Oregon State Hospital must comply with court order, report says – Oregon Capital Chronicle
An independent expert has called on Oregon State Hospital to speed up discharges and admit patients waiting for jail sooner to reduce the ongoing backlog of bed demand.
The hospital is under a federal court order to admit aid and support patients within seven days. They are patients in prison waiting for mental health treatment to enable them to participate in their defense.
The hospital is also under federal orders of fix several issues who were identified by an investigation of a patient who escaped late last year. At the same time, hospital officials are trying to fill dozens of jobs to make up for a staff shortage.
The recent recommendations on admissions and discharges came in the latest report from an independent expert who was hired under an agreement between the health authority, which oversees the hospital; Oregon Disability Rights; a Portland-based public defense firm, Metropolitan Public Defenders Services; and sick. They sued the state for delays in admitting aid and support patients, who occupy just over half of the hospital’s beds. The hospital had a court-approved suspension of the seven-day admission order during the pandemic, but that was lifted.
The public hospital is almost at capacity, according to the report. With approximately 750 beds under agreement, nearly 710 are occupied. They include approximately 560 at the main Salem campus and 145 at the Junction City campus.
Awaiting discharge patients who find themselves stuck in hospital with nowhere to go continue to be a problem while help and support patients languish for days in jail.
The consultant, Dr. Debra Pinals, a Michigan psychiatrist who has worked with other states on similar issues, filed her first report in January. The second, published on Tuesday, contained multiple recommendations.
The director of the Oregon Health Authority greeted them.
“I am encouraged by the thoroughness of Dr. Pinals’ work and his careful assessment of the capacity challenges facing the state,” Allen said in a statement. “I think his recommendations are reasonable and achievable and I look forward to seeing them implemented.”
Pinals said the hospital had improved admissions between its two reports, but noted that recently wait times and the waiting list have started to grow.
“The state is to be commended, along with the community, for all efforts to turn people away who do not need hospital care,” the report said, adding that this trend must continue.
As of May 1, nearly 70 patients receiving help and assistance were waiting to be admitted with an average wait time of 16 days. This marked a drop from late January, when admissions were suspended due to a Covid outbreak.
The report calls on the hospital to better track hospital census, admissions and discharges. He also called for more transparency, including the development of a public website with legal actions, budgets and other documents and data. He said the hospital should develop a patient assessment process that includes people with mental health issues to make consistent and transparent placement decisions.
Many recommendations focused on reducing wait times to enter and leave the hospital. He said to comply with the seven-day order, the hospital would have to discharge aided and assisted patients when deemed capable. Since the pandemic hit, the hospital has held these patients for an additional 30 days when they challenged their fitness determination.
“This has helped extend the length of stay for many people,” the report said.
The report found that since 2012, 15% of patients receiving help and assistance had stayed longer than six months in hospital. If administrators limited those patients to six months, the hospital could accommodate 130 more patients a year, according to the report.
Pinals said state employees should assess patients who help and assist in prison sooner to identify patients who no longer need hospital care and arrange treatment in the community.
At the same time, the report noted that more than a third of patients receiving help and assistance had been hospitalized several times, compared to 10% of those who had been civilly or voluntarily committed.
Pinal recommended that the state establish better community support for patients once they are released, an idea welcomed by Disability Rights Oregon.
“It is widely believed that expanding home and community services – the full continuum in every Oregon county – will ensure people with disabilities get the services and supports they need to stay in homes,” said Emily Cooper, an attorney for the organization. “We know that not only will this allow people to be served at home, but it could also disrupt the revolving door of people entering and exiting the criminal justice system.”
Part of this support should be a “community navigator” who works with discharged patients.
“You can think of him as a super-charged case manager — someone to help you navigate the hoops of getting and maintaining a continuum of service,” Cooper said.
The report says the state should have a community browser pilot program ready by December.
Hospital officials should also work with community providers to help discharge other patients, Pinals said.
“The public hospital must be able to make room for new admissions to OSH and place people who no longer need institutional care in a less restrictive setting,” the report said.
He called on the state to gradually reduce admission wait times, reaching the seven-day limit by next February.
Between Pinals’ two reports, an aided and assisted patient died in the Washington County Jail. Cooper said the death could have been avoided.
“He had been waiting 10 days for admission,” Cooper said. “If the state was able to transport him within seven days, this patient could still be alive.”
He had stopped eating and drinking in prison and died of malnutrition and dehydration, she said.
The Washington County Health Department did not respond to a request for comment late Wednesday afternoon.
She said Disability Rights Oregon was concerned about the potential harms associated with extended prison stays. She said the organization would continue to consult with attorneys for locked-in patients “to try to mitigate damages from now until the state is in compliance.”
The report also called for legislative changes. Pinals noted that Oregon law places no time limits on hospital stays. The hospital keeps patients for the duration of their sentence or for three years, whichever is shorter.
Pinals said the reprieve for those charged with misdemeanors should be the maximum sentence for their crime or 90 days, whichever is shorter. Patients charged with crimes must be treated for a maximum of six months, unless the offense involves “serious violence”. These patients should stay longer, but no longer than a year, according to the report.
Cooper said the report comes at the right time. The health authority recently announced hundreds of millions of dollars in spending on behavioral health and addiction treatment services. The money will be used for workforce training, increased provider reimbursements, treatment and housing.
“The state has unprecedented funds for nearly a year to fund behavioral health – the whole continuum. They now have the resources in the state coffers. They now have a plan on how to prioritize their actions said Cooper.