News - Local

Saturday, Jul. 11, 2009

Psychiatric facility’s procedures critiqued

Grand jury recommends steps to ensure the safety of patients and to protect the county’s interests in case of legal action

Comments (0) |

Potentially dangerous patients taken to the county Psychiatric Health Facility need greater protections to ensure safety, the county civil grand jury says.

Acknowledging that they lack the expertise to make medical decisions, grand jurors nonetheless said the county needs to review its decision-making process on when to take a patient to the emergency room.

In addition, it should provide speedy toxicology screening when necessary, the grand jury wrote.

Finally, the grand jury said, videos of patients’ isolation room behavior should be kept for two years, not the current 30 days. The longer time would be “a way of assuring appropriate treatment of patients, and protecting the county in the case of legal action.”

Karen Baylor, San Luis Obispo County’s behavioral health administrator, said the department is working on its formal response.

Grand jurors investigated the processes at the facility after they received a complaint from a man who was taken there in the early morning hours of Oct. 12, 2007. The man, who was not identified, provided his medical records.

San Luis Obispo police had picked him up on a “5150 hold” — a designation for those considered a danger to themselves and others.

Witnesses said the man was running down the street threatening others and wielding a baseball bat. When police arrived, he put down the bat and went quietly, but responded incoherently to questions and “emit(ted) a high-pitched whistling sound most of the ride.”

An officer wrote that he “was incoherent. He could barely talk. He could not answer questions. He kept laughing and whistling.”

The man, “combative and uncommunicative,” was admitted. An admission form said that a day earlier he had removed a pain medication patch he used for arthritis.

The facility’s staff ordered a “regular” toxicology test that might have identified a drug reaction, but did not send him to an emergency room for an “emergency” test.

The routine test can take a business day or more, whereas emergency test results can be obtained more quickly, according to the grand jury.

Police and mental health personnel consider it “excessively time-consuming” to take mental patients for evaluation by emergency room physicians, the grand jury wrote. It can keep police off patrol for hours.

The patient spent a difficult night, at one point defecating on himself. He was given anti-anxiety medication. The county reached his wife, who was out of town, and she told them he had never had a psychotic episode. In mid-morning they released him.

Because of the 30-day time limit on holding on to videos, grand jury members were unable to witness for themselves interactions between patient and staff.

Nonetheless, the grand jury said there is no evidence to support the man’s conclusion that his treatment was abusive, degrading or life-threatening.

They added that professionals say that “deciding when a psychotic individual is suffering from a medical problem such as a drug reaction and when that individual is actually mentally ill is one of the more difficult issues they face.”

In the end, the grand jury recommended that the department review its decision-making process and keep the videos longer.

The 19-member county civil grand jury, composed of citizen volunteers, investigates complaints about county government.

Its recommendations are not binding, but the departments it investigates must file a formal response with Superior Court.