A U.S. District Court judge Monday released the state's mental hospitals from federal oversight on all but one issue - a significant step in ending a costly six-year reform effort.  

The extensive court-supervised changes were imposed on four hospitals in 2006 as part of a settlement to a lawsuit by the U.S. Department of Justice. The department alleged that the state was violating patients' civil rights by heavily drugging and improperly restraining them and failing to provide appropriate treatment.   

Last fall, Judge Audrey Collins released San Bernardino's Patton State Hospital and the Central Coast's Atascadero State Hospital from federal oversight. At Monday's hearing in Los Angeles, she agreed to free Metropolitan State Hospital in Norwalk from further federal review.

She said she continued to be troubled, however, by the death last spring of a Napa State Hospital patient who was placed in handcuffs while he was in a prone position. Collins ordered further monitoring there to ensure that the hospital is complying with a federal recommendation against such restraints. The continued oversight is expected to last between seven months and one year.

"There is nothing graver than the loss of a life," Collins said during the hearing.

Brandon Joseph Coates, a patient who stood 6 feet 4 and weighed 300 pounds, died May 1 after hospital security officers whom he had allegedly assaulted placed him face down in handcuffs. In their filings with Collins' court, federal attorneys called it part of "a pattern of incidents of death and serious harm over a recent 16-month period" resulting from poor use of restraints.

Such restraints contributed to one patient's broken bones and another's death in 2011, according to a declaration from the court monitor, Virginia psychiatrist Mohamed El-Sabaawi.

California Deputy Atty. Gen. George Prince, who was in court representing the Department of State Hospitals, had sought the full release of both facilities from federal scrutiny.

But Kathy Gaither, chief deputy director of the Department of State Hospitals, said in a statement that the department was "pleased that the court recognized the progress made in the state hospital system by lifting the consent judgment, excluding one specific aspect at one hospital."

The oversight of the four hospitals resulted in hundreds of millions of dollars in additional state spending and was intended to make patients safer and improve their care. But a Times investigation earlier this year found that in key respects the effort failed: Violence shot up overall, patients on average were confined longer and treatment suffered.

Officials with what was formerly known as the California Department of Mental Health retained a controversial consultant in 2002 to help put the reforms in place. But after Nirbhay Singh abruptly resigned in January 2011, the state undid a number of the reforms he had aggressively advocated.