Los Angeles General Medical Center's psychiatric inpatient unit had the fourth-highest rate of confinement among similar facilities in the United States, newly released annual statistics show. It's the latest evidence of a persistent pattern that is worrying local leaders and mental health advocates.
Under federal law, hospitals are prohibited from restraining mentally ill patients except to prevent them from harming themselves or others. Patients are to be strapped only as a last resort if other procedures fail. Experts warn that it can traumatize patients, undermine trust and increase the risk of injury.
Public hospitals run by Los Angeles County once again had the highest inpatient psychiatric detention rates among California facilities, according to data released this week by the Centers for Medicare and Medicaid Services. The latest numbers from the federal government cover 2022.
That same year, the detention rate at Los Angeles General's inpatient psychiatric unit at the Augustus F. Hawkins Mental Health Center in Willowbrook was 48 times the national average.
That rate of suppression was far higher than that of Zuckerberg San Francisco General Hospital, a public hospital in San Francisco, and Bellevue, another large safety-net facility in New York City.
“It's scandalous,” said Erin Sacks, a law professor at the University of Southern California who has studied the use of restraint for decades. Sachs said the county needs to look into the practices of other facilities, including those in other countries, where detentions are used much less frequently.
Restraint is “a fairly widespread practice here, and it doesn't have to be that way,” she says.
The latest numbers follow a Times investigation last fall that found Los Angeles General's detention rate ranked among the highest in the nation from 2018 to 2021.
A review of county reports by the Times found 200 cases each month in which psychiatric inpatients were held for more than 24 hours, with dozens of cases lasting the equivalent of a week or more. was.
New numbers show Los Angeles General's restraint rate is closer to pre-pandemic levels in 2022. This percentage doubled from 2020 to 2021. County officials previously said efforts to curb the spread of the coronavirus at Hawkins, including canceling group occupational therapy and recreational therapy, likely contributed to the increase.
The Department of Health Services, which operates the county hospital, said in a statement that Hawkins' detention rate “reflects the need to protect the safety of patients and staff, and that the small number of extremely violent and “We are greatly affected by the number of patients suffering from cancer.” or state facilities. ” County officials have said in the past that long wait times for long-term care added to patient anxiety.
County officials also cited “required detention times to protect the safety of patients and staff during transfers between facilities.” Hawkins is located far from the hospital's main campus in Boyle Heights, which county officials previously estimated led to more than 1,400 hours spent in transit each year.
In response to the Times' findings last year, the Department of Health Services also noted that Los Angeles General is a safety-net hospital in the Skid Row neighborhood compared to other hospitals that don't accept the same kinds of difficult patients. They argued that it is not possible to rank them fairly.
Mental health experts disputed many of those explanations, pointing out that LA General's rates are much higher than those at safety-net facilities like Zuckerberg and Bellevue. Some criticized the practice of uniformly restraining patients when transferring them from one campus to another as excessive.
Following the Times investigation, two Los Angeles County supervisors publicly called on health officials to find alternatives to physical restraint for Hawkins patients.
Supervisor Hilda Solis, whose district includes Los Angeles General's main campus in Boyle Heights, said in October that she was “working to identify ways to reduce infection rates,” including bringing a psychiatric ward to the main campus. said. Supervisor Holly Mitchell, who represents the area where Hawkins is located, said she also wants the issue to be discussed publicly at the Board of Supervisors meeting.
So far, no such discussions have taken place.Solis and Supervisor Janice Hahn Lindsey Horvath did not comment on the new numbers.
Supervisor Kathryn Berger said in a statement that the newly released numbers reflect the “systemic challenges and realities” facing rank-and-file employees in the city of Los Angeles, and the Department of Health Services. I agree with the point.
“Other hospitals can turn them away, but the county can't. We are a safety net. So the most violent and severely mentally ill people end up here,” Berger said. Ta. It also said the county lacks a “network of secure psychiatric inpatient facilities that can effectively treat violent mentally ill patients.”
Mitchell said in a statement that this is a “complex issue” and that Hawkins has a higher proportion of violent and severely mentally ill patients than other facilities.
Dr. Mitchell, who visited Hawkins and spoke with staff, said it was an “outdated building that was not designed to promote health and healing, like a modern psychiatric facility” and the need for more treatment beds. expressed concern about. and a funding system that “recognizes that some patients have more acute needs than others.”
“My expectation is that DHS will continue to evaluate techniques to serve our residents with dignity and consideration and ensure that restraints are only used when absolutely necessary,” Mitchell said. concluded.
At this week's meeting, Los Angeles County Hospital and Healthcare Delivery CommissionCommissioner Barbara Siegel, who advises county supervisors on patient care, cited the Times investigation and called for the issue of restraint to be discussed at a future meeting.
“The big question is what the county is doing to achieve the reductions,” Siegel said.
Dr. Roderick Shaner, former medical director of the county's Department of Mental Health, said county supervisors should make clear to hospital officials that reducing restraints is a priority and that “the L.A. general leadership continues to “We want to be confident that we are taking this issue seriously.” ”
“External testing is very effective,” said Shaner, who worked to reduce the use of restraints in psychiatric facilities in Los Angeles County before retiring in 2018. “Just knowing that you're being watched will cause people to look for other ways.” “
Additionally, county leaders should “require hospital leadership to bring in outside experts,” said Pamela Lu, policy advisor for Disability Rights California. Lu said the best bet would be to bring in people who operate similar types of facilities, she said. “If you're just an outsider coming in and trying to tell them what to do, you might say, 'Oh, I know this is really hard, but I want you to do X, Y, and X. Have you ever considered it?”
Kathleen Crowley, executive director of the ProCoverage Institute, which provides training to hospitals to reduce the use of restraints, said she was “very disappointed” in L.A. General's statistics.
To reduce the number of patients, county regulators need to issue “clear directives” to reduce the use of restraints and consult with hospitals about what resources are needed to make that happen, he said. she stated.
Crowley said she understands why hospital officials feel the challenges make that impossible. But “I've seen it done so many times,” she said, recounting her experience at a hospital that houses people with criminal histories related to mental illness.
