LONG BEACH >> Behind the locked gates of La Casa Mental Health Rehabilitation Center on Paramount Boulevard, employees say dangerous conditions threaten the safety of patients, employees and the surrounding community. Mentally ill clients regularly escape from the 190-bed facility, recently with lethal consequences, and patients in the middle of severe psychotic episodes have struck and injured employees, they allege.
But La Casa managers insist the facility is well run and provides a much-needed service to rehabilitate the mentally ill in Los Angeles County. They say on-going contract negotiations with the facility’s newly formed employee union are to blame for employee safety complaints. And, they say, anyone who works with the severely mentally ill should know there are inherent risks to the job.
“The nature of our patients implies a certain amount of risk in treating them. Those risks don’t magically disappear when they walk through our door,” La Casa administrator Barbara Roush told the Long Beach City Council last month as the council considered a resolution in support of the contract negotiations.
Still, the employee complaints have caught the attention of other elected officials in the region, some of whom are calling for additional scrutiny of the county-contracted facility.
“This is a very serious issue for me. Having clients assaulting staff, that is a serious concern. An individual was killed not that long ago — at the Napa State Hospital — so safety is definitely a concern,” Assemblyman Anthony Rendon, D-South Gate, said, referring to the 2010 strangling death of psychiatric technician Donna Gross at the hands of a patient at that facility.
“But there is also an impact on the surrounding community,” Rendon continued. “Client escapes could have a dangerous effect on the community.”
Rendon has asked the State Department of Health Care Services to investigate safety issues at La Casa, located at 6060 Paramount Blvd.
From AWOL to dead
Patient Christian Torres, 20, was very agitated one day in May when he used sheer force to bust through the locked gate at La Casa and escape on foot.
Hours later, he was dead in police custody.
“He broke through a gate no one knew could be broken through. Yes, he was very upset. Staff was trying to calm him and finally he just broke through the gate,” said Dr. Richard Miller, who oversees patients at La Casa and other county-contracted facilities as Countywide Resource Management Medical Director for the Los Angeles County Department of Mental Health,
Hours after Torres broke out, just before 7 p.m., Long Beach Police were called to an industrial property less than half a mile up Paramount Boulevard from La Casa where two security guards had detained Torres when he entered the private property and broke into several employees’ cars, according to a police statement. Police handcuffed Torres, moved him to an open area and shortly thereafter he went into medical distress, according to the statement. Officers and paramedics attempted unsuccessfully to save his life.
The Long Beach Police Department would not provide further details on the incident, citing an open investigation.
The Los Angeles County Coroner still has not determined Torres’ cause of death.
While the consequences are not normally so severe, escapes from La Casa are common.
Last year, 29 patients escaped the facility. The number has steadily declined from 70 in 2008, but county overseers say more must still be done.
“It’s not uncommon to have a couple a month,” said Mary Marx, Countywide Resource Management District Chief for the Los Angeles County Department of Mental Health.
At the county’s request, La Casa has submitted a plan of correction to decrease the number of AWOLs.
Some escapees climb trees, some hop the fence and some just walk away when they have the opportunity while out on a supervised excursion.
“They put themselves in danger. They put the community in danger,” said licensed vocational nurse Neilanie Besana, who has worked at La Casa for five years and is pushing for increased safety precautions at the facility.
But according to Miller and Marx, most of the AWOL patients just go home when they leave and many return to La Casa within a matter of days.
Besides Torres, Miller could only recall one other situation in which an escape situation turned bad when an AWOL woman was hit by a car.
“I have never heard of any particular community issues from AWOL patients,” he added. “The individual is more at risk than the community.”
Community strain or support?
Long Beach Police are notified when a La Casa patient escapes. La Casa staff also call them when patients get violent with one another or staff. The facility was responsible for an average of 145 calls for police service every year from 2010-2012, according to Long Beach Police Department statistics. Those hundreds of calls only resulted in seven arrests, according to the department.
This is a small price to pay for the service La Casa provides the community caring for the mentally ill, according to La Casa supervisors.
“If we are not able to do it, as the only mental health rehab center in the county, then who will? The jails, the emergency rooms, the streets?” Roush said.
Ninety-nine percent of the patients at La Casa are placed there against their will by the county Department of Mental Health and a court order. Many have cycled in and out of state mental hospitals, emergency rooms and jails, suffering from serious illnesses such as schizophrenia or bipolar disorder.
They spend several months to several years at La Casa with the goal of becoming stabilized and rehabilitated enough to live in an unlocked group home, with their family or on their own. The facility works by rewarding good behavior with greater freedom. Patients first earn free access to the courtyard and later the ability to take supervised and unsupervised leaves from the facility.
For the majority of patients at La Casa, the treatment works — 85 percent of those released after treatment do not end up back in the hospital, Miller said.
“The greater risk to the community is people who are not in programs, who are not in treatment,” La Casa spokesman Daniel Danzig said. “Our folks are being managed, being helped.”
A dangerous job
But some La Casa employees say many patients there aren’t ready for the freedom and rehabilitation of the facility, where they are allowed to walk freely in common areas and interact with one another and staff.
“They keep bringing in patients that are not stable. They are still highly psychotic,” Besana said. “We don’t feel very safe from patients, and they are not very safe from each other.”
Besana was attacked by a patient who was fixated on her and struck her with a telephone. She was not injured but when she returned to work the next day, she was expected to work with the same patient, who attempted to attack her again.
“Some of the clients are aggressive, they are unpredictable. Some of them come from the county jail. The shouldn’t be there,” agreed Besana’s coworker Luz Flores.
Flores is on medical leave from her job as a mental health worker at La Casa after she was also attacked by a patient. She was attempting to stop a male patient from kicking a female patient when she was shoved to the ground, knocking her unconscious and hurting her back. She had to be taken to the hospital. Since the incident in April she has not returned to work and is seeking workers comp.
Flores, who makes $9.30 an hour, accuses La Casa of prioritizing its bottom line over safety.
Los Angeles County pays La Casa $233 a day to treat each patient in its mental health rehabilitation center. In fiscal 2012-2013, it paid the facility about $15.5 million.
Employees say they need more staff on-duty, including a security guard, and more training to handle psychotic patients. Earlier this year, they held a five-day strike to demand safer working conditions.
Danzig said La Casa screens clients carefully before admission.
“If they are too aggressive or have violent tendencies, they wouldn’t be admitted to the program,” he said.
Danzig said the facility has had only two workers comp claims in recent years related to physical injuries.
Likewise, La Casa has only reported to the county one incident this year in which someone at the facility was injured and required medical attention, Miller said. It had no such incidents last year and two in 2011.
In addition to these issues, Rendon’s request for an investigation into the facility also raises concerns about broken and missing equipment and inadequate food and supplies provided to patients.
In June, state regulators determined that La Casa was violating laws regarding employee training and drug ordering, but those problems have yet to be remedied, according to Rendon’s complaint.
While the county contracts with La Casa, the state’s Department of Health Care Services licenses the facility and is responsible for ensuring it follows state law.
Officials from DHCS said they are reviewing Rendon’s concerns and wouldn’t comment specifically on La Casa. They said such facilities are visited and reviewed annually.
