The Oregon State Hospital will make some immediate changes to ease overcrowding, its top official confirmed following a court-ordered review of the hospital’s admissions backlog.
Superintendent Dolly Matteucci said the hospital will change its policies this month in three areas: admitting patients more quickly, taking steps to change its policy for discharging patients more quickly, and returning patients to the court who have been deemed able to participate in their own legal defense.
Those three changes, she said, will help make room for those on the wait list.
“We will be prioritizing that work as we continue to work on the larger project plan,” Matteucci said.
The commitments come in response to a review by Dr. Debra Pinals, a behavioral health director from the Michigan Department of Health and Human Services. As the hospital faced two lawsuits about delayed admissions, a federal judge appointed Pinals to investigate the hospital’s admissions practices and come up with comprehensive recommendations for reducing the delays.
In a 35-page report released last week, Pinals said the hospital should try to lower its average wait times for new patients. By August of this year, the average wait time should be 22 days or less, and by January of next year 11 days. By Feb. 14, Pinals said, the hospital should be averaging its court-ordered requirement of admitting patients in seven days or less.
Pinals recommended the hospital more frequently assess patients to determine if they’re ready to be released. Other suggestions included expanding patients’ access to substance abuse disorder treatment, seeking out more funding for community-based mental health programs and improving its collection of admissions data.
Pinals also recommended a slate of changes that may require action by state lawmakers. She called for the Legislature to allocate more money toward community mental health services that get people out of the hospital and into treatment in their own counties. And, she said, state agencies should try to find alternatives to the state hospital for lower-level offenders.
Matteucci and Steve Allen, the behavioral health director for the hospital’s parent organization Oregon Health Authority, said they expect to be able to accomplish all of Pinals’ recommendations.
“We sat at the table once a week talking through all the issues and looking at opportunities to improve the system,” Allen said. “The short answer is, there’s nothing in this report we don’t agree with.”
State mental health advocates from Disability Rights Oregon, meanwhile, said the recommended changes are a good road map, providing clear instructions for the hospital to reduce its admissions backlog.
But Emily Cooper, the nonprofit’s legal director, said the February deadline to get the backlog to seven days or less is still a cause for some concern.
“We understand that system changes can take time, but there are still dozens of patients waiting in jail for court-ordered mental health services,” Cooper said. “Every day that a person is so sick they can’t aid and assist, every day that person waits in jail is a day they can be irreparably harmed.”
Cooper pointed to the case of Bryce Bybee, who died in April after refusing food while held in the Washington County Jail. The 22-year-old was on the admissions list for the state hospital at the time after a judge ordered he be admitted for treatment because of his refusal to eat.
Matteucci wouldn’t discuss Bybee’s death, citing patient privacy laws and ongoing litigation. But she said the hospital was already working on changes to its admissions policies before Bybee died.
One immediate policy change aims to prevent delays like the ones that preceded Bybee’s death, however.
Matteucci said family members or doctors of people waiting to get into the hospital can now make formal requests for those patients to get fast-tracked admission. Before, she said, only jail staff could make that request.
The hospital has struggled to maintain sufficient staffing through the pandemic, leaning heavily on outside staffing agencies.
Allen, the behavioral health administrator, said the staffing problems won’t likely affect the ability to implement the changes. But he said community clinics that have staffing problems of their own, which would make it harder to transfer recuperating patients to facilities closer to home.
“Workforce challenges are everywhere, especially following the pandemic,” he said. “That’s certainly the case in behavioral health care. We’ve had facilities that have had the physical space during January and February. Now we’re verging on July and we don’t have them up and running, and it’s purely about the workforce.”
A federal judge ordered a third-party review of the state hospital’s admissions practices as part of a long-running legal dispute with Disability Rights Oregon.
The group won a court order in 2002 that required the hospital to admit within seven days people who have been accused of a crime but deemed mentally unfit to aid in their own defense.
Since the early days of the pandemic, though, Disability Rights Oregon said the hospital has failed to quickly admit those patients. Instead, Disability Rights Oregon said, they languish in jail without treatment, a violation of their civil rights.
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. The modified order was lifted in December, but the hospital has still struggled to meet the required seven-day time limit.
And in November 2021, attorneys for two men who were found guilty of crimes except for insanity sued the state hospital, saying they were supposed to be admitted for treatment but, because of the delays, instead sat in a Multnomah County jail for more than six months.
—Jayati Ramakrishnan
