A consultant hired as part of a legal settlement released a series of recommendations for the Oregon State Hospital to ease an ongoing crisis of slow admissions and overwhelmed capacity.
Dr. Debra Pinals, a behavioral health director from the Michigan Department of Health and Human Services, delivered her first of two reports on Monday, the product of a monthlong review of practices at the state-run psychiatric hospital.
A second report from Pinals, recommending long-term fixes, is due April 29.
Pinals was hired to to evaluate the hospital’s admissions problems as part of its ongoing legal dispute with the advocacy group Disability Rights Oregon, which says the hospital has failed to quickly admit patients who have been found unable to appear in court on their own defense. Those patients, Disability Rights Oregon has said, are instead languishing in jail without needed mental health services in violation of their civil rights.
Pinals talked to more than 20 state hospital administrators, as well as six patients.
The 20-page report recommends making more efforts to discharge or avoid the admission of patients who don’t need hospital-level care; using space at the hospital’s recently opened Junction City unit to house newly-admitted patients; and tracking patient admissions through a uniform data system.
Pinals’ report said that as of Friday, there were 93 people waiting to get into the state hospital with aid-and-assist orders, indicating they can’t aid in their own defense at trial.
Those patients had been waiting in jail for an average of 22.5 days, she said.
The number of patients waiting for admission more than doubled from the beginning of January, when Pinals reported that 46 patients were waiting for entry. She noted that the spike was likely due to a pause in admissions because of a COVID-19 outbreak at the hospital.
The hospital, she said, should examine why community health services unnecessarily send people to the hospital when they don’t need to be institutionalized and push for legislation that requires better community-based mental health treatment services in each county.
And the data system she recommended would include a dashboard detailing the number of patients waiting for admission, their legal status and how long they’ve been waiting.
A state hospital representative did not respond to questions about when administrators would make the recommended changes.
K.C. Lewis, Disability Rights Oregon’s managing attorney, said the report was an important first step to bring the hospital into compliance with a 2002 court order that mandates timeline admissions for aid-and-assist patients. But he was concerned by the problems it lays bare. Current wait times for patients to get into the hospital are more than three times the duration allowed under the court order, he said.
“The problems at the state hospital are a symptom of our society’s overreliance on the criminal justice system to deal with people with mental illness,” he said. “These recommendations are an excellent starting place, but solving this problem in the long-term is going to require policymakers who are willing to have difficult conversations and make bold choices about what kind of system we want to have.”
The report also advises the hospital to coordinate the admissions of guilty except for insanity and aid and assist patients to reduce the jail wait times of both groups. Those two patient populations have been worst affected by the admissions delays.
The admissions court order stems from a 2002 lawsuit filed by Disability Rights Oregon. In that case, a federal judge ordered the state hospital to admit aid-and-assist patients within seven days. In May 2020, a federal judge modified the order to accommodate the state hospital’s limited admissions policy, intended to reduce the risk of a COVID-19 outbreak and allow for a quarantine period for new patients. Disability Rights Oregon protested, saying it violated patients’ constitutional rights. The dispute eventually led to the agreement that the hospital undergo a review from Pinals.
And in November, two patients who were found guilty of crimes except for insanity sued the state hospital. They said they were ordered for state hospital treatment but, because of delayed admissions, instead sat in a Multnomah County jail for more than six months.
The pandemic has strained the state hospital in other ways. Complaints from staff and patients about assaults and discrimination have increased, and an employee shortage led the state to call in the National Guard twice over the summer to staff the hospital.
—Jayati Ramakrishnan
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