New UCI Medical Facility Sparks Debate : Health care: Originally intended to house psychiatric patients, the almost-completed building is now being considered for other uses.

A gleaming edifice of steel and glass, the latest addition to the array of buildings at UCI Medical Center in Orange is just a few weeks from completion. But, after seven years of planning and construction, no one knows precisely what will go in it.

The 81,000-square-foot building was erected with $16.5 million in state money on a promise that it would have 92 beds to house acute psychiatric patients. But now hospital administrators are considering plans to include space in the new building for a collection of departments dealing with everything from Alzheimer’s disease to brain tumors.

Although nothing is finalized, plans call for the building to house not just psychiatry, but such disparate disciplines as neurosurgery and epilepsy evaluation, hospital administrators said. It would have between 16 and 23 beds for adult psychiatric patients as well as psychiatric units for adolescents and geriatric patients.

That apparent shift has members of the hospital’s psychiatric department--as well as a prominent state senator--deeply disturbed, and has sparked what one administrator calls “a family feud.”

Hospital administrators accused the psychiatrists of behaving selfishly. They argue that the project as originally conceived just won’t fly in the current world of health care, where big insurers increasingly frown on paying for inpatient psychiatric care.

“It’s very clear that the health care marketplace has changed dramatically since this project was first conceived in 1986,” said Donald L. Hicks, the medical center’s senior associate director. “We’re trying to act as good stewards of the state’s investment, to find what is the highest and best use of the facility.”

But advocates for the mentally ill say such reasoning ignores a persistent need for top-notch treatment centers. They also say any shift from the building’s original purpose violates the will of the Legislature. Instead of 92 beds, they expect that half that number, at most, will be dedicated to people suffering mental illnesses.

“They’re blatantly going against the legislative mandate,” Steven Potkin, the medical center’s director of psychiatric research, said. “The question is, has the demand for psychiatric services decreased 50% in the last seven years? That’s clearly not the case.”

The dispute has also caught the attention of state Sen. Newton R. Russell (R-Los Angeles), a member of the Senate’s special committee on developmental disabilities and mental health.

“It concerns me,” Russell said. “It seems to me the hospital administration has an obligation to either continue in the direction that was approved or come back to the Legislature and obtain permission for some changes.”

The new structure was built to replace an antiquated, 50,000-square-foot covey of offices and wards that currently house the medical center’s psychiatric department.

While the program is one of six in the nation funded by the National Institute of Mental Health and is the only research and training center in the United States designated by the World Health Organization, its current home “looks like its from the Dark Ages,” one doctor said.

Tragedy, they say, is sometimes the result. Last week, a suicidal patient at the existing 71-bed psychiatric facility managed to knock down an attendant, burst through a door and escape. A few hours later, the man leaped from a five-story parking structure and was critically injured. Some at the psychiatry department contend the escape wouldn’t have occurred had they been in the new building, which features better safeguards.

In 1986, the state Legislature responded to complaints and approved money for the new building. At the time, university officials lobbied hard, suggesting that the building would provide state-of-the-art research facilities, allow the use of new drug treatments unavailable elsewhere and, as a result, attract more patients.

The facility was to be equipped so doctors could monitor sleep patterns and biological rhythms that psychiatrists increasingly suspect play a role in some mental illnesses. Throughout the night, doctors would be able to draw blood samples and measure hormonal levels without waking a patient.

Just as the new building began to take final shape, the dispute over what would go on inside erupted. In April, psychiatry department leaders met with hospital administrators to go over financial plans. Administrators told the doctors that the changing health care climate was forcing them to devise a business plan that would reflect fiscal reality.

The psychiatrists asked for a follow-up meeting to go over the plans but say they were “shut out” by hospital administrators and have been largely kept in the dark ever since.

“It was all handled surreptitiously,” said Dan Weisburd, a former president of the California Alliance of the Mentally Ill whose son has received treatment at the UCI Medical Center’s psychiatric unit. “They haven’t gone back to the Legislature; they’ve tried to use the back door.”

Hicks, the medical center’s senior associate director, said critics are putting a sinister spin on well-intended efforts by hospital leaders to “be on the front edge in terms of a university hospital helping society go forward.” Opponents of the plan, he said, are making much ado about “a sizing issue.”

“I think those folks who would take exception are holding a parochial view,” Hicks said. “It’s an attitude of ‘I want what I want when I want it and I want what I want.’ ”

Instead of sticking to outdated notions, administrators want to put under one roof a “family of services” that deal with illnesses of the brain, Hicks said.

Typically, he said, about three-quarters of the medical center’s psychiatry beds are occupied. “I don’t think there’s any problem with the county being underserved in terms of acute inpatient psychiatric beds,” he said.

Advocates for the mentally ill couldn’t disagree more. Although the county has 18 hospitals offering some form of psychiatric care, all except UCI Medical Center are private.

“If you don’t have insurance or someone in the family isn’t willing to mortgage the house for treatment, you aren’t getting in to those private institutions,” said Eldon Baber, executive director of the Alliance for the Mentally Ill of Orange County. “The poor, the indigent, the underinsured, the uninsured, people on Medi-Cal and Medicare, all those folks who don’t have those fancy health insurance policies have to rely on UCI.”

But the facility wouldn’t be solely for the indigent. With its promise of superior care and comfort, the new UCI psychiatric center would lure a broad mix of patients, Baber said.

“I’m sure it would make money,” he said. “It’s one of seven world-recognized research programs. We’ve got more research projects going on there than anyone knows about. You will see people coming from outside the county.”

Even so, Baber and others contend that hospital administrators are being driven by more than just the fiscal bottom line.

“Mental illness has always been something people want to shove in a closet,” Baber said.