State hospital must work with counties to help patients return to communities, expert’s report says

The Oregon State Hospital on May 28, 2021. (Amanda Loman/Salem Reporter)

The Oregon State Hospital must work with counties across the state to help patients return to community settings, expand its substance abuse treatment and produce more frequent data on court-ordered admissions, according to a report by an expert the state brought in to address the hospital’s capacity issues.

State officials by next year should cut two weeks off the time that some people needing care are held in jails until there is room at the state hospital, the consultant recommended.

Data on state hospital discharges showed the rate of patients returning to the hospital were highest among those found unable to aid and assist in their defense due to a mental illness or disability, the report said.  To offset that risk, the Oregon Health Authority, the hospital’s parent agency, by July will have to start planning to add “community navigators” to help those patients in community settings. A “pilot” for the navigators is expected by December.

The Sunday report is the second released by Dr. Debra Pinals, clinical professor of psychology and director of the University of Michigan’s Program in Law, Psychiatry and Ethics.

The state contracted with Pinals as part of a temporary settlement that the state, advocacy group Disability Rights Oregon and Metropolitan Public Defender agreed to on Dec. 10 after 19 years of litigation over delayed admissions that left people needing treatment in local jails.

She was retained to plan improved state hospital staffing so the hospital could admit more patients and comply with judges’ orders to do so. Several people who should otherwise have been treated at the state hospital instead sat waiting in county jails, court documents showed. Hospital administrators have argued in court that the agency didn’t have the resources needed to admit everyone ordered by judges.

The state hospital cares for about 500 Oregonians with mental illnesses and disabilities who are ordered by judges to get state treatment. People unable to understand criminal charges against them or assist in their own defense are supposed to receive treatment at the hospital to get to the point they can participate in the criminal justice system and understand their legal rights and responsibilities.

All parties involved in the settlement previously agreed to several short-term actions based on Pinals’ recommendations in a Jan. 30 report. Those included speeding up discharge processes for patients who don’t need hospital care, coordinating admissions lists between patients found guilty except for insanity and aid-and-assist patients to shorten overall jail times for both, and using data to monitor the hospital’s compliance with court orders.

The state hospital has since created a data dashboard and started publishing monthly data on admissions in April, according to Pinals’ report.

She said there has been progress since the first report in reducing the number of people awaiting admission to the hospital, but she found a recent increase in days waited and number of people waiting. 

The number of people hospital officials determined didn’t need hospital care exceeded the count of those awaiting admission, her report said.

The report mentioned that one person awaiting admission to the state hospital died in jail since her first report. 

Bryce Bybee, 22, died in the Washington County Jail while on the admissions list for the state hospital, according to reporting by The Oregonian/OregonLive. A circuit judge determined Bybee was unfit to stand trial and ordered that he be moved to the hospital within seven days. He remained in jail, where he died 10 days later.

“Although the circumstances of that death are being examined separately,” Pinals wrote in her report, “all parties recognize the critical need to maximize access to the hospital when needed, but everyone with whom I spoke recognized that there is no simple single solution that will fix the issues that are contributing to the increased referrals to OSH and difficulties with discharges that creates ongoing barriers to opening space at OSH for those waiting in jails and other places.” 

Pinals recommended a long-term plan for the hospital to admit patients for court-ordered treatment more rapidly.

Disability Rights Oregon and the health authority must now decide whether to settle the ongoing lawsuit. If they don’t reach a settlement, they’ll return to court over whether the state should be ordered to follow the recommendations. 

Emily Cooper, legal director for Disability Rights Oregon, described Pinals’ report as “a roadmap to compliance” with a 2002 federal order which required the hospital to admit aid and assist patients within seven days.

“The state has had the behavioral health funding allocated by the legislature and now with the neutral expert recommendations—a plan,” Cooper wrote in an email. “The effectiveness of the recommendations will be tested in the following months. We are and stay committed to protecting the rights of people waiting, and too often languishing, in jail for transfer to the state hospital.”

In a Tuesday news release, OHA Director Patrick Allen said, “I am encouraged by the thoroughness of Dr. Pinals’ work and her careful assessment of the capacity challenges the state faces. I believe her recommendations are reasonable and achievable and I look forward to seeing them applied.”

Pinals recommended that by August the state hospital start publishing data on admissions twice monthly, instead of once.

As soon as possible, Pinals said the hospital should develop a website that provides public access to information and documents related to the federal order. Those would include federal court orders, settlement agreements, public reports, legislative testimony, policies, funding opportunities and notices of meetings.

The health authority must also resume its pre-Covid policy of discharging patients previously found unable to aid and assist in their own defense back into the community after a forensic evaluation finds they are now capable.

Pinals said the agency should stop the temporary policy established during the pandemic of keeping patients up to 30 days past such an  evaluation if the findings are contested. That has contributed to lengthy stays at the hospital “beyond clinical recommendations,” the report said.

To increase capacity, the state hospital by July should plan for earlier evaluations to determine if patients can be discharged or released to community care.

Pinals’ report recommended increased funding for community mental health care and substance abuse treatment.

The services are critical, she said, because state data shows a “close nexus” between people returning to the state hospital and those struggling with both mental health and substance abuse disorders.

Her report also called for legislative changes that place time limits on community restoration for those receiving court-ordered treatment.

Ahead of the 2023 Legislative Session, she said OHA should work with Disability Rights Oregon and other stakeholders to seek legislative funding for community restoration programs across the state. Through community restoration, patients can receive treatment while living in their own home or a residential program to help them transition back into the community, according to a Disability Rights Oregon pamphlet.

She also recommended that treatment be a priority over prosecution when people are accused of misdemeanor crimes.

“Many of these individuals need hospital level of care, but their criminal issues are more minor, raising questions about the use of ‘restoration’ as a means of accessing services when prosecution is not ultimately going to be pursued,” she wrote.

Pinals recommended “benchmark” wait times for jailed patients to be admitted to the state hospital should be no more than 22 days by Aug. 1, 17 days by Oct. 1, and seven days by Feb. 14, 2023.

Contact reporter Ardeshir Tabrizian: [email protected] or 503-929-3053.

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