For Daniel Butts and others at OSH, treatment comes with a price tag – $678 per day

By Barbara LaBoe, The Daily News Online, April 6, 2013

Oregon State Hospital

Oregon State Hospital

The 130-year-old state mental hospital treating accused cop-killer Daniel Armaugh Butts has a storied history, including filming of the 1975 Academy award-winning film “One Flew Over the Cuckoo’s Nest.” When it comes to patients like Butts, though, the focus is on their future — and determining whether they’ll return to face criminal charges.

Oregon State Hospital, a mix of sleek, modern buildings wrapped around the iconic red brick and white copula of the historic “J Building,” houses about 600 patients on any given day. Nearly three-quarters of them have been charged with a crime.

About a fifth of the patients are like Butts — those who have been court-ordered to receive psychiatric care until they’re well enough to stand trial. These patients present OSH doctors with an interesting quandary: Helping their patients recover, only to watch them return to court and possible prison terms. Butts, for example, faces the death penalty if convicted of the Jan. 5, 2011, shooting of Rainier Police Chief Ralph Painter.

“You do think about that,” Dr. Christopher Lockey, chief psychiatrist at Oregon Health & Science University and director of forensic evaluations at OSH said during a tour of the hospital last month. “It can be hard knowing they’re going back to jail and prison, but it’s still rewarding to see patients get better regardless of the legal considerations. … We have very sick people here, and we do our best to improve their lives.”

Patients like Butts are known as “370 patients” for the section in Oregon state law that allows judges to order such treatment. Last year the hospital averaged 107 such patients on any given day.

Butts was sent to OSH by Columbia Circuit Court Judge Ted Grove in February after defense experts testified the 23-year-old Kalama man is schizophrenic. Grove found that Butts isn’t competent to assist is lawyers with his defense. His criminal trial is on hold until doctors — and ultimately Grove — agree Butts is better.

Each case is unique, but odds are Butts will return to court.

“The vast majority go back,” Lockey said.

While it’s a secure facility with electronic doors and video cameras, OSH is a hospital first, officials said.

Hallways resemble a cross between a college dorm and a community hospital. Rooms include a bed, dresser and desk, with community rooms and laundry facilities near the central nurses station. Smaller “sensory rooms” also are available where patients can sit quietly, listen to music or watch a soothing light show.

Patients eat in a cafeteria and take classes on “treatment malls” — a hallway of classrooms that patients move through based on their schedule. In between they walk through several courtyards that dot the inside of the facility. The hospital’s baseball field is the only part of the structure that has a fence, and it was designed with a curved top and anti-grab material instead of the razor wire seen at a prison.

Patients are segregated into different locked units based on their illness, progress with treatment and any particular risks they might pose to staff or patients.

Most of the hospital is just two years old. The new hospital was built to replace aging facilities after a 2005 state report found unsafe conditions and outdated treatment methods.

Turn certain corners though, and you’re “stepping into history,” as Dr. Arthur Tolan, director of Forensic and Legal Services, describes entering the remaining parts of the 130-year-old “J Building.” Portions of the building were used in “One Flew Over the Cuckoo’s Nest” filming, though most of those were removed during construction of the $280 million new hospital in 2011. The historic structure now houses offices, some treatment rooms and the state’s Museum of Mental Health — including an exhibit on the film.

Many of the hospital’s patients will eventually return to their communities or less restrictive treatment. Even some 370 patients are likely to return home or to group homes after serving out sentences, having charges dropped or improving mentally after being civilly committed. So treatment for all patients at OSH is now designed to prepare them for the outside world.

“The whole concept is really personal choice, independence and personal responsibility,” Tolan said. “We want to give hope, a sense of moving forward.”

That treatment comes with a hefty price tag.

The hospital spends $247,000 a year — $678 per day — housing and treating each 370 patient.

Patients are legally responsible for their bills, and the fees stay on the books until their deaths. But it’s unlikely most 370 patients will ever be able to pay their bills. Butts, for example, has already been found indigent in his court case and received state-appointed defense lawyers.

Despite the cost, Lockey said the treatment is necessary to protect the rights of the accused.

“Society has decided it’s not going to prosecute people who aren’t responsible (due to mental illness),” he said. “Even when that’s a struggle.”

Hospital officials couldn’t discuss Butts directly, citing privacy reasons, but they said all 370 patients follow the same general routine.

After initial evaluation, a treatment team is assembled, including a psychiatrist, psychologist, social worker, nurse manager, the patient and possibly family members.

The team determines a patient’s specific problems and he or she can then choose from several classes that address those needs. Hospital spokeswoman Rebeka Gipson-King likens it to a community college course fair. Actual treatment for 370 patients is the same for every other patient, only the classes might vary, Lockey said. They’re also all kept on one of the most secure units of the hospital — at least initially.

A 370 patient likely would take classes such as symptom management and medication management as well as psychotherapy and group sessions, Lockey said. They can sign up for recreation, such as yoga or basketball, but even those are designed to teach patients to follow rules and interact with others.

“Everything, even recreational activities, are teaching certain skills,” Tolan said.

All 370 patients also take a class on the legal system.

“You don’t want people to stand trial if they don’t understand the process,” Lockey said.

In Butts’ case, he also will take antipsychotic medication prescribed by defense-hired doctors. If he refuses, as he did while in the Columbia County Jail, Judge Grove has ordered that Butts be forcibly medicated.

Reports on 370 patients’ status are due to the judge at 90 days and then every 180 days. Reports also can be sent more frequently if a patient is making speedier progress. The first report on Butts is due to the court in mid June.

Once the treatment team thinks improvement has been made, they ask for a forensic psychiatrist to evaluate the patient. The evaluators also work for the state, but they’re not part of the treatment team, nor do they work for prosecutors. The separation allows evaluators to remain more objective, Lockey said.

The final decision about whether a patient is now competent enough to assist his lawyers is made by the judge — not the doctors. If there’s dispute, defense lawyers present their own experts before the judge rules.

The length of stay at OSH varies with the illness and crime a patient is charged with. Patients cannot be kept at the hospital on 370 status longer than the maximum sentence for their crimes. For patients facing serious charges, like Butts, the maximum limit is three years.

After three years without improvement the patient might be civilly committed or could be released back into the community. Patients might also be re-indicted for the crimes and sent back for more treatment. Columbia County District Attorney Stephen Atchison has said it’s highly unlikely Butts will ever be released without a trial.

Last year, 67 percent of the 307 patients at the hospital were found able to return to court, but Lockey said the numbers are even higher when you count patients there for more than one year and whose stay straddles two calendar years. Overall, hospital evaluators declare between 80 to 90 percent of all 370 patients able to return to court, he said.

“We’re pretty good at treating people and moving them forward.”