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But the conditions at Psychiatric Emergency Services suggest that there has been a stagnation in Contra Costa's mental-health services. The grand jury report and other documents and emails obtained by the Express demonstrate that agency administrators have misrepresented the facts, cited vague and obstructive regulations for expediency, withheld data about controversial and dangerous treatment practices such as mechanical restraint, and targeted certain employees for retaliation.
While the problems at Psychiatric Emergency Services seem intractable, the documents suggest they are primarily the work of one administrator, Chief Operation Officer and Chief Financial Officer Patrick Godley, an accountant with no medical or mental-health training, who has nixed all nascent proposals to remove minors from Psychiatric Emergency Services.
Psychiatric Emergency Services was originally designed to hold 14 to 20 patients per day. It now holds double that amount on a regular basis, according to a 2017 white paper report jointly prepared by the Mental Health Commission in tandem with Behavioral Health Services. And the number of patients who visit Psychiatric Emergency Services annually is steadily increasing.
From 2007 to 2010, the median number of patients was 6,727. But between 2014 and 2019, the median has increased to 10,511 patients. Annual patient volume has leveled off the past few years, but with patient sleeping on the floor and children and adolescents staying longer than the legal 23 hours, the building has little to no room to grow.
There is some evidence of correlation between overcrowding and the increase of aggressive acts including physical violence. During 2019, there was a high of 764 adult patients and 64 youth patients during April. That elevated attendance coincided with 12 incidents of youth aggression, the highest for the year, according to Behavioral Health Services numbers.
Dr. Zeller, who now consults hospitals on the development of crisis stabilization units for the Emeryville-based medical company Vituity, said it's very difficult to raise quality of care for psych patients because they are typically a low priority on most hospital campuses. Psychiatric trauma is not obvious, there's no blood, no broken bones and you can't see the conditions in an X-ray, Zeller said. "For many people, just putting these patients away somewhere is enough."
Furthermore, he noted, psychiatric patients and their families are typically not likely to show up at supervisors' meetings and medical committees to lobby for improved services, which adds to their anonymity and makes it easier for hospital administrators to ignore bad conditions and substandard treatment.
In 2015, an opportunity presented itself to ease the pressure on Psychiatric Emergency Services. A wing of the hospital known as "4-D" was vacant. It seemed to advocates like a good opportunity to improve the conditions for patients at the facility. The wing was used as a locked psych ward at one time, and it had been unused for years. A group of stakeholders led by Vern Wallace, then the chief of the hospital's Behavioral Health Child and Adolescent Program, began putting together a plan to resurrect 4-D as a 10 or 20-bed inpatient unit for youth.
"We were all excited about the prospect of opening an inpatient facility in 4-D," McLaughlin said. "Vern felt like he had the support of the administration and he worked with children's advocates, mental-health advocates, hospital staff, the various committees. It looked good."
The first step of the plan was to conduct a financial feasibility study, which was undertaken by Wallace, a highly respected county employee who had most recently overseen the development of the Children's Mental Health Clinic in Antioch. Wallace did exhaustive research on the daily cost of beds, average length of stays in the state, cost of salaries and benefits to run the unit on a 24/7 basis, plans for healthful activities such as art classes, and even a meal schedule. His financial forecast was quite rosy.
According to his data, start-up costs such as retrofitting, supplies, and durable goods would have been paid for through the Mental Health Services Act. Consequently, he believed, the facility would actually have saved the county a good deal of money, provided that any excess beds that weren't being used were leased out to nearby counties also experiencing an acute shortage of inpatient beds. Wallace had also generated interest in dedicated beds from the counties of San Francisco, San Mateo, Alameda and Marin as well as Kaiser Hospital. He estimated that full occupancy would have saved the county $1,719,350, including the money saved from farming out county patients to other counties, where patients are isolated and family members often have difficulty visiting or participating in family meetings with doctors and nurses. But even at just 85 percent capacity, he projected that the county would have saved money.
But Patrick Godley immediately killed the report, buried it without any written analysis and little comment. Then, according to a series of emails obtained by the Express, Godley put a plan in motion to undermine Wallace and "side line him."