(Amanda Loman/Salem Reporter)

The Oregon State Hospital by spring will have to produce data showing progress in admitting people with mental illnesses for court-ordered treatment on time, according to a report by an outside expert the state brought in to address the hospital’s capacity issues.

The hospital will have to stop prioritizing admissions of “aid and assist” patients – people facing criminal charges who were unable to aid and assist in their own defense due to a mental illness or disability – over patients found guilty except for insanity. It will also have to avoid keeping patients at the hospital longer than necessary or legal.

The Jan. 30 report is one of two to be 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 a 19-year legal battle over delayed admissions.

Pinals is contracted to develop a short-term and long-term plan to address the state hospital’s staffing crisis so it can comply with judges’ orders to admit patients. Court documents showed several people who should otherwise have been receiving treatment at the state hospital instead sat waiting in county jails. Hospital administrators have argued in court that it doesn’t have the resources to take in everyone that judges order be admitted.

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

All parties involved in the settlement agreed to several short-term actions based on Pinals’ recommendations, which included speeding up discharge processes for patients who don’t need hospital-level 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.

Her recommendations for a long-term plan are expected by April 29. Disability Rights Oregon and OHA will then meet and decide whether to settle. If they don’t reach a settlement, they’ll return to court over whether the state should be ordered to follow the recommendations. 

By Thursday, the Oregon Health Authority must submit a  progress report to Pinals describing what the hospital  is doing to prevent or lower the number of hospital admissions of patients “who can be clinically served in a less medically intensive level of care,” as well as ways it has funded other community resources for people who are restored to where they are competent to stand trial.

“Long term compliance with the court orders and the Constitution will require bold action on the part of the state hospital and policymakers,” KC Lewis, managing attorney at Disability Rights Oregon, wrote in a statement. “To be clear, for the moment we are still headed in the wrong direction: the number of monthly referrals to the State Hospital has more than doubled over the past decade, and continues to grow every month. The only true path to compliance is for the state to invest in community resources for people with mental illness and divert more people with mental illness out of the criminal justice system.”

"OHA appreciates the availability of ($123 million) in infrastructure and investment grants and ($20 million) for Aid and Assist services in the community that will help alleviate the burden on the hospital," hospital spokeswoman Aria Seligmann said in an email.

State judges have found the hospital and the Oregon Health Authority, its parent agency in contempt six times in the last three years for not complying with their orders.

The contempt findings indicate the state hospital failed to follow judges’ orders in Jackson and Washington counties to admit people to the Salem hospital.

Eight contempt proceedings initiated over the past four months remain open, with six in Marion County. Judges use contempt proceedings to enforce court orders that weren’t being obeyed. Contempt isn’t considered a crime under Oregon law but can result in fines and jail time for those who don’t comply with judges’ orders.

By March 1, the parties will develop a data dashboard showing progress in complying with judges’ orders to admit patients. The data is expected to be distributed “across entities” by April 1, the report said. OHA will review whether additional staff are needed to create the dashboard and, if so, request funding from the state Legislature.

To ensure aid and assist patients and patients found guilty except for insanity wait around the same time to be admitted from jail, the state hospital will have to prioritize admitting those found guilty except for insanity to its Salem campus. The hospital has previously said it needs to prioritize patients under orders for mental health treatment to help them aid and assist in their own defense. A 2002 federal order required the hospital to admit aid and assist patients within seven days.

The hospital will then have to assess whether patients should be moved to its Junction City campus to free up beds in Salem. In November, a new 24-bed unit opened at the Junction City campus and another 24 beds are expected to open early this year.

According to the report, some state courts and community mental health programs are not following state laws requiring that aid and assist patients who no longer require hospital-level care be discharged.

The state hospital and OHA will have to review the discharge processes for patients committed to the hospital and by March 3 present the review to the Multi-Occupancy OSH Vacancy Resource & System Improvement Team, a recent effort to discharge patients who no longer need hospital-level care. The review will also be shown to Pinals and the parties involved in the settlement with a goal of implementing new protocol by March 14, according to the report.

The report said OHA has proposed legislation that would allow counties to be charged for patients who no longer need hospital-level care..

The state hospital is trying to work with the counties home to patients on the “Ready-to-Place list” which means they are ready to transition back into their communities, according to the report.

“Each person on the ‘Ready to Place’ list is occupying a bed at the state hospital that could be immediately freed up for someone who truly needs Hospital-level care but instead is sitting in jail,” Lewis said.

The state Department of Justice will evaluate cases filed across the state on behalf of the state hospital if they believe state courts or community mental health programs aren’t following the law.

“This report is a good first step but there is a long road ahead before these problems are solved,” Lewis said. “It's going to take commitment and creativity from all of the parties involved, and support from policymakers to solve this problem.”

This story was updated after the state hospital provided a statement.

This story was updated after a local attorney brought a contempt proceeding against the state hospital Tuesday in Marion County Circuit Court. 

PRIOR REPORTING:

State hospital gets outside help for admitting mentally ill people under judges’ orders

State hospital embroiled in contempt proceedings for not admitting mentally ill people court-ordered to get treatment

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

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