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From Los Angeles Times

Owner of Pasadena's Las Encinas Hospital accused of applying lax standards at its Chicago facility

University of Illinois review finds inadequate staffing, sexual assaults among patients, mishandling of medication and poor patient oversight and blames 'corporate-level quality of care issues.'

by Rong-Gong Lin II, Los Angeles Times

May 23, 2011

The parent company of a troubled Pasadena psychiatric hospital where multiple patient deaths and the rape of a teenage girl have come under scrutiny is being criticized for a corporate culture said to breed safety problems.

An independent review by the University of Illinois at Chicago for that state's Department of Children and Family Services found that Corona-based Signature Healthcare Services has "corporate-level quality of care issues."

Those include inadequate staffing, sexual assaults among patients, mishandling of medication doses and poor oversight of patients. "The root causes of these deficiencies," the report concluded, "can likely be attributed in large part to a dysfunctional corporate context."

The company operates two hospitals in Arizona, one in Chicago and four in California; those are in Pasadena, Covina, San Diego and Ventura. The facility in Chicago was the subject of inquiries by the Chicago Tribune in 2010. The newspaper found that there have been at least four reports of youths sexually assaulted or abused at that facility since July 2008.

The Times previously reported that the company's hospital in Pasadena, Aurora Las Encinas Hospital, came under review after allegations that a 14-year-old female patient was raped while facility staffers slept; the deaths of two patients who were unmonitored while undergoing detoxification; the hanging suicide of a male patient; and the fatal overdose of a patient who ingested contraband drugs smuggled into the facility.

The new Illinois report coincides with a whistleblower lawsuit by an employee of the Pasadena hospital against Las Encinas, alleging that the owners of the hospital defrauded the U.S. Centers for Medicare and Medicaid Services by providing "minimal, substandard care to patients."

In a written response, Aurora said the University of Illinois report, which focused on Aurora Chicago Lakeshore Hospital, overreached; it unsuccessfully requested that the most critical findings be deleted.

Executives said the report "comes to the easy but erroneous conclusion that [Chicago Lakeshore Hospital] must be criticized for failure to eliminate all risk." The hospital also said it took aggressive action to increase patient supervision after reports of sexual abuse.

Other findings in the university's 44-page report on the Chicago hospital:

"Staffing patterns create an extremely unsafe environment and poor patient care," a worker told the report authors, who were in the university's department of psychiatry. Authors reported seeing a staff member sleeping on duty, prompting patients to point and giggle.

The report's authors said it was unhelpful for the hospital to fault only staff members for lapses in care, "especially when it now seems clear that corporate officials were fully aware that this intractable patient safety issue signaled an organizational failure."

http://www.latimes.com/news/local/la-me-mental-hospital-20110523,0,6443282.story?track=rss

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Secure Communities program: A flawed deportation tool

The program, once billed as a voluntary partnership between the Department of Homeland Security and localities, is now mired in controversy.

May 23, 2011

When federal officials first announced the Secure Communities program in 2008, they billed it as a powerful tool in the battle to identify and deport illegal immigrants who had been convicted of violent crimes. Dozens of states, including California, signed on, agreeing that police would submit the fingerprints of all arrestees to be checked against federal databases for criminal convictions and deportation orders.

But the program, once billed as a voluntary partnership between the Department of Homeland Security and localities, is now mired in controversy. The government is investigating whether it has failed to nab dangerous criminals and has instead been used to target low-level nonviolent offenders. Since its launch, more than half of those deported under Secure Communities had minor or no criminal convictions, according to Department of Homeland Security statistics. In Los Angeles County, for example, nearly half of the 11,774 deported under the program from August 2009 to January 2011 had no convictions or had committed misdemeanors. They were targeted for deportation because the program doesn't distinguish between criminals and those who illegally entered the U.S. or overstayed a visa — a civil violation.

What's more, in some cities with large immigrant communities, police are concerned that their participation in the program will have a chilling effect on immigrants' willingness to report crimes or provide useful information. They point to cases like that of Isaura Garcia, an immigrant living in Los Angeles, who called 911 in February to report an alleged beating by her partner. Because police often arrest both parties in domestic disputes, her fingerprints were submitted to immigration officials; despite having no criminal record, she was flagged for deportation proceedings because she was in the country illegally. Another case involved a street vendor with no prior criminal record who was was arrested in downtown Los Angeles last month after she ran when police approached her. The woman remains detained, though no charges were filed, and is awaiting deportation for being in the U.S. illegally.

The result is that a growing number of states that were initially drawn to the program are telling the Department of Homeland Security that they want to withdraw or modify their participation. A bill sponsored by Assemblyman Tom Ammiano (D-San Francisco) would require that only the fingerprints of convicted felons be submitted to immigration officials. It would also allow any county to opt out of the program. The bill is now before the full Assembly.

If federal immigration officials are unwilling to target the people they said they would target, then Ammiano's proposal will set modest and sensible limits. It would help focus enforcement efforts on felons who commit rape, murder or other violent crimes instead of street vendors and domestic violence victims.

http://www.latimes.com/news/opinion/opinionla/la-ed-secure-20110523,0,787775,print.story

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Creating a 4th Amendment loophole

The Supreme Court failed to keep a lid on police excesses with its ruling this week in a Kentucky drug case.

May 23, 2011

One of the most important functions of the Supreme Court is to put legal limits on police excesses. But the court failed to fulfill that responsibility last week when it widened a loophole in the requirement that police obtain a warrant before searching a home.

The 8-1 decision came in the case of a search of an apartment in Kentucky by police who suspected illegal drugs were being destroyed. The police, who said they smelled marijuana near the apartment, had knocked loudly on the door and shouted, "This is the police." Then, after hearing noises they thought indicated the destruction of evidence, they broke down the door.

Police don't need a warrant to enter a residence when there are "exigent circumstances," such as imminent danger, the possibility that a suspect will escape or concern about the immediate destruction of evidence. But in this case, the police actually created the exigent circumstances that they then capitalized on to conduct the warrantless search.

According to Kentucky's Supreme Court, the exigent-circumstances exception didn't apply because the police should have foreseen that their conduct would lead the occupants of the apartment to destroy evidence. Overturning that finding, Justice Samuel A. Alito Jr. wrote for the court that as long as the police officers' behavior was lawful, the fact that it produced an exigent circumstance didn't violate the Constitution. That would be the case, Alito suggested, even if a police officer acted in bad faith in an attempt to evade the warrant requirement.

But as Justice Ruth Bader Ginsburg pointed out in her dissent, Alito's reasoning "arms the police with a way routinely to dishonor the 4th Amendment's warrant requirement in drug cases. In lieu of presenting their evidence to a neutral magistrate, police officers may now knock, listen, then break the door down, never mind that they had ample time to obtain a warrant."

Ginsburg also dismissed the argument that entering the apartment in the Kentucky case was necessary to prevent the destruction of drug evidence. Quoting the majority opinion, she wrote that "persons in possession of valuable drugs are unlikely to destroy them unless they fear discovery by the police." Therefore, police can take the time to obtain a warrant.

Allowing police to create an exception to the warrant requirement violates the 4th Amendment. That is how the court should have ruled.

http://www.latimes.com/news/opinion/opinionla/la-ed-exigent-20110523,0,3062005,print.story

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From the New York Times

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Police Seek New Ways to Defuse Tension

LOS ANGELES — When the police arrived, she was barricaded inside her apartment with her former girlfriend, threatening suicide, a gun in her hand.

“Let your hostage go!” one of the officers shouted.

It was the beginning of a seven-hour standoff that brought out the SWAT team and the Fire Department, cost the City of Los Angeles tens of thousands of dollars and could well have ended in lost lives.

But three years later, when two Los Angeles police officers interviewed the woman, Shawn Baxendale, in prison, she told them the police could have handled the situation better. The use of the word “hostage” by the first officers at the scene, she told them, stunned her — her ex-girlfriend had insisted on staying and could have left at any time, she said — and it made her feel that she had no options left.

“At this point I'm thinking, there's no going back,” Ms. Baxendale said.

The interview, recorded on videotape, is part of an unusual project started by the two officers, Detective Teresa Irvin and Officer Michael Baker, to gain insight into the mind-set of people involved in potentially violent encounters with the police.

They hope the information gained from the interviews — they have conducted about 40 over the last four years — will help law enforcement officers, especially those who are the first to respond to a scene, learn to diffuse volatile moments rather than escalating them.

“Cops like to solve things right away,” said Officer Baker, a senior SWAT team negotiator who in more than 25 years on the force has responded to hundreds of “barricade” situations. “But I think that attitude sometimes causes a response that isn't appropriate.”

“Just the way you approach a situation verbally or with your body language can put people on the defensive,” Officer Baker said. “It's been my experience from talking to people that a lot of them get scared, and that's why they react the way they do.”

The interview project began informally. In 2007, Detective Irvin, a field supervisor with the Mental Health Evaluation Unit who has been with the department 18 years, started following up on some cases, visiting people at their homes, in prison or in psychiatric hospitals and asking them what led them to such drastic actions and how the police could have handled the situation better.

Although police officers held debriefings to discuss how operations were handled, Detective Irvin said, “We were never going back and actually speaking to the subject. It was incredible, the amount of information they would actually provide to us.”

Detective Irvin and Officer Baker have been asked to speak about the project at law enforcement conferences and military training programs and have been contacted by police departments interested in doing similar interviews themselves. They are developing a training program for the Los Angeles department.

The Los Angeles police respond to about 100 calls involving barricaded subjects each year. Often, alcoholism, drugs or mental illness is involved, and in some cases the person has had repeated contacts with the police. How officers respond and what they say when they first arrive at a scene is critical, Detective Irvin and Officer Baker said.

The interviews, they added, make clear that it is never a single event that leads people to such extreme actions, but the accumulation of many stresses.

“Everyone has a breaking point, and that's what happens in these situations,” said Officer Baker, who added that the Ms. Baxendale, the woman who barricaded herself in her apartment, “was basically not a bad person. She had a bad day.” (Ms. Baxendale served four years in prison for criminal threats and negligent discharge of a weapon, but now has a successful business.)

One of the men Detective Irvin and Officer Baker interviewed — they would identify him only by his first name, George — was struggling financially and had a host of medical ailments when he stood for hours with a gun outside the Hollywood police station in what investigators said was an effort to get police officers there to kill him.

He had first gone up to the Hollywood Hills to shoot himself, George said in the interview, but after 12 hours he realized he could not pull the trigger.

“I was getting a little crazy at that point, dehydrated, too,” he said. “And the idea came to me I could go down to the police station and wave a gun around a little bit and somebody would take care of it.”

At first, he said, the officers at the station did not notice him, but once they did, a standoff ensued. “They showed amazing restraint,” he said, adding that one reason he eventually put down his gun was that he did not want a police officer to have to deal with the emotional effects of having shot him. He was not charged with a crime.

Another man interviewed was a severe alcoholic who frequently called the police and was often suicidal. He seemed grateful for visitors when they interviewed him at his house, Detective Irvin said.

As they were leaving, the man handed her a paper bag holding a suicide note and a toy gun painted with nail polish to look like a Tec-9 assault pistol. The man told them that he had planned to use it later that night to provoke the police into shooting him, but that, at least for the time being, he had changed his mind.

“Yeah, we're helping him by going, but we're also helping the officers,” who might end up face to face with the man and his toy gun, Detective Irvin said.

In conducting the interviews, she said, she and Officer Baker arrive unannounced and ask if the subjects will participate. The questions are unscripted.

But they always include asking how well the officers who first responded handled the situation and what could have been done better. In cases involving barricades, they ask: “Why didn't you come out? What could have caused you to come out sooner? Did someone say something that caused you to stay inside?”

So far, the only person who has refused to be videotaped, Detective Irvin and Officer Baker said, is Joseph Moshe, a man who in 2009 was accused of making threats against the White House and who then drove to the federal building in West Los Angeles, where SWAT officers pumped so much tear gas into his car that the Fire Department had to hose him down afterwards.

But Mr. Moshe, who at the time was in a psychiatric hospital until he could be deemed competent to stand trial, agreed to the interview and told Officer Baker that he remembered him from the standoff at the federal building.

Whatever broader lessons Detective Irvin and Officer Baker have drawn from the interviews, they have also used them as opportunities to establish bonds with people they may meet again in far less relaxed circumstances.

“When the relationships are formed, it makes it a little more difficult for them to think about not just putting themselves at risk but also the responders,” Detective Irvin said.

http://www.nytimes.com/2011/05/23/us/23swat.html?partner=rss&emc=rss

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Editorial

Chilling Echoes From Sept. 11

As the 10th anniversary of the terrorist attacks in New York, Washington and Pennsylvania draws near, one of the main recommendations of the 9/11 Commission remains unfulfilled: the creation of a common communications system that lets emergency responders talk to one another across jurisdictions.

The problem was laid bare in the tragic cacophony at the World Trade Center, where scores of firefighters perished as police and fire officials couldn't communicate on antiquated radio systems before the second tower fell.

Four years later during Hurricane Katrina, emergency workers from across the nation faced the same dangerous problem. They had to resort to running handwritten notes to warn of shifting conditions.

Congress should be haunted by the threat of new disasters finding rescue workers still incommunicado. Responsible lawmakers can mark the 10th anniversary by passing legislation to finally create a national public safety communications network.

The overall challenge is more complex than it sounds, touching on questions of financing, broadcast spectrum fights, technology innovation and turf battles among local public safety agencies.

Congress can begin cutting through a lot of that by approving the reallocation of radio spectrum to wireless broadband providers and public safety agencies. This would allow creation of a modern emergency system providing common access when needed by voice, video and text for responders now using separate voice systems typically jammed up in emergencies.

Senator John Rockefeller IV, chairman of the science and transportation committee, is championing the commission's dedicated spectrum approach, warning that the faulty emergency communication on 9/11 was “probably the greatest killer other than the planes themselves.” He has the support of the ranking Republican, Kay Bailey Hutchison of Texas.

Crucial details remain to be settled.

Would a nonprofit corporation best manage the new network? What's the best way to get commercial broadcasters to yield needed spectrum — through incentive auctions proposed by the Obama administration?

Once Congress acts, this new generation of wireless broadband would require years of infrastructure construction. In the meantime, public safety and homeland security officials across the nation have been tapping into billions in federal aid designed to patch improvements into existing voice systems.

Critics warn there's been too much reliance on buying hardware and not enough on planning and coordinating among fiefdoms still reluctant to come to terms on single useful systems. In New York, where the scars of 9/11 remain raw, there is not yet a fully compatible system among police officers, firefighters and Port Authority forces, but officials insist they are making progress.

How many warnings does Congress need? How many more people will be endangered because of bureaucratic wrangling or political inertia? “Further delay is intolerable,” the commission's leaders, Thomas Kean and Lee Hamilton, declared earlier this year. They are right.

http://www.nytimes.com/2011/05/23/opinion/23mon1.html?pagewanted=print

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