Jury’s Mental Hospital Report Assails Forde

The San Diego County Grand Jury on Wednesday blasted the county’s management of the Hillcrest mental health hospital, saying that the performance of Health Services Department Director James Forde should be reviewed immediately.

The hospital suffers from an unclear chain of command, lax supervision and poor record-keeping, the grand jury said. Doctors either refuse to accept patients who belong at the hospital or fail to care properly for those who are there, the jury said.

The jury said it found records documenting “incidents of sexual activity” involving patients at the community mental health hospital, known as CMH, as far back as July, 1983. The panel suggested that some of the instances of sexual activity “may actually constitute rape.”

“It is apparent to the jury that the director of Health Services and his top staff are out of touch with what is going on at CMH,” the grand jury’s report said. “It is further evident that the director and his top staff had no intention of looking into the problems at CMH until the public, the press and grand jury brought the problems to their attention.”

Clifford Graves, the county’s chief administrative officer, said the grand jury report contained almost no new information.

“I recognize a lot of things that have already been taken care of and others that were identified in my proposal to the board,” said Graves, whose own performance was the subject of a critical grand jury report a week ago.

Graves on June 10 unveiled a comprehensive, $1.3-million plan aimed at turning around the troubled Health Services Department by adding new administrators and line employees and reorganizing the department’s chain of command. But with Graves’ own future as the county’s top administrator due to be decided by the Board of Supervisors next week, there has been little reaction to his ideas for curing problems many believe he could have prevented.

If the grand jury’s report broke little new ground, it did provide details of allegations that had been made only in a more general way before. Specifically, the jury said its eight-month investigation found:

- Improper medical practices. Patients were inappropriately released from or refused admission to CMH, and there were cases in which patients ordered to CMH by the courts were not admitted. Doctors at CMH on the night shift often leave orders that they not be disturbed, leaving their chores to the nurses on duty, the report said.

- Unlicensed employees. In one case, the department fired the program manager for CMH after the grand jury pointed out that she did not have the credentials required for the job. A month after the employee was fired, the grand jury learned and told the Health Services Department that the employee still had keys to CMH.

- Sex involving patients at CMH. The grand jury cited a computer print-out titled “Adverse Incident Report for 1984” which it said documented “incidents of sexual activity since April, 1984.” Other handwritten and typed material documented incidents as far back as July, 1983. “Many incidents are listed as occurring in patients’ rooms; however, some are documented as having taken place in the day room, music room, patio and kitchen,” the report said. “The ‘mental condition’ of the patients involved is listed as ‘confused, poor contact, disoriented, depressed, sleeps a lot, or slow-witted.’ It does not appear that these incidents involve two consenting adults, and in some instances may actually constitute rape.”

- Sloppy administrative practices. The jury said it found discrepancies in the recording of diagnoses and medications given to patients who died at CMH. “Discrepancies were also noted concerning time of death, day of arrival, requests for emergency cardiopulmonary resuscitation . . . and progress notes.”

In addition, the jury said, its members who toured the hospital found blank drug prescription forms left in unsecured areas. The forms, some of which were collected by the jurors, included physicians’ names, states and federal license numbers.

“This lack of security is an unacceptable practice, particularly in a setting with the mentally unstable,” the report said.

The jury had harsh criticism for Forde. The report said the embattled health services director told the jury he believed that all the allegations about CMH had come from one disgruntled employee.

“San Diego County must have a director of health services who is able to provide leadership and sound management direction, and who has the will to step forward with sound recommendations for improvements . . . before the situation becomes so critical that the department is inundated with daily crises,” the report said.