Vista del Mar psychiatric hospital may soon get privileges restored after suspension

Seven months after suspending the authority of a local psychiatric hospital to admit involuntary patients because of major problems, including deaths and medication mix-ups, Ventura County officials are finalizing a plan to safely restart admissions.

County officials have not shared details of the plan that's still under review, but said they will on or after Tuesday with both management of the Vista del Mar Hospital and the public. A week later on May 21, the Ventura County Board of Supervisors is due to weigh reinstatement of the hospital's privileges for the involuntary patients who accounted for half of its admissions.

"We anticipate that Vista del Mar will have an opportunity to have its designation reinstated by the end of this month," the board's chief legal counsel, Tiffany North, said Thursday.

The county's top mental health official, Loretta Denering, removed Vista del Mar's authorization in October, citing repeated failures and lack of progress in correcting them. But she said early on that the private Ventura hospital could regain the designation if it made necessary improvements. To do so, it had to meet a 15-page set of standards for Ventura County hospitals allowed to treat involuntary patients under a landmark law known as the Lanterman-Petris-Short, or LPS, Act.

The law sets out the limited conditions under which patients can be treated against their will because they are in danger of harming themselves or others or are gravely disabled.

Denering cited issues arising directly after patient discharge as well as during hospitalization in a letter advising hospital CEO Colton Reed of the suspension last October.

She said two patients died within days of discharge, one patient was released with another patient's medications, five patients were restrained or secluded without a doctor's orders and a patient's allegation of rape within the hospital was not reported. Additionally, several patient units were operated without the required level of staff, she said.

Reed said earlier this month that he believed the hospital was ready to regain the designation.

Vista officials have submitted written materials showing how the facility meets the standards and shared improvements the hospital has made with the county's Behavioral Health Department, he said.

"At this time, we have completed all the steps they’ve outlined to this point and are currently waiting on their determination," Reed said. "We feel confident in our position to regain our LPS designation and being able to resume serving this population for our community. We have made and sustained necessary improvements over the last year and a half to best serve and meet the needs of our patients."

Those improvements include updated processes and procedures plus extensive amounts of staff training and retraining, he said.

Inspecting the record

The Star asked to inspect the hospital's application for reinstatement, which consisted of three binders of materials including policies, procedures, correspondence and bylaws. Vista sued for a court order to stop the county from releasing the materials to The Star as public records, arguing they were exempt because they consisted entirely of private documents of a privately owned and operated hospital.

But the county released them after a judge denied Vista's request for a court order in April. Some records contained notations showing that certain policies had been altered after the suspension, but did not show how.

County officials declined to say what they thought of Vista's application and whether they were looking for changes in implementation as well as policy. They also declined to say what specific changes they are requiring if the hospital goes back into full operation or how the county would follow through to make sure they were implemented until the plan is released.

North said county officials are "looking very carefully and moving very deliberately" on various requirements in the plan. Included are patient safety, patient care, staff training and reports that Vista will be required to make to the county, she said.

County officials said they had reviewed the 1,000 pages of materials and directed a team of experts and behavioral health staff to review the information as well as documents from state investigations conducted at the hospital. They also shared the experts' opinions with hospital officials so they could respond to them and invited community members to comment on their experiences with the hospital.

County officials considered how to give community residents access to the hospital's inpatient care while also protecting patient rights and keeping involuntary patients admitted to the hospital safe, according to a prepared statement.

"Our goal throughout this has been to provide a process that is fair to (the hospital) that also takes account of the seriousness of the events that have taken place at the facility under the current management, and our responsibility to the vulnerable patients under involuntary commitment," the statement says.

Kelly Long, chairwoman of the Board of Supervisors, said safety and care of patients will be of utmost importance to her when the board considers the next step.

"I am looking at paths forward and that will be heavily weighed in any decision for me," she said.

Shortage of inpatient psychiatric beds

Both the board and mental health advocates supported the suspension last October based on patient safety concerns and despite a recognized shortage of inpatient beds in the area.

Ventura County has 43 beds on the campus of Ventura County Medical Center with another 55 available at Vista for a county of 850,000. The shutdown further restricted the supply and officials predicted it would lead to more patients being shifted outside the county for care in a psychiatric hospital.

That appears to have materialized.

The number of mental health patients being transported outside the county has averaged four a day since the suspension went into effect a little over six months ago in mid-October compared with a daily average of three patients in the prior five months, according to the county agency overseeing ambulance services. Over a six-month period, that increase could translate into scores of patients.

Health Care Agency spokeswoman Ashley Humes said many factors play into the figures both before and after the suspension and that the officials could not attribute it to any single cause without more analysis.

Janis Gardner, chairwoman of the county Behavioral Health Advisory Board, said the entire panel agreed with the suspension because of the seriousness of the findings. Still, it is a deplorable situation when patients grappling with serious mental health crises have to leave the county for care, said the longtime member of the lay board that evaluates mental health needs and makes recommendations on funding.

"It could be a very big burden on the family," she said. "It is unfortunate that this happened at Vista."

Liz Warren, executive director of a client-run advocacy group called The Client Network, said major questions must be answered before the beds for involuntary patients are reopened.

"I would want to know exactly what the plan of corrective actions is, how they're going to protect client rights going forward, how they are going to keep these horrific events from happening again," she said.

Additionally, she wants to make sure the county has adequate oversight and accountability in place for Vista del Mar. Warren, who also sits on the advisory board, said she's concerned that was lacking based on the findings against Vista.

Located in Ventura, Vista del Mar is a private, for-profit hospital that admits adults and adolescents both on an involuntary and voluntary basis. It is the only psychiatric hospital in Ventura County that admits adolescents ages 12 to 17. VCMC's admissions in the Hillmont Psychiatric Center are restricted to adults.

Reed, Vista's CEO, said admissions of voluntary patients have remained stable and that the hospital continues to be licensed and accredited. But the suspension has had a large impact on the facility, half of which was occupied by involuntary patients, he said.

He said the hospital worked to protect core staff during the suspension while reducing the number of people working on contracts when their agreements expired. He said no one has been laid off from the staff of approximately 150.

He has declined to comment on Denering's findings or to say who is ultimately to blame for the problems.

Kathleen Wilson covers courts and local government issues for the Ventura County Star. Reach her at kathleen.wilson@vcstar.com or 805-437-0271.

This article originally appeared on Ventura County Star: Vista del Mar hospital could be reinstated for involuntary patients