Last week, the department turned over 900 unredacted pages of citations detailing incidents of abuse and neglect, some of which led to the deaths of 13 patients in the five centers since 2002. The CIR said the centers had some responsibility in another six deaths.
The centers currently tend to 1,115 patients with profound or serious developmental disabilities, like cerebral palsy, epilepsy and autism.
The department released the documents in response to a CIR lawsuit filed in 2012, but not before it went to the California Supreme Court. In February, the court unanimously ruled (pdf) that the Long-Term Care, Health, Safety, and Security Act of 1973 plainly stated that all CDPH documents are public records. The agency can redact names of patients but not a whole lot more.
The department argued in Superior Court—and lost—that it was abiding by a different law, the Lanterman Act of 1967, that forbid it from releasing “confidential information obtained ‘in the course of providing service’ to mentally ill and developmentally disabled individuals.” The court said the Long-Term Care Act was newer and more specific.
The department appealed and the California Court of Appeal split the baby, ruling that the two laws should be “harmonized.” The court crafted a scheme whereby it would set parameters for the limited release of certain information. The high court tossed that out and said to do what the Superior Court ordered.
The high court noted that the Act’s “inspection and citation process serves to punish by naming and shaming facilities that violate the law” and functions as a preventive to “protect patients from actual harm, and encourage health care facilities to comply with the applicable regulations and thereby avoid imposition of the penalties.”
That works best without massive redaction.
The centers have come under attack for more than a decade over a lack of security that endangered patients, employees and visitors. A 2002 report from the California Attorney General said the health care staff, as well as the security forces, were overworked, underfunded and ill-prepared. The California State Auditor reported in 2013 that many of the 28 reforms recommended by the AG had gone unattended to.
The centers are being scaled back as care emphasis shifts to group homes, where the aim is to offer mainstream community integration rather than segregation in larger settings. The big institutions were cutting edge in the 1960s.
Supporters regard it as a cost-effective way to continue along a path from virtual imprisonment to integration. Critics complain that the state is abdicating responsibility for its most vulnerable residents by placing more of their care in private, for-profit hands, rather than funding improvements and managing the facilities better.