Patients, Staff at State Hospitals Worry Coronavirus Will Wreak Havoc

As respiratory therapist Anthony Hernandez tended in recent weeks to patients ravaged by COVID-19 at a San Gabriel Valley hospital, his concern for his own son — locked in a different kind of hospital 50 miles to the east — only grew.

Hernandez’s son has been confined to Patton State Hospital in San Bernardino County, since a criminal court found him not guilty by reason of insanity after a frenzied assault on his own parents five years ago. These days, the 24 year old is doing well, his dad says, stable on medication he takes for schizophrenia.

But at Patton, the threat of an outbreak of the coronavirus looms large.

“It’s just a ticking time bomb waiting to explode,” said Hernandez, who with his wife was visiting their son three or four times a week before the visitor center shuttered last month.

In California and around the country, public officials and criminal justice advocates have raised urgent concerns about the safety of inmates and staff at jails and prisons, carceral institutions that could be overrun by the coronavirus that causes the COVID-19 illness. But there’s a lesser known set of institutions facing similar, potentially more daunting, challenges: the state mental hospitals.

The California Department of State Hospitals has been scrambling since mid-March to put protective measures in place to prevent the spread of infection. In written answers to questions, an official said the department is following the guidance of the California Department of Public Health and federal Centers for Disease Control and Prevention and “continues to plan, assess and evolve its preparedness and response due to rapidly changing circumstances.”

The 13,000-employee workforce is being screened before they are allowed to enter the facilities. Visiting has been suspended, as have most admissions and discharges. And each of the five state hospitals in the past week has established quarantine units for patients pending test results or those suspected of infection. A statewide “isolation/quarantine strike team” is reviewing those protocols. Meanwhile, staff have been directed to maintain social distancing, according to state officials, and to instruct patients to do so.

The department declined to share how many of the system’s 6,000 patients have been tested for the virus, but internal records obtained by KQED show that count at 30 as of April 8 — just one of them at Patton. None have tested positive, though two employees, both at Patton, have. So have three outside contractors working at Metropolitan State Hospital.

Despite the department’s statewide efforts, a half dozen employees, labor union leaders and several patients expressed concerns in recent interviews that the hospitals remain at risk.

“There are lapses for the staff members and lapses for patients where there are all these areas that the virus can seep in,” said Chuck Garcia, a senior psychiatric technician at Metropolitan State Hospital in Los Angeles County’s Norwalk.

Some employees interviewed for this report asked that their names be withheld, fearing retaliation if they spoke on the record. Garcia spoke as a staff union leader, chapter president of the California Association of Psychiatric Technicians.

He and others said screenings that staff undergo before entering the building are flagging only those who are symptomatic or have knowingly come into contact with someone who is ill, and that makes protective measures inside the hospital even more important.

Most movement by patients in and out of hospitals has ceased. But Garcia said ill patients who needed to be hospitalized at outside facilities have left and returned. While they were tested for the coronavirus at those facilities, Garcia said, some remained hospitalized for a long time after the test — nine days in the case of one patient — and were not retested or quarantined when they returned to Metropolitan.

“They should be retested upon returning and go straight to the isolation unit where everybody's got protective equipment,” Garcia said.

The department, citing medical privacy laws, did not respond to questions about that case.

Staff say the tests are in such short supply that symptomatic patients may be slipping through the cracks. As for employees who’ve shown symptoms, many have not been able to get tested in the community.

“You send me home. I call my doctor. They say self-quarantine,” Garcia said. “But I don’t know if I’ve actually had it or not, and if I am positive, I’ve exposed people at work. But we’ll never know who.”

While jails and prisons can confine inmates to their cells to avoid the spread of infection, the state hospitals — which also include Napa State Hospital, Coalinga State Hospital and Atascadero State Hospital on the Central Coast — cannot.

The vast majority of men and women confined in the state hospital system have been accused or convicted of crimes directly linked to their mental illness. Yet the hospitals are treatment facilities — not prisons — and patients move about freely in their units. Many employees, including psychiatric technicians, registered nurses, rehabilitation therapists and psychologists, interact closely with them daily.

Still, not all staff are taking precautions.

The hospitals only recently began issuing one surgical mask per day to all employees. Those can prevent the spread of contamination by the wearer. The N95 masks, which protect the wearer against outside infection, have been doled out more selectively to staff “working in higher risk situations” with patients known or suspected to be carrying the virus, state officials said.

Yet, according to interviews and internal emails shared by staff, wearing a surgical mask remains voluntary, except at Patton, where administrators last Thursday informed employees that a San Bernardino County public health order now requires it.

One clinician, who asked not to be named because management instructs employees not to speak to reporters, said that there were “a significant number of people who work at Patton who are not wearing masks, not wearing gloves, not practicing social distancing. People are sharing pens. You have people who are taking this extremely seriously working next to people who aren’t.”

That could prove tragic, as many patients are elderly and others have underlying health conditions due to medication side effects and poor self-care, among them obesity, diabetes and hepatitis C.

Jaime Garcia, who works at Coalinga State Hospital and is that facility’s president of the California Association of Psychiatric Technicians, said the workers he represents “are basically making a choice on whether they wear a mask or not.”

Meanwhile, he said, employees concerned that existing supplies won't last have been buying or making their own. Paul Hannula, the union’s chapter president at Atascadero State Hospital, said his wife, also a psychiatric technician, has also been making hand sanitizer at home at night to bring behind the gates.

“We are doing everything we can, all day, every day since this started to make it as safe as possible for our members,” Hannula said.

For the loved ones of patients inside the system, the uncertainty of the past few weeks has felt like forever.

“There are so many families going bananas right now because we haven’t been able to see our kids, to keep them going while they’re in there,” said Hernandez, the respiratory therapist, who asked that his son not be named to protect his medical privacy.

Instead of the three to four visits a week, complete with picnic lunches, the family must now rely on phone calls.

He told his dad that each unit gets yard time alone now, with plenty of space. But inside, social distancing isn’t happening, for patients or most staff. Treatment groups and most patient jobs have been suspended. Still, he’s doing OK.

“I like to play guitar on the unit, I like to exercise, I like to read books,” he said.

But the changes have been hard on other patients. One friend, he said, “Used to be kind of like a busy person. He has a job, but now he’s doing nothing and he’s staring at the ceiling on his bed and talking to himself. I didn’t expect him to decompensate the way he has.”

Hernandez said his son’s treatment team recommended him for release a full year ago, though he’s still awaiting acceptance to a conditional release program.

“As the family members, we want our kids out of there that don’t need to be in there,” he said, “just like what’s happening in the criminal justice system, in the jails and so on.”