From the Oregonian, July 25 2009

Changes are happening at Oregon’s 126-year-old state mental institution. How much and how fast it is changing are what U.S. Department of Justice investigators will consider when they return this week for their first comprehensive evaluation since November 2006.

Following that last visit, the team released a report in January 2008 chronicling abysmal conditions at the hospital that not only hindered patients’ recovery but threatened the safety of both patients and staff.

They’ll return to see metal scaffolding snaking up the old “J” building, where the movie “One Flew Over The Cuckoo’s Nest” was filmed. They’ll hear hammers and power drills.

Demolition of some deteriorating buildings has begun to make way for a new hospital scheduled to open in 2011. A second hospital is scheduled to open in Junction City by 2013.

Until then, most patients will continue to live in crowded, outdated wards. But a string of six craftsmen-style cottages were recently refurbished to house patients nearing discharge.

Hospital leadership stresses that the changes are more than cosmetic. So far, reviews from staff are mixed.

“I think there are a lot of improvements started in patient care,” said Dan Smith, a psychotherapist who has worked at the hospital for seven years. “I would rate it as a C — I would like to see it be an A”

But Randy Davis, a mental health therapist and hospital employee since 1997, is slightly more positive. “I’m known around the hospital as being pretty cynical. If we can staff the new hospital the way it needs, then I’m very hopeful.”

Following their last visit, federal investigators criticized the hospital for relying too much upon seclusion and restraints as a way to control out-of-control behavior. Since then, data shows a decline in both practices.

Changes at the hospital have also helped reduce violent incidents. From January to June, there were 226 incidents of aggression between patients, down from 386 incidents in the first six months of 2008. The hospital reported 362 patient attacks on staff in the first six months of this year, down from 404 during the same period last year.

Yet at the same time, the hospital has seen a rise in the number of cases in which patients harm themselves — 184 last year up from 128 in 2007.

In an interview last week, hospital superintendent Roy Orr said he’s concerned about the trend of patients harming themselves and has a plan to address the problem.

Staffing remains the toughest challenge the hospital faces. Key leadership positions — including a chief psychiatrist, nursing officer and pharmacy director — have been filled since the federal investigators visited in 2006.

But a shortage of workers means nurses, aides and other front-line staff are still routinely required to work double shifts –despite warnings from federal investigators that a fatigued work force increased chance of injury to patients and staff.

“We have more work ahead of us than behind us,” said Orr, who was hired in February 2008, a month after the Department of Justice report was released.