2 Investigates: John George psych hospital admins address overcrowding

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Chronic overcrowding problems at John George Psychiatric Hospital and allegations of unsafe working conditions first reported by 2 Investigates took center stage at Monday’s meeting of the Alameda County Board of Supervisors Health Committee.

Administrators from John George and Alameda County Health Care Services appeared before the supervisors to address the overcrowding problems, which have included patients eating and sleeping on mats on the floor of the hospital’s Psychiatric Emergency Services (PES) department.

Staff members described the conditions as “inhumane” and befitting "a third world country." Some told 2 Investigates that they’ve witnessed 20 patients for every one nurse, and up to 70 patients for every doctor. But officials with Alameda Health Systems (AHS), the agency which oversees John George, dispute those numbers, telling KTVU that they’re staffing ratio was four patients to every one caregiver for 90 percent of the time in 2015.

At the committee meeting, AHS administrators admitted that overcrowding was a problem and presented ideas for short- and long-term solutions, including hiring more on-call doctors, diverting patients to other local resources, and a multi-million dollar expansion proposal that stalled three years ago.

“I think this is something requires a lot of immediate attention,” said Supervisor Wilma Chan. “I think it really it an emergency and we really have to put the patients first.” Chan also pointed out that simply limiting PES’s capacity and turning patients away may ultimately end up with more people being diverted to Santa Rita Jail by law enforcement instead of receiving the mental health care they need. “We don’t want to solve one problem and create a problem somewhere else.”

Alameda County has the highest rate of 51-50 holds in the state, according to Guy Qvistgaard, Chief Administrative Officer of John George. The code refers to a California code that allows law enforcement to place a person under an involuntary psychiatric hold. Qvistagaard attributed a spike in 51-50 holds in Alameda County as a contributing factor to overcrowding at John George, but disputed claims that the increases were putting patients or staff in danger.

“We all agree that overcrowded conditions are not the best for patients,” he said, in a prepared statement to the Supervisors. “But where I part ways with our critics who say increased volume has resulted in an unsafe environment or poor patient experience, is that assaults per thousand patient hours are at historic lows.”

AHS officials provided 2 Investigates with data that showed reported assaults at rate of a fraction of a percent. Qvistgaard also referred to lower numbers of reports of patients being restrained, as well as increased satisfaction scores from patient surveys. Similarly, county Patients’ Rights Advocate Francesca Tenenbaum said her office has received only four complaints about assaults at John George since the beginning of 2016.

However, John George nurses and doctors afraid to reveal their identities told 2 Investigates that they’ve witnessed frequent and sometimes brutal assaults on staff and patients alike. Several staff members who spoke during the meeting’s public comment period disputed whether PES currently provided a safe environment for patients and workers.

“How can you be therapeutic in an environment where more and more people are being pushed in upon you? Where you feel like you have to fight. Where you feel like you are being pushed into a corner. Where if you just get a mat to sleep on the floor that’s a bonus for you for the day. To me that’s not a therapeutic environment,” said Ben Castillo, a former registered nurse who says he is no longer on the job because of a workplace assault and injury. Castillo called overcrowding a “consistent” problem at PES. “There’s no way you can help someone recover in that environment.”

Another nurse described a constant influx of patients and ambulances. “They're coming in sometimes six, seven at a time,” said nurse Ruby Sloan. “We're overwhelmed. We have to scream that we're too overcrowded before the people stop coming in.”

Alameda Health Systems says it has hired 20 full- and part-time privately contracted doctors to fill shifts, over the last three weeks. Last month, a judge denied a temporary restraining order filed by attorneys for the union representing John George’s doctors, seeking to prevent those new hires, saying it put current doctors’ job in jeopardy. AHS says it is still in negotiations with the union over its contract.

The board’s Health Committee took no action at Monday's meeting, but agreed to take up the issue again next month.