O.C. Doctor to the Disabled Painted as Hero, Villain

COSTA MESA — To his colleagues and other supporters, Dr. William Cable is a hero, a man who has risked his job, put up his own money to sue the state, and suffered harsh retaliation to save the lives of frail disabled patients.

“He is brilliant and brave and kind, and probably the best doctor in Orange County,” said Jocelyn Dougherty, a fellow doctor at Fairview Developmental Center, where Cable is chief of medical staff.

To his superiors and others, he is an obstructionist who single-handedly is trying to subvert well-intentioned state policy, which calls for transferring patients out of medical facilities like Fairview and into privately run group homes where they live in more normal settings.

In two federal lawsuits, Cable has contended that many of those transferred patients are suffering serious injuries--even drowning and choking to death--in group homes throughout the state.

State officials say they’re doing their own study on whether there are problems with transfers, and won’t address Cable’s specific contentions. But even before the lawsuits were filed, they had reprimanded him, suspended him, forced him out of his Fairview office and reassigned him to another job.

A letter of reprimand last August from his supervisor accused Cable of “inexcusable neglect of duty,” adding, “You should have known the charges you made against Fairview would bring discredit to the facility [and] its employees.”

“He is on a one-man mission to eliminate community placements,” wrote Rebecca Helgeson, the owner of Independent Options Inc., a San Diego County private group home, in a letter to Fairview administrators that has become an exhibit in one of the lawsuits.

Cable, 50, a native of New Zealand who has practiced medicine in Orange County for 15 years, has not sought the spotlight. After several requests for comment, he finally consented to a brief interview. “It’s just one of those things where you couldn’t stand by and continue to see the deaths and other injuries of people who can’t speak for themselves,” he said.

In his lawsuits, Cable has charged that the Americans with Disabilities Act of 1990 has been used by politicians and private group home operators to evict patients by claiming that they are gaining more freedom.

Worst of all, Cable says, severely retarded patients who can’t talk are being moved over the objections of their aging parents, or with no representation at all because their relatives have died or abandoned them.

“The state’s policy is dump ‘em and run,” said Cable’s attorney, Francis Hardiman. “The more severely retarded they are, the less represented they are, the easier it is to just kick them out. Once they’re moved out, they get lost for good.”

State officials strongly disagree.

“That is completely untrue,” said Michael Mount, chief counsel for the state Department of Developmental Services. He said placements are made only after careful consideration, and aimed at “giving consumers a choice” about where they live.

But many parents are on Cable’s side.

“We all pray now that our kids will die before we do,” said Joe Preston, 75, a retired engineer from Anaheim who has a 45-year-old daughter and a 40-year-old son in Fairview. “Because if we die, they’re gonna treat ‘em like animals . . . just transfer them wherever there’s a bed open.”

Preston, past president of a statewide organization of families of retarded patients, said both his children need 24-hour, regimented medical care like that provided at Fairview.

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Mount and others with the state Department of Developmental Services, which oversees Fairview and six other state developmental centers, say the transfers are for the good of the disabled. They say they are simply following the terms of a 1994 court settlement negotiated with the parents of four disabled patients, who said their children deserved the opportunity to live more normal lives, outside of locked state-run facilities.

Cable doesn’t object to transfers for less-retarded patients, but says the state has gone overboard. After more than 3,000 transfers in recent years, he says, those left in state institutions are the most profoundly retarded--those who literally cannot speak, feed or bathe themselves. Those patients are the most vulnerable to serious injury or death.

Tammy Hopp, executive director of Voice of the Retarded, an Illinois-based advocacy group, said that while many patients were “warehoused” in sometimes horrific facilities through the 1970s and deserved better, “it’s a movement that’s gone too far.”

Hopp said the California experience mirrors disturbing national trends of “downsizing” care for the mentally ill and disabled. Washington, D.C., New Hampshire, Rhode Island and Vermont all have closed their public facilities for the disabled, she said.

She said the California lawsuits--the first of their kind--are being watched carefully across the country.

“We’re grateful to Dr. Cable for shouldering this,” Hopp said. “It’s extremely costly and there’s not a lot of precedent.”

Early in July, Cable won a partial victory when U.S. District Judge Gary L. Taylor issued a preliminary injunction banning the state from transferring any patients who were not represented legally, citing the risk of “irreparable harm.”

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Legislative hearings were held last spring to examine the issue of transfers. A year ago, Gov. Pete Wilson ordered Camarillo, the state’s most prestigious mental hospital, to empty its beds, with many of the longtime patients transferred to Fairview. In May, he ordered an independent review of the state’s procedures for placing severely disabled people into the community.

But Cable’s victories have not come easy.

Last summer, he was reprimanded after asking if a patient’s parents had been notified about her transfer, and objecting to the action on medical grounds. Last October, he was suspended without pay for 10 days after writing a letter to a doctor in San Diego, informing him about the medical needs of a patient. His superiors accused him of “dishonesty,” “inexcusable neglect of duty,” and “breach of confidentiality.”

Hugh Kohler, executive director of Fairview, said this week, “Dr. Cable is not running a private practice. He is a state government employee. . . . People who live at Fairview are patients; they’re not citizens at large, subject to public scrutiny.”

Cable’s lawsuits also charge he returned from vacation last August to find his desk had been emptied and his papers and belongings moved to an isolated building plastered with asbestos warning signs. He has been subjected to random checks of hundreds of prescriptions he has written, one of his lawsuits states.

Cable was also transferred from his original ward to a job caring for the most acutely ill patients, the most difficult work at the hospital, according to colleagues.

“It is punitive, I think,” Cable said. “It also took me away from an area where I would be exposed to discharges of patients.”

Neither Kohler, Mount nor anyone else from the state nor from Fairview would comment on the disciplinary actions, citing the ongoing litigation.

Cable is by many accounts a dignified, soft spoken man, “with a bit of steel just underneath,” according to his longtime friend and former private practice partner Dr. Philip O’Carroll.

A resident of Huntington Beach, where he lives with his wife and 15-year-old son, Cable has formidable medical credentials. He is a licensed neurologist, psychiatrist, pediatrician and internist who has been at Fairview since 1994. He interned in Chicago, trained in four specialties at Massachusetts General Hospital, the teaching hospital for Harvard University, and worked at the National Institutes of Health in Washington, D.C.

“He never intended to bring a class-action suit,” said Hardiman, his attorney. “It just kind of snowballed.”

Cable said that while many dedicated workers at Fairview saw the same problems he did, he was in a better position to bring the lawsuits because he has a private practice he can fall back on.

He filed his first suit for $3 million in damages last December after being suspended--claiming the Americans with Disabilities Act and his civil rights had been violated when he was prevented from protecting disabled patients.

Within weeks, they learned that a woman who had been transferred out of Fairview had died in a Long Beach group home. Cable and Hardiman filed a second suit on behalf of all 800 Fairview patients in March. For months, the doctor and his lawyer have prepared paperwork, gathered statistics, sought experts, and attended hearings, paying the costs out of their own pockets. Judge Taylor’s temporary stay remains in effect until the court cases are concluded.

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Through it all, Cable has kept his cool in a tense environment, colleagues say.

Cable’s resolve doesn’t surprise his former partner O’Carroll, who first met Cable when they both did residency work at Massachusetts General.

“He always worked long, long hours. He always stood up for what he believed was right. He is very persistent, he will stick with something he believes in until the bitter end,” O’Carroll said.

Through the years, Cable has been bitten, scratched and punched by his severely disabled patients. He shrugs off the attacks, saying that because his patients can’t speak, it is their way of letting him know something hurts.

“I love my work,” he said. “The care of the mentally retarded is one of the most challenging areas of medicine.”

What really bothers him is the treatment he’s received at the hands of his bosses.

“It’s very painful,” he said. “Working for the state . . . there is no normal system of accountability, just intimidation.”