Judicially-committed to live 'normal' lives

Editor’s Note: This is the first of a two-part look at the Porterville Developmental Center’s Secure Treatment Center.

Twenty-two developmentally disabled people deemed incompetent to stand trial for alleged serious crimes are finally living in an $85.7 million expansion to the Porterville Developmental Center.

The 96-bed addition to the state hospital’s Secure Treatment Center stood empty for nearly one year before officials finally selected from its pool of judicially committed clients — most of whom are severely mentally disabled and have compulsive behaviors and violent tendencies — those who are the least functioning and began moving them into the new residences in May.

The design, architecture and furnishings in the six 5,000-square-feet units showcase the legal and social strides made in the past four decades to support and enable people with developmental disabilities to live independent and normal lives. The expansion is the state’s attempt to balance the special needs of its forensic clients, including keeping the surrounding community safe, while meeting federal certification requirements that could ultimately, for the first time, lead to millions in Medicaid reimbursement dollars.

“Porterville is at the lead for the design for developmentally disabled,” Executive Director John Sawyer said. “It’s the first in the nation — we’ve even had folks from Florida calling about our construction here, because they’re interested in whether we’re going to become certified, and they are interested in the building design.”

The forensics
“One of the purposes of the expansion was to provide a better living environment,” Sawyer said. “The goal in the new area was to provide single rooms so each client could learn how to take care of their own room, access their own room and live with others, but not in the same room. We’ve gone from a communal living, dormitory style to an individual room style; we feel that helps with the behavioral issue the clients have, plus it will help us meet certification.”

Judicially committed clients are categorized as forensics, and are sent to Porterville for meeting one of four categories: “incompetent to stand trial,” “mentally disordered offender,” “not guilty by reason of insanity,” and “sexually violent predator.” Some inmates and wards of California Department of Corrections are transferred to the hospital for mental health treatment.

The drive to make the developmentally disabled more independent, and ultimately meet federal certification to receive Medicaid reimbursements, has meant forensic clients, including suspected rapists and murderers, are living in conditions far better than those who are imprisoned in county jails, state penitentiaries and federal prisons.

“They’re here because they’re developmentally disabled. We’re here to try to treat them and try to place them back into the community. We’re not a prison where we house them and throw them out on the streets and wait for them to come back in six months,” Sawyer said.

The expansion sits on 120 acres and includes six units each with 16 bedrooms and bathrooms — one per client — and includes a recreational area with a state-of-the-art gym large enough for 500 people and a swimming pool built to Special Olympics specifications. In comparison, the original secured treatment area structures, which will remain at least partially occupied, were built in 1953 and are reminiscent of college dormitories. In the original area, a client shares a room, enclosed only partially, with four others and a shower with six others.

The new dormitories are comprised of two halls with eight bedrooms each. Each client has his own living space with a connected bathroom. Throughout each 16-room pod are: laminate wood floors, windows that black-out at the flip of a switch and floor-to-ceiling quarry tile in each bathroom. Clients are living alone in large, private spaces, with electrical outlets, desks and a plethora of cabinets.

“Each client now has access to their own room with their own key card so they come and go, which is a real privilege that they didn’t have before when they were living dorm style,” Sawyer said. “The certifiers are really geared toward individualization.”

Struggling for Medicaid
According to the Centers for Medicare and Medicaid Services’ Survey and Certification Division, for the past 20 years the Porterville Developmental Center has received Medicaid reimbursements for all of its clients except for forensics. It has struggled, and ultimately failed, to obtain certification in the Secure Treatment Area because of its likeness to a prison, including the high, chain-linked fence along the perimeter.

It used to be that the fence was monitored by security guards who observed the boundaries from towers. In May, the 28 guards were laid off and replaced by high-tech security cameras, because, according to Sawyer “licensing didn’t like the towers.”

Porterville opted to withdraw the secure treatment beds from certification surveys in 2001, after continually failing to come into compliance. The Centers require hospitals to meet eight survey criteria, ranging from vocational training to hygiene and communication skills, to receive Title 19 Medicaid reimbursements. Although the Porterville Developmental Center’s Secure Treatment Center may have met most of the eight criteria, its fence held it back.

Paula Perse, who heads the Centers’ Long-Term Care Branch has not seen the expansion, but said the drastic changes were likely to increase the Secure Treatment Center’s chances to finally secure federal money.

“Certainly giving individuals their own space, opportunity for privacy and retention of personal possessions all fall within the individual rights that we look at very closely,” she said. “The goal is for the individuals to have a benefit of all their rights like any other citizen in this country, and not have them be restricted. Having a fence is something the survey will look at closely to make sure the patients’ rights are not violated.”

Reducing reliance on institutions

Although construction for the new units began quietly in 2006, planning began eight years prior. Brainstorming started the same year the Camarillo Developmental Center closed, preceded by the shuttering of the Stockton Developmental Center two years earlier. Both centers housed forensic clients in fenced-in areas, as is done at the Secure Treatment Center at the Porterville Developmental Center — now the only such facility in California.

For a variety of reasons, the client population at PDC — and at other facilities for the developmentally disabled — has continued to decline.

According to Barbara Dickey, an attorney with Disability Rights California, the state’s institutions have progressed tremendously from the days when hospitals were called insane asylums. During late 19th and mid 20th centuries, newspaper articles told stories of residents being restrained for days, living in filthy conditions and altogether treated cruelly.

“The stigma was that these were the ‘feeble minded’ or ‘retarded’ people and society wanted them out of sight,” Dickey said. “All of the facilities were pretty much situated away from the community, and a lot of them were set up to be self sufficient so people in the community would never have to run into a person with a mental retardation. It was kind of the out of sight, out of mind mentality.”

Now, there’s a system populated with highly trained professionals giving sophisticated care focused on helping patients take control of their own lives and live in the outside world. The transformation followed the Legislature’s passage of the Lanterman Act in 1969, proposed by Rep. Frank Lanterman at the urging of those who wanted the developmentally disabled to get the services and supports they need to live like people who don’t have disabilities. It mandated a preference for community placements, and outlined the right to make choices about where to live, attend school, work and the services and supports they receive.

But the biggest push since 2002, when the population at the Porterville Developmental Center began sliding, “would be the passage of Americans with Disabilities Act in 1990. The short answer is that law said that people with disabilities, including people with adult mental retardation, should not be unnecessarily segregated, and essentially these big developmental centers are segregating people on the basis of their mental disabilities,” Dickey said.

 

The need for Medicaid
As California lawmakers grapple with a $20 billion budget shortfall for Fiscal Year 2009–10 and 2010–11, they must decide what services to slash and where to allocate scarce revenues. In Fiscal Year 2009–10, expenditures for health and social services programs, including those provided to the developmentally disabled, are estimated to be about $25 billion or 29 percent of statewide General Fund spending.

According to the nonpartisan Legislative Analyst’s Office, the Department of Developmental Services — which runs the state’s four development centers — will account for approximately 10 percent of General Fund spending. The proposed appropriation, however, is 4 percent less this year, with the Governor outlining $2.39 billion in his May revise to the Fiscal Year 2010-11 budget, compared to $2.48 billion the year before and $2.51 billion in 2008-09.

For now, the Secure Treatment Center continues to be funded fully with General Fund dollars. According to Department of Developmental Services spokeswoman Nancy Lungren, Medicaid reimbursements will allow the state to continue providing services even when the Legislature trims its budget during financial crises.

“The state is so broke. It’s worth it not to deplete the General Fund, especially when you see how in the hole we are as a state,” she said.  

On average in the past five years, Porterville has received $44.1 million annually in Medicaid reimbursements for its clients living outside the secure perimeter. As federal reimbursements are normally 50 percent of the cost for caring for a client, forensic clients stand to earn about the same if the new units are certified.

But Porterville has yet to put in the call for a survey as it is still addressing federal requirements.

“They want to have all their ducks in a row,” Lungren said. “I don’t think they’re thinking of failure, I think they’re doing everything possible to meet federal standards.”