraint. For example, because children are the most vulnerable to injury and death from mechanical restraints, they cannot be kept in restraint or seclusion for more than an hour without a renewal order from physician or licensed practitioner.

And that information is considered public provided the identities of the patients is withheld. However, the hospital administration has refused to disclose any information about its use of restraints including how often restraints are used on children.


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