Contra Costa County is defending censorship as a matter of legal liability in deleting all information from written reports of violence in the psychiatric unit at Contra Costa Regional Medical Center in Martinez.

In response to a public records request, the Times received 40 reports of incidents that occurred between Jan. 1, 2004 and Aug. 10, 2009.

All information on each of the reports was completely blacked out, including the date and description of the incident.

The county's censorship extends to its own appointed Mental Health Commission, which has been unable to access the same reports.

Spurring the document request were anonymous calls to the Times about violence in the mental ward.

One caller said that a patient stabbed a psychiatric nurse in the temple with a pencil or a pen. Another informant said that a patient grabbed a nurse by the hair and slammed her head against a wall.

In 2005, Times health care reporter Sandy Kleffman obtained from the county the same reports with only the patients' names inked out. Her stories about violence in the unit prompted a federal investigation and a threat to cancel Medicare and Medicaid contracts worth millions. The county agreed to improve safety and was not penalized.

Since then, the anonymous calls about violence on the ward have continued. When the Times submitted a new information request, it received the 40 fully censored reports on violent incidents.

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By refusing to release complete information, the health department is ignoring state law and preventing the county's Mental Health Commission from acting to correct problems, commission Chairman Peter Mantas said.

An attorney who specializes in public records law said the county violated the law by denying access to information about mental ward violence.

The county is "entitled to redact names from incident reports, which is usually a sufficient answer to concerns about personal privacy," said Terry Francke, general counsel for Californians Aware, an advocacy group for public meeting and public records laws. "It gives no idea of who's involved in the incident, so no one's privacy is involved at all."

A private attorney retained by the health department had a different view.

California law protecting the confidentiality of mental health patients trumps the right of the public to know what is happening in the mental ward, said Shirley Morrigan, a partner with Foley & Lardner LLP in Los Angeles.

A health care provider could be liable to fines of as much as $25,000 per incident and civil damages if even one person were able to identify a mental patient through the release of a report, she said.

The crux of the disagreement comes in six words in a 1980 state law.

The state Welfare and Institutions Code measure states that health agencies can be held accountable for releasing confidential information about patients "in the course of providing services."

Francke and other public records law advocates said that mental health information about diagnoses, medications and treatments of patients are off-limits because they involve providing services.

However, accounts of violent incidents do not fall into the realm of providing services because they have nothing to do with a patient's treatment and are more like police reports, Francke said.

Morrigan countered that since the requested reports are internal hospital documents, the information is relevant to how the clinic provides services, and their release automatically exposes the hospital to legal liability.

"Police reports are public information," she said. "But these aren't police reports — they're reports of unusual occurrences put together by hospital risk management to monitor service."

County health department Director William Walker consulted Morrigan before ordering the redactions, Fowlie said.

Mantas, the Mental Health Commission chairman, said panel also was unable to review the county's corrective action reports, which outline what the health department will do to prevent violence.

"Even though all mental health commissioners have signed confidentiality agreements authorizing us to make client contact, we received no reports," he said.

Reach Rick Radin at 925-952-5053.