Tough Sledding: One reporter’s dogged pursuit of data from Calif.’s dangerous psych hospitals

A friend who works for the federal government once laughed when I told him I was having trouble getting interviews with scientists at a public health agency. Agencies with a mission to protect health are most guarded, he told me, because it’s so hard for them to uphold their mission.

His words resonated as I started investigating conditions at psychiatric facilities operated by California’s Department of State Hospitals (DSH). The risks facing workers at the state’s mental hospitals made national news in 2010, when a popular psychiatric technician named Donna Gross was strangled by a patient on her way back from a break. Although the longtime Napa State Hospital patient had a violent history, he’d been given a pass to walk freely on the hospital grounds.

State officials claimed they’d taken measures to improve safety after Gross’ murder, including distributing personal duress alarms and tightening screening for grounds passes.

But were those measures enough to keep workers, and the patients they cared for, safe? State facilities don’t allow reporters on the wards to interview staff or patients, outside of official tours. One psychiatrist likened the situation to North Korea. And getting access to documents, records and statistics to answer this question proved difficult.

The first logical place to look is the DSH web site, which includes links to reports and data. To the department’s credit, these reports include statistics on violence, but they are shared only in PDF, not in spreadsheets that lend themselves to analysis. When I started exploring this issue, only the 2014 Violence Report was available, which reported stats only across the system, not broken down by hospital, which could mask trouble spots.

Are measures to keep workers and patients at psychiatric facilities safe working? State facilities don’t allow reporters on the wards to interview staff or patients, outside of official tours. One psychiatrist likened the situation to North Korea. And getting access to documents, records and statistics to answer this question proved difficult.

A subsequent report came out in the fall of 2015, which did include rates by facility, but again, the reports come only in PDF. To get the underlying data, I had to file public records requests. (You can also scrape data from PDFs using tools like Tabula and Cometdocs, but they can involve a lot of cleanup.) And though I requested the records in electronic format, preferably Excel, the spreadsheets I received had problematic formatting with narrative interspersed with data on assaults that required hours of processing to get ready for analysis. 

DSH also participates in California Health and Human Service’s Open Data Portal, but don’t expect to find much there.

When agencies offer records through open data portals, as Sarah Cohen, editor of The New York Times’ computer-assisted-reporting team lead and former IRE president, told California Data fellows last year, they’re often just steering you to the information they want you to have.

For the DSH, that data does not include statistics on assaults. If officials did share that data on the open portal, the agency would be making it easier for the public to come to their own conclusions about how well DSH is fulfilling its stated mission: “Providing evaluation and treatment in a safe and responsible manner, seeking innovation and excellence in hospital operations, across a continuum of care and settings.”

It sounds like any hospital’s mission. But the facilities operated by DSH aren’t typical hospitals. These facilities, like other state mental hospitals across the country, were originally designed for civilian psychiatric patients but now serve an entirely different population.

Decades of well-intentioned policies and court decisions pushed civilian patients with mental illness out of state hospitals with the promise of treatment in the community. That promise went largely unfunded and unfulfilled, leaving many of those with the most severe mental disorders untreated. Many ended up on the streets or in increasingly overcrowded prisons.

And now state psychiatric hospitals, which were designed to treat the vast majority of mentally ill people who are not violent, have increasingly filled their beds with the subset of those who are.

In California’s state hospitals, over 96 percent of patients are forensic, meaning they come through the criminal justice system, many after committing horrific crimes. The patient who killed Donna Gross was sent to Napa after he’d been declared legally insane when he’d repeatedly stabbed a Sacramento woman, who miraculously survived.

California houses 37 percent of forensic patients in the country. Most come to the hospitals after spending time in jail, where they are unlikely to receive treatment and so are more likely to be mentally unstable. That also increases the risk of violence.

About half of assaults at the state hospitals occur within 120 days of admission, according to the DSH’s 2015 Violence Report. Since there are rolling admissions, and the other half of assaults occur throughout the year, it means that staff and patients are at risk of being attacked on any given day.

And as union reps told me, the risk of violence is not evenly distributed. Psych techs like Gross spend the most hands-on time with patients. And with 3,500 psych techs and over 2,700 assaults in a year, union consultant Coby Pizzotti told me, “It’s not a matter of if you get assaulted, it’s when you’re going to be assaulted and how severe.”

It’s well known among hospital employees, union reps and scholars that statistics on assaults at forensic facilities are routinely underreported. Workers get so used to being victims they learn to accept it, one psych tech told me. They often downplay the risks on the job so their spouses and children don’t freak out. Many are afraid to speak to reporters, fearing they’ll lose their job. Luckily, I found a psychiatrist and psych tech who were willing to speak on the record; they helped show the reader what it’s like to work in a place where fear is part of the job.

But I still had to find other data sources to check against the assault statistics I got from the state. None of these alternate sources was available on California’s Open Data Portal. All required public records requests. There are several resources to help you increase the success of obtaining records, starting with knowing what’s exempt, what to know before filing and what kind of wording to use.  The Reporters Committee for Freedom of the Press offers a state-by-state guide. Know the law before you file a records request.

Decades of well-intentioned policies and court decisions pushed civilian patients with mental illness out of state hospitals with the promise of treatment in the community. That promise went largely unfunded and unfulfilled, leaving many of those with the most severe mental disorders untreated. Many ended up on the streets or in increasingly overcrowded prisons.

Napa State Hospital has its own police department on the grounds. So I requested police logs for several years from the Napa Department of State Hospitals. I requested records on overtime worked by staff over the past two fiscal years from DSH. I requested records on worker injury claims filed against DSH for the past few years. (You can look up individual cases through the Department of Industrial Relations’ Electronic Adjudication Management System, but you need to know the name of the injured worker. You can’t do a bulk search by facility, and the state declined my request for the database of injuries, citing patient confidentiality.)

And because hospitals must fulfill federal and state requirements to keep their license to operate, I requested 2567 reports, which detail hospital inspections, along with “plans of correction” to address any findings of deficiencies, from the California Department of Public Health, which oversees licensing and certification of the state hospitals. You can find complaints about hospitals on the CDPH’s long-term care portal.

The Association of Health Care Journalists offers resources devoted to increasing transparency of hospital inspections, including a database of 2567 reports for states across the country. You have to be a member to access these resources.

It took months and months to receive all those records, as well as considerable back and forth with public information officers who would not let me talk with program staff. But it was worth the wait.

As I reported for KQED, in the years following Gross’ death, workers at California’s five state hospitals suffered on average 2,795 assaults a year, costing California taxpayers over $82.7 million in workers’ compensation claims over the past two fiscal years alone. According to the Los Angeles Times, staff at Napa State filed 289 workers’ comp claims in 2010, the year Gross was killed. Records I obtained from the state showed that over the past two fiscal years, that number jumped to 517 and 519, respectively. 

Patients committed nearly 26,000 assaults — 11,000 against staff — between 2011 and 2014, the latest year for which data is available. And over the past two fiscal years, psych techs and nurses lost more than 105,000 days of work — the equivalent of 473 full-time employees — forcing their unharmed colleagues to work over a million hours of overtime. Taxpayers paid $53 million in overtime last year for psych techs alone.

Excessive and mandatory overtime takes a great toll on staff, compromising their own and patients’ safety at work and making a mess of their home life. It would be much safer for staff — and better for patients, who stand to benefit from a more therapeutic environment — if the state had just hired more qualified psych techs and nurses, rather than forcing staff to work so much overtime at taxpayer’s expense. If you do the math, that means California’s 18.4 million taxpayers could have underwritten the 473 new jobs for less than they’d each pay for a latte at Starbucks.

Read Liza Gross' California Data fellowship story here.