From the Salem Statesman Journal, March 6, 2011

The odyssey of Oregon State Hospital patient Rebekah Brewis has taken extreme twists and turns.

From abused runaway as a child to legal activist now.

From suicidal prisoner to recovering mental patient.

From male to female.

From despair to hope.

Her stay at Oregon’s main mental hospital raises questions about care and supervision provided for a still-evolving, transgender patient. Behind-the-scenes, the unique case is drawing attention from federal investigators, who are in the midst of an ongoing four-year-old investigation of patient care at the Salem psychiatric facility.

In another development, a Marion County judge soon will hear conflicting evidence about the quality of care provided for Brewis, as well as dueling views about hospital monitoring of the patient, who bitterly complains about near-constant surveillance.

This story, drawing on hospital records and interviews with Brewis, retraces her harrowing path to the state hospital. It also looks at the crux of the legal controversy.

In 2007, Jorey Brewis, as he was known at the time, was locked up in a state prison, serving time for robbery.

Racked by discomfort with his male body, a condition known as gender identity disorder, Brewis made repeated attempts to kill himself.

The rare condition went untreated behind bars, and Brewis castrated himself in his cell. In 2007, he used nail clippers to cut out his testicles, records show.

Brewis was committed to the state hospital after being caught with prison contraband — a razor. He pleaded guilty except for insanity to the charge and landed at the psychiatric facility in December 2009.

At OSH, Brewis dresses in women’s clothing, wears makeup and takes doses of feminizing estrogen — all part of her ongoing transition from male to female. She has legally changed her name to Rebekah.

In Marion County court papers, Brewis claims that she doesn’t receive adequate treatment for gender identity disorder. She also alleges that the hospital is violating her rights by housing her on an all-male ward, where she draws around-the-clock staff monitoring, known in hospital parlance as a “constant.”

A two-day hearing on the case is scheduled for March 31-April 1 in Marion County Circuit Court.

Brewis, 30, seeks a court order requiring the hospital to provide proper treatment for her medical conditions, including gender identity disorder, Post-Traumatic Stress Disorder and a deviated septum.

She also asks for a court order to immediately halt the hospital’s practice of keeping her on a “constant” watch.

Legal papers assert that Brewis “must be treated for her GID at preliminary levels before she can continue to higher levels of treatment, up to and including gender reassignment surgery.”

In an interview with the Statesman Journal, Brewis said she is not asking the state to provide her with a sex-change operation.

“I believe it’s medically necessary, but I can see how people would try to make it a polarizing issue,” she said. “It would just be one of those issues that would rile people up because they don’t understand it. And it wouldn’t get far.”

Outcast among men

In an affidavit filed for her case, Brewis maintains that “OSH does not have adequate policies and procedures in place to deal with transgender patients, and I am targeted and discriminated against as a result.”

She outlines a litany of complaints, such as the hospital’s unwillingness to provide her with electrolysis to remove unwanted facial hair and humiliating encounters with other patients and staffers.

Brewis also objects to being housed on Ward 35C, an all-male ward.

During an interview, she described herself as an outcast on the unit.

“I’m female, and I shouldn’t be here,” she said. “I should be on a co-ed ward at least, with other females. If I try to befriend anyone here, they get flak from other men. I’m just totally isolated.”

Brewis has a private room on the ward but shares bathroom facilities with more than 30 men. She takes her turn when the bathroom is not occupied.

Brewis said she feels unsafe on the ward. She recounted being attacked in the shower by one patient and being targeted by what she described as a “death threat letter,” allegedly written by a group of male patients.

“They called it the hate-the-bitch-club,” she said.

Typically, two hospital staffers are assigned to shadow Brewis when she is on the ward during the day. At night, one staffer is posted outside her bedroom door.

Brewis said she feels spotlighted and trapped by the rigorous monitoring.

“It’s outrageous,” she said. “What makes it even more bizarre is that when I’m over at treatment mall, I don’t have any constant at all, and there are a lot more people there than on the unit.”

Troubled childhood

Born in Grants Pass, Brewis was abused, neglected and shuttled in and out of foster homes during a chaotic childhood, according to reports in her hospital file.

Gender confusion emerged when Brewis was in grade school, reports show.

“Rebekah describes multiple instances growing up as a child where she did not fit in with her assigned gender,” wrote a hospital therapist in one report. “She did not get along with other children and started becoming socially more isolated.

Fear, shame and anger deepened with a barrage of insults and bullying Brewis experienced at school.

As a teenager, Brewis repeatedly ran away from school and foster homes.

“Frequently she would run away while she was in high school and spend time in the woods crying,” the report says.

Misery morphed into a cycle of drug abuse, homelessness, suicide attempts, hospitalizations, crime and incarceration.

Brewis spent time in Oregon’s juvenile corrections system for stealing a car and fleeing from police.

Later, Brewis was sentenced to 70 months in the adult prison system for robbery. Behind bars, Brewis had numerous conflicts with inmates and corrections officers, and the original sentence was extended by a series of offenses, including assault and supplying contraband.

Stints in prison segregation units heightened the inmate’s depression, anger and isolation. After repeated suicide attempts and acts of self-mutilation, Brewis was transferred to the state hospital.

Court date, release loom

Hospital reports indicate that Brewis has been diagnosed with Post-Traumatic Stress Disorder, as well as gender identity disorder.

She has “frequent nightmares” stemming from “multiple traumatic and negative experiences” in her life.

Therapists report that Brewis has made significant progress on a path to recovery, and she has gained a sense of purpose through activism. Recently, Brewis joined several other patient activists in lobbying for legislation at the Capitol. She also has made her views known at meetings of the state hospital advisory board.

Brewis is on track to be conditionally released from the hospital.

The state Psychiatric Security Review Board recently authorized the hospital to move forward with a plan to place her in a group home in Portland.

No date has been set for Brewis to leave OSH. She doesn’t expect it to happen before the March 31 court hearing.

For Brewis, the legal battle about her hospital care and supervision has fueled a desire to become a lawyer.

After she leaves OSH, she plans to study social work at Portland State University, get a bachelor’s degree and then move on to law school.

“I have a lot of history in law already. I think I’d be well ahead of the curve,” she said.

Judge approves hearing

Brewis won a preliminary-round victory in her legal fight with the state, when Circuit Judge Joseph Guimond denied a state lawyer’s motion to dismiss her complaint.

“I find there exists significant issues of material facts surrounding the treatment provided this plaintiff by defendant’s physicians, especially in light of the ‘unusual’ nature of plaintiff’s physical and emotional problems,” Guimond wrote in a Dec. 10 letter to attorneys representing Brewis and the state hospital.

The judge noted that “this is not your ‘normal’ habeas corpus case. A threshold problem is whether to refer to the plaintiff as a male (in the defendant’s brief) or female (as in the plaintiff’s brief).”

As the Marion County court hearing nears, the federal Justice Department appears to be delving into how Brewis has been treated at OSH.

A lawyer from the Civil Rights Division of the U.S. Department of Justice recently visited OSH and met with a group of patients. Brewis was among them. She also had a private session with the federal attorney.

“They’re looking at my case because of gender discrimination,” Brewis said. “They are gathering documents and are pleased with what they have.”
State rebuts claims

The state denies Brewis’ claims of discrimination and inadequate treatment for gender identity disorder in legal papers.

“OSH does not have policies specifically addressing the treatment, care, custody and management of GID,” Dr. Mark Diamond stated in an affidavit filed before he stepped down as the hospital’s chief medical officer.

“Hospital policies govern the overall treatment opportunities available to all patients. The hospital’s mission is to deliver respectful psychiatric services that are of high quality, effective in cost, and promote patient recovery.”

Thomas Castle, a state assistant attorney general representing OSH, wrote in a legal brief that the hospital has provided Brewis with appropriate care, including hormone replacement therapy and psychotherapy for gender-identity disorder.

As Castle tells it, intensive staff supervision of Brewis is warranted and provides a safety precaution for patients on Ward 35C.

“Close supervision is of benefit to all … Providing 1:1 constant supervision comes well within the accepted judgment, practice or standards of professional mental health organizations,” he wrote.

Underscoring the unusual nature of the case, Castle’s legal brief refers to the plaintiff — Brewis — as a female in some paragraphs, such as “…Ms. Brewis has an unpredictable nature…,” and as a male in other paragraphs, such as “his adversarial problem-solving style interferes with his ability to cope with the everyday stressors presented in the hospital environment.”