Judge rules for strict limits on some Oregon State Hospital stays

From the Oregonian, August 30, 2022

A federal judge has decided that the Oregon State Hospital must impose strict limits on how long it treats patients who have been accused of crimes but in need of mental health treatment.

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The ruling by Judge Michael W. Mosman seeks to ease the state psychiatric hospital’s overcrowding, speed the admission of new patients and prevent people awaiting admission from languishing in jail.

Effective immediately, the hospital must release “aid-and-assist” patients accused of misdemeanors within 90 days of admission, and those accused of felonies within six months of admission. Those are patients found by judge unable to participate in their own defense at trial.

The judge, however, also gave three district attorneys who opposed the motion until January to monitor the discharge of patients and provide alternatives that could aid the hospital admissions crisis. The prosecutors had argued restricting treatment times would result in people accused of serious crimes being released into the community before they’ve been fully rehabilitated.

The judge’s decision overrules an Oregon law that allows the hospital to hold an aid-and-assist patient for up to three years, or the maximum time that a person could have been sentenced to prison for their alleged crime, whichever is shorter.

Amber Shoebridge, a state hospital spokesperson, said that under the restricted timelines, the hospital can still keep patients for up to one year who have been charged with “violent felony” under state law, such as causing or threatening serious physical injury or a sexual offense.

Disability Rights Oregon, the state’s largest disability advocacy group, and Metropolitan Public Defenders requested the order. The groups have protested the hospital’s lengthy admission delays. Disability Rights Oregon had previously won a 2002 court order that required the hospital to admit aid-and-assist patients within seven days so they can get the mental health treatment they need instead of sitting untreated in jail.

But the hospital has struggled to meet that timeline, and the pandemic only made the problem worse.

Emily Cooper, legal director for Disability Rights Oregon, said she was “relieved” by Mosman’s decision.

“It’s a very promising first step,” Cooper said. “We’re talking about people that are getting harmed every day they wait in jail, and some who have died. That’s what this is today, let’s make some more room to get those people in sooner.”

The hospital has identified about 100 people who should be discharged immediately under the new timeline. They will be released to treatment centers in their home counties over the next six months, Shoebridge said. Counties will be given 30 days’ notice before a patient is sent to them. She said the release of those 100 patients will not delay the discharge of new patients as they become eligible.

Patrick Allen, the director of Oregon Health Authority, said he looked forward to working with community groups to return patients to their home counties.

The request to strictly limit treatment times was based on a court-ordered review of the state hospital’s admissions policies conducted earlier this year by Michigan-based mental health expert Dr. Debra Pinals.

Pinals’ 35-page report from June suggested the hospital gradually decrease its wait times for patients, aiming for an average of 22 days or fewer at the start of August; 11 days by January; and to be back in compliance with the 2000 federal court order, averaging 7 days or fewer, by Feb. 14.

The hospital was not on track to meet that goal, prompting Disability Rights Oregon to request new admissions guidelines.

Documents that the state hospital submitted to the court show that in the first half of August, the hospital admitted 54 patients who waited an average of 38 days to get in. As of Wednesday, 76 people were waiting to be admitted to the state hospital, and they had been waiting an average of 19 days to get in.

The state hospital, overseen by the Oregon Health Authority, did not oppose the motion.

But three district attorneys pushed back on the restrictions, saying patients charged with significant crimes should not be released from treatment prematurely. Billy Williams, the former U.S. attorney for Oregon, argued on behalf of the district attorneys for Clackamas, Washington and Marion counties.

The prosecutors said in a joint statement Monday afternoon that they plan to continue monitoring hospital admissions, as per the judge’s ruling. They called the lack of opposition from the Oregon Health Authority and the state hospital “unusual.”

Kevin Barton, the Washington County District Attorney, said the prosecutors felt compelled to act because they believe the restricted treatment times will have a negative impact on public safety.

Some of the problems dogging the state hospital, such as overcrowding and staff shortages, have also hit community mental health facilities.

Cooper, the Disability Rights Oregon attorney, said the lack of local mental health beds is still a problem, but a recent surge of state funds dedicated to mental health services should help accommodate patients as they go back to their home counties.

Pinals’ investigation was prompted by two federal lawsuits over the hospital’s admissions policies, including the long-running dispute with Disability Rights Oregon and a separate lawsuit brought in November 2021 by two Multnomah County men found guilty of crimes except for insanity. They argued the state had violated their civil rights by keeping them in jail for six month despite being ordered into treatment at the state hospital.