From The Oregonian, May 19, 1991 – not available elsewhere online

When double killer Michael McCormack walked away from the Oregon State Hospital in March, he riveted public attention on the blocklong J Building that hugs Center Street.

Legislators screamed about lax security.

Headlines trumpeted a series of escapes from the hospital that houses Oregon’s most dangerous psychiatric

But behind the headlines and the hospital’s century-old walls lurks a darker story. It is a tale of meager resources and inhumane conditions. Of a decaying monstrosity from the golden age of public asylums. Of government inertia in the face of a growing number of defendants who use the insanity defense. Of wire screens and suicide.

“It’s the pits. The state hospital is the pits,” said Steven Gorham, an attorney who has represented many patients, including McCormack.

Oregon’s system of managing defendants judged guilty but insaneis tangled in irony. It contains the best and the worst. The Psychiatric Security Review Board that supervises these patients was the first unit of its kind. The board has been hailed as a model and adopted by other states.

But this lauded system founders in the gloom of the state hospital’s Forensic Psychiatry Department. The 331-bed unit, which has undergone explosive growth in the last decade, is among the nation’s most poorly funded and thinly staffed psychiatric units.

Several buildings that house the nine forensic wards on the Oregon State Hospital campus are dilapidated. Richard S. Vohs, forensics director, is ashamed to take visitors onto the maximum-security wards. He rarely has to. Most of the people who come here arrive in chains.

“For a modern psychiatric facility, I can definitely say that in my 20 years of working in public mental health, I don’t think I have ever seen anything as bad,” said Vohs.

Tall, barred windows puncture the chipped, yellow brick walls of the J Building, giving the hospital the look of an old fort. It is indeed a citadel of last resort. Consider:

• *Private psychiatric care costs about $500 a day. Oregon spends $131 a day on forensics patients. On some wards, up to six beds are crammed into a room measuring 24 by 30 feet. The wards are dirty. There are no janitors; ward staffers must mop and scrub amid their other duties.

  In comparison, the Colorado State Hospital, rated one of the top public psychiatric units, spends $220 a day per patient. And its staff does not have to clean wards, serve food and escort patients. Its members concentrate, instead, on treatment and internal security.

• *Of 79 U.S. prison forensics units surveyed in 1988, Oregon’s was ranked 74th in staffing levels. The Oregon ratio of 0.6 staff members to every patient is about half the national average of 1.1 to 1.
• *Forensics spends less than $20 per employee on training each year. That, notes Daniel Reichman, president of the union local, is less than most fast-food chains spend to train their counter help.
• *In 1988, the Governor’s Commission on Psychiatric Inpatient Services urged that the 1883-vintage J Building be demolished because of health and safety dangers. The same report warned that the outside walls of the newest building on the campus, erected in the 1950s, were at risk of falling off. A $4 million renovation is under way at the five-story 50 Building, where the walls are not the only problem. The top floor has been vacant for years because faulty plumbing could not deliver water that high.
• *The wards, choked with cigarette smoke, have neither circulating fans nor air conditioning. Interior summertime temperatures routinely reach 100 degrees. In winter, the ancient heating system often fails. One morning last winter, Vohs said, the temperature on one ward dipped to 44 degrees.
• *On Ward 48C, one of two maximum security wards located in the J Building, patients are locked in their rooms overnight and power is turned off. There is no automated locking system; each room must be locked — and unlocked — individually. Patients worry what would happen in a fire.
• *In the last decade, the forensic wards have recorded tling number of suicides. The governor’s commission noted overhead pipes, wire window screens and other suicide hazards. Thirteen patients have killed themselves in 10 years, most by hanging. Five died in 1983 alone.

Dr. Peter J. Batten, the Marion County medical examiner, has studied suicide at the hospital since the 1960s. In 1983-87, Batten said, the suicide rate in the forensics unit was 48 times that of the general population and more than 25 times that at the state penitentiary.

While it is risky to draw conclusions from a statistical base as small as 13 deaths, the rates do point to a problem. At Colorado State Hospital in Pueblo, a forensic program of similar size, director William Ross says there have been only three or four suicides in the last 10 years. But the Colorado hospital is better staffed and has no blind spots in its 17-year-old maximum-security unit. Patient rooms and showers can be watched from the nurse’s station. Not so at Oregon State Hospital.

“We have taken corrective actions on suicide hazards as best we can,” Vohs said. “ But are all of them eliminated? Hardly. With the exception of the 50 Building remodel, we’re still in desperate straits.”

The suicide rate has dropped as hazards were eliminated. Pipes are concealed and fine mesh now covers many wire window screens.

Forensics has had just two suicides since 1987, but insiders know suicide will never be eliminated. Forensic patients are at high risk, and determined patients are difficult to stop.

The suicide threat is exacerbated by the hospital’s staffing and building problems, say Vohs and others.

Police and hospital reports on the unit’s last suicide reveal the dangers of thin staffing.

On the evening of Aug. 8, 1989, 10 patients from Ward 48B, the other maximum-security unit, were locked in their rooms. One staff member was on the ward. Other attendants were with patients “yarding out” in the recreation yard.

The patient in Room 8 had been brought up after he climbed the yard’s 12-foot-high fence and cut his finger slightly on razor wire.

The 39-year-old man had been in the state hospital since 1978, when he tried to kill an old woman. Diagnosed with schizophrenia, tormented by delusions and hallucinations, he had not responded to treatment.

His chart warned he was a physical threat to others, and he had attempted suicide twice before. In November 1984 and March 1989, he tried to hang himself. On the day he died, he asked another patient to tell his mother he loved her.

Policy called for spot checks at irregular intervals no longer than 15 minutes. At 7:05 p.m., the lone aide saw the man pacing in his room. When the aide returned about 7:15, the patient was hanging from the iron window screen.

The aide struggled to lift the unconscious, 215-pound patient and unknot the green sheet looped around his neck. He held him up for a time, then, in desperation, let him go and ran for help.

He returned moments later with shears. Another aide arrived and they worked furiously to cut the sheet. The shears broke. The first aide ran for more help. The second strained to lift the patient. He finally slipped the knotted sheet off the patient’s neck, but the man was dead on arrival at Salem Hospital.

The death in Room 8 had a chilling footnote. As the aides struggled to save the hanged patient, they glanced at his roommate, a schizophrenic who was sent to the hospital after raping his mother. The man sat on his bed with his hands folded under his head. He had watched his roommate hang himself. He then watched the frantic rescue efforts. He never spoke. He never moved.

After the suicide, the hospital changed policy. Two staff members would remain on the ward when patients are yarded out.

“It shouldn’t be so easy to kill yourself in there,” said Mike Caruso, a former patient on Ward 48C. “ But it’s real easy to hang yourself off those wire windows, and there’s places in the bathroom to do yourself, too.”

A hospital investigation found no staff wrongdoing. The report did note, however, that “it must be recognized there are suicide hazards . . . and that the correction of suicide hazards has been an ongoing process for several years.”

“These tragedies are really a horrible part of our operation,” said Vohs. “If we had the appropriate facilities, a modern psychiatric environment — the adequate, and I’m not asking for anything beyond the national average, adequate, minimally adequate staffing and appropriate training — we could prevent many of these.”

While the state hospital suffers from a lack of resources, Oregon’s Psychiatric Security Review Board remains a model.

“Like a lot of things around here, we are conceptually very strong and fiscally very weak,” said Dr. Joseph D. Bloom, chairman of the psychiatry department at Oregon Health Sciences University. “We have a lot of enlightened law here, but not a lot of follow-through that is enlightened.”

The review board was created in 1978 out of concern about the rising number of defendants pleading insanity. Sent to the state hospital, these defendants were often released after brief treatment. Judges did not have the time or expertise to track these people.

“Under that system, the ‘not guilty by reason of insanity’ tended to be a ticket out the door, and you beat the system that way,” said Jeffrey L. Rogers, Portland city attorney and former member of the review board.

The review board changed all that. Today, defendants who are guilty but insane are placed under the board for long stretches. Typically, the board will supervise a defendant for the maximum time he or she would have received if found guilty .

The board’s chief mission is to protect the public and it rarely severs control over a patient before the sentence expires.

The board has five members: a psychiatrist, a psychologist, a criminal lawyer, a person from the parole/probation system and a member of the general public. Board members say the interdisciplinary approach is the key to their success, which by most accounts has been substantial.

The board has been endorsed by the American Psychiatric Association and copied by other states.

But the board’s caseload has soared. In the 1980s, the forensics department at Oregon State Hospital was adding a ward every 18 months to keep up with the influx of review board clients.

Today, the board supervises about 470 patients. About seven in 10 patients have psychotic illnesses, with schizophrenia the most prevalent disorder. Kathleen Haley, the board’s executive director, says most patients also have a history of “self-medication” with illegal drugs and alcohol.

The definition of forensic patients is a sensitive one in the mental health community. Professionals bristle at stigmas reinforced by popular depictions of ax-wielding psychopaths. They say insanity acquittees, as defendants are called, are fundamentally people with mental illnesses who can be dangerous if their illnesses are not treated.

In 1981, the attempted assassination of President Reagan by former mental patient John Hinckley Jr. Hinckley’s subsequent acquittal by reason of insanity rred many state legislatures to revise their insanity defense statutes.

Oregon was among them. The legislature revised the law to exclude offenders with personality disorders from claiming insanity. It also changed the language of the law to “ guilty except for insanity.” The change would reflect how the state handled these defendants.

But the revision did not change the fact that under the law these defendants are not convicted of a crime; the law does not hold accountable people who cannot distinguish between right and wrong.

The board steers patients toward treatment and community release. The state spends $47,972 a year for a forensics bed, which is more than seven times as much as a community release slot costs.

Board chairman Richard Sly sees treatment as dovetailing with the board’s charge to protect society. All but a handful of these patients eventually will be freed. If their mental illnesses are not controlled, they will pose a threat to themselves and others when they get out.

“These are citizens of Oregon who by no fault of their own have inherited or developed a mental illness,” said Sly. “They are not people who are crazy and out of control. They are people who have periodic symptoms of an illness that is treatable, by and large. They’re children of normal everyday parents. They are moms and dads of kids in our schools. We’ve even had patients who are university-level professors. They’re not bad people.”

Many of them, however, do commit horrible crimes when their illnesses go unchecked. Of the 46 different crimes committed by board clients, murder has the highest incidence. Thirty-three killers are under board supervision.

The severity of a crime, its frequency and the patient’s mental state are key criteria the board weighs when considering someone for conditional release.

About 155 of the board’s 470 patients are out in public. Despite the notoriety of the McCormack case, the board has had few problems with patients “acting out” while on release, Haley said.

Patients on release meet weekly with a case manager; most are placed in supervised group homes and receive daily treatment. Drinking is banned and random drug testing is often required. Patients must report their movements and gain board permission to leave an area.

When the board learns a patient has violated the terms, it moves swiftly. Haley says the patient is usually picked up within hours of a caseworker’s call.

Haley, Vohs and others believe Oregon’s overloaded public mental health system has helped drive the rise in board cases. Dammasch State Hospital has not accepted voluntary commitments since 1986. Community mental health programs are swamped, and odds are slim of an uninsured person finding help in the public system.

Haley says the board often sees defendants who have intentionally committed crimes to get treatment.

“I think we have to start funding our mental health treatment,” she said. “I mean we’re the end of the road. We’re the end of the line for a lot of people. I’d like to see the day when we have a declining population . . . because people are getting treatment sooner. That’s what I’d like to see.”

On a Friday morning, about 20 of the 27 patients on Ward 48C have gathered for a ward meeting, one of the few times each week the patients spend time together. Patients generally keep to themselves. It can be dangerous not to.

Up on the third floor, behind seven sets of locked gates and sally ports, Ward 48C is the forensic unit’s ward of last resort. This unit houses the state’s most dangerous psychiatric patients. Many patients will “flat-time” it here, spending their entire sentence buried in the murk of the J Building.

“It’s a hell,” said Gorham, the defense lawyer. “It’s the second-worst place in Oregon to be institutionalized. The worst is the psychiatric ward at the state penitentiary. If there ever was a dungeon, those two places are it.”

Patients and staff agree Ward 48C is a dump.

While electroshock therapy is a thing of the past and physicians are more cautious about over-sedating patients, life on the wards is not that much different from the grim portrayal delivered by “One Flew Over the Cuckoo’s Nest,” which was filmed here in the 1970s. A haze of cigarette smoke assaults visitors who step through the black iron cage into the smoking room on 48C. The ceiling panels are stained mustard yellow. Along with eating, sleeping and watching TV, smoking is one of the ward’s few activities.

Down the hall in the TV room, the grimy mauve walls reflect a somber mood. Wire screens cover the windows that overlook Center Street and the world. A photographic mural faces the big-screen TV the patients purchased. The forest photos were meant to brighten the hospital. They only add a pathetic note to these dismal surroundings.

“The minute you walk into that environment you automatically get depressed,” said Mike Caruso, a former patient. “There’s a dull feeling that comes off the walls and floor. You know how wine has a fine bouquet? That part of hospital has no bouquet at all.”

The agenda lists 10 items and the meeting holds to parliamentary rules. A plan to rent videotapes for the ward is approved. Patients want a set of weights for use in the yard. They also want a Frisbee.

Complaints often center on the building. The toilets don’t always flush. It’s too cold in winter. Too hot in summer. On some wards, the staff south-facing windows with foil to keep out the sun on hot days.

The staff shares the view of the facilities. Don Marshal, a mental health therapist on 48C, says: “We’re caught in the dark ages. I watched `911′ on television when they went to the Soviet Union. They went inside an old Soviet hospital and it reminded me of the state hospital.”

Most staff members express frustration, too, that with cleaning, dining and escort duties, they do not have time to treat the patients. They point to the McCormack escape as an example of how they are asked to do more with less. The suspension of pass privileges has raised tension on many wards. Nine half-time positions added to the security department were carved out of existing ward staff.

“We are all for security,” said Dr. David Jobe, the psychiatrist on 50F. “However, we now have to beef that up without any added resources. We don’t have any more resources, so we have to take away from the therapy part, and we’re already into the pig trough to start with.”

Lack of resources makes life on Ward 48C more dangerous. Staff members are occasionally attacked. Tools are kept locked and staffers watch for sharpened objects. But patient violence is hard to control on a ward where the pencil is the weapon of choice. It all makes for a surreal work environment.

“It’s difficult to work here and go home and explain to somebody,” said Daniel Reichman, the local union president. “You asked if the general public understood institutions. I don’t think a lot of our families always understand. They can’t come to Daddy’s office. They can’t come to where Mommy works. And it’s real hard to go home and explain to somebody how you feel after somebody comes down the hall with a pencil stuck in their eye because the voice of God told them to pluck their eye out.”

What the future holds for the forensic system is difficult to gauge. Optimism does not abound at the state hospital.

Donald Strecker, 37, a patient on Ward 48C, has served about 15 years of a 20-year sentence for rape and sodomy. He maintains his innocence but holds a dark view of what life will be like when he gets out.

“The likelihood of me getting a job and landing back on my feet is zero to none,” he said. “The most I could hope for is a cheap hotel room on skid row, a bottle of wine and to die in my own puke.”

This spring, Measure 5, the property tax limitation, nearly sank a successful program for sex offenders. The probation sex offenders program on Ward 47B was scheduled to close July 1, along with Ward 50F. A revised budget proposal by the Mental Health Division would extend the sex offender program a year and preserve Ward 50F. The proposal is before the Legislature.

Vohs shudders at a future under Measure 5.