Troubles at the Oregon State Hospital

New Concerns About Racism, Transphobia Raised With Oregon State Hospital Leadership

Lund Report – October 20, 2021

Members of Oregon State Hospital’s Advisory Board want answers from the hospital’s leader after hearing from a staff member about the treatment of a transgender patient, a Black patient and a Black nurse.

READ – letter from the Oregon State Hospital Advisory Board to Superintendent Dolly Matteucci, September 28, 2021
READ – letter from Disability Rights Oregon to Gov. Kate Brown and OHA chief Pat Allen, September 27, 2021
READ – letter to Disability Rights Oregon from Oregon State Hospital Superintendent Dolly Matteucci, October 18, 2021

The hospital’s advisory board sent a letter to Superintendent Dolly Matteucci asking for a review of the hospital’s patient rights policy so employees can confidently report incidents without fear of retaliation and know the complaints will receive a prompt and thorough investigation.

The Lund Report obtained a copy of the Sept. 28 letter. It’s the second public letter in a month about the state-run hospital that top officials have received from organizations that have heard employee concerns directly. Disability Rights Oregon sent a Sept. 27 letter to Oregon Health Authority Director Patrick Allen and Gov. Kate Brown after conducting a hospital visit and interviewing staff members who expressed a range of concerns, including a staffing shortage and a lack of treatment for patients.

The hospital responded Monday to that letter, outlining steps it’s taken, including stepped-up recruitment efforts and an updated policy that lets clinicians escalate concerns about a patient. According to a hospital official, the staffer no longer works there.

The advisory board letter calls on the state to set its sights higher at the hospital as it treats vulnerable people with better policies that protect patients and staff who report problems. The residential psychiatric care facility serves about 500 patients at any point and has a main campus in Salem and a smaller campus in Junction City.

“It has come to the attention of the Oregon State Hospital Advisory Board through good faith reporting, some concerning incidents and practices have occurred at the hospital,” the letter said. “These reports also highlight safety concerns and fear of retaliation from staff for voicing and reporting these concerns. These reports are especially troubling because we are at a critical juncture in this country’s history. Endemic racism and transphobia are no longer swept aside to be dealt with later or forgotten entirely.”

The letter, which quotes accounts from the same staffer directly, reports the following incidents:

Black Patient Denied Eye Care

The letter said that, according to the former staffer, a Black patient was “continually exposed” to COVID-19 and denied care in the eye clinic. It also said the Black patient was assigned to a separate unit due to his violent history. That unit was designated for COVID-19 patients.

When the hospital had COVID-19 patients, staff placed those patients in one hall of the unit and the Black patient in the other hall, the letter said. Because the same staff were assigned to care for the Black patient and the COVID-19 patients, the Black patient was constantly exposed to the virus, the account said.

“Email reports of the concerns were not responded to,” the account said. “He was also denied care in the eye clinic initially due to the doctor being afraid, even though he would be accompanied by a nurse and two security guards. Throughout this, staff and the clients were put into dangerous situations. I feel as though my ethics were put in jeopardy and was genuinely concerned about my licensure in being asked to do things I deemed as illegal.”

Transgender Female Put In Male Unit

In another instance, a transgender patient who transitioned from male to female was placed in a “max security, ALL male unit because she wouldn’t take her meds,” the letter said. That patient, however, had no violent issues for three years.

“She has struggled badly since this and has decompensated due to the strain of it,” the letter said, quoting the staffer. “In my opinion this is unsafe and abusive. She identifies as a female and they are putting her at risk by placing her in an ALL-male unit as well as not honoring her identity. She has since had to be restrained multiple times and is assaulting people again. How could she not, as she is in an unsafe and caustic environment?”

Black Nurse Faced Racist Comments

In another instance, the staffer saw a traveling, contracted nurse face racist comments.

The letter said the nurse has more education and training than other employees there and someone said, “Oh well, I didn’t think you were an RN, we see your kind around here all the time and they aren’t actually nurses.”

The staffer said the incident was reported to human resources and nothing was done.

“The only response given was an email stating ‘Do you know what can of worms you’re opening?’” the letter said.

The advisory committee is asking for more commitment to education about diversity and equity. The committee also wants a timeline for a response to the allegations and information about who is responsible for follow-up work and putting changes in place.

Hospital Plans To Brief Committee

In a statement, Oregon Health Authority spokeswoman Aria Seligmann said the hospital takes all workplace complaints seriously and thoroughly reviews reports.

“We encourage patients and staff to voice their concerns and we do not tolerate any retaliation toward anyone who reports an incident” Seligmann said, noting the incidents were reported by a former employee.

The hospital’s chief medical officer has reviewed the two incidents involving patient placements and Superintendent Dolly Matteucci has offered to brief the advisory board members, Seligmann said.

It’s unclear from the statement whether the hospital’s leadership believes those patient placements were handled appropriately.

That briefing process will “provide a complete and transparent review of the clinical factors involved in each case, in a manner that protects each patient’s privacy,” Seligmann said. “She looks forward to answering their questions.”

As for the incident with the nurse, hospital managers reported it to the health authority’s Office of Equity and Inclusion, which handles the agency’s discrimination complaints, Seligmann said, adding that the hospital does not tolerate workplace discrimination. That office will investigate the matter and brief the advisory board.

Hospital Response To Other Concerns

Disability Rights Oregon staff heard repeated warnings from hospital staff and providers about overworked employees and a lack of appropriate care for patients. The advocacy group had toured the hospital without an escort, using its federal authority through Oregon’s Protection and Advocacy System. Disability Rights Oregon is the state’s federally designated mental health care watchdog.

Hospital staffers had expressed concerns that included chaotic patient transfers, inadequate discharge planning, a lack of substance abuse treatment for patients and a lack of clear protocols for transferring a patient to the COVID-19 unit. In their totality, the staffer interviews painted a picture of a hospital in “complete disarray,” Disability Rights Oregon wrote in its September letter to state officials.

Matteucci, the hospital superintendent, responded to Disability Rights Oregon in a letter on Monday. Matteucci acknowledged the COVID-19 pandemic and staffing crisis has hit the hospital hard. For example, the hospital had to suspend its so-called “treatment mall” and do unit-based treatment instead, which has fewer options for patients.

The hospital also converted a unit to treat COVID-19 patients, which required patient and staff transfers throughout the hospital.

“All of these steps have had necessary and unavoidable consequences,” the letter said. “Creating a COVID-19 isolation unit meant asking staff to move to other units to manage new patients with higher levels of acuity. The unit-based group treatment model lacks the variety of treatment opportunities we can offer in the treatment mall.”

However, Matteucci said those steps were necessary to keep COVID-19 infections down, noting the hospital hasn’t had any deaths from the virus.

Other points in the letter:

Staffing: Matteucci said hospital staffing continues to be a challenge with mandatory overtime shifts for employees. That comes as the hospital moved to enhanced staffing levels across units in response to recommendations from its nurse staffing committee.

“It’s no secret that these mandated shifts have had a significant impact on staff morale, but they have been a necessary tool to meet the enhanced unit staffing required under our most recent staffing formula and help patients get through the changes in programming the pandemic has forced on OSH,” Matteucci wrote.

The hospital has increased its contracts with staffing agencies and has 68 agency nurses, certified nursing assistants and mental health technicians on board. Oregon National Guard troops also serve in a support role at the hospital. They are due to be there until Dec. 31.

Treatment: On the patient treatment front, Matteucci said the hospital uses a “cohort model” with clinicians from treatment services and psychology staff to provide group treatment to patients in two or three units to offer a range of options and limit the risk of COVID-19 spreading.

The hospital has “begun to resume co-mingled patient activities” and plans to return to the treatment mall model after COVID-19 subsides, the letter said.

Matteucci said substance abuse treatment is available. But there are limits. For example, aid-and-assist patients are at the hospital because they need to regain competency so they can aid in the defense of criminal charges they face. Substance abuse treatment may be part of their treatment plan, but it’s not the primary objective of the admission, the letter said.

Patient Transfers: The superintendent stressed it’s not hospital policy to move patients between the Salem and Junction City campuses without clinical consideration. That was another staff concern.

However, Matteucci said the hospital had to “move patients throughout the hospital quickly to ensure the safe and appropriate placement of all of its current and incoming patients” to put its COVID-19 strategy in place and efficiently use the hospital’s beds.

Matteucci added that she has directed staff to incorporate “comprehensive clinical information” before a patient transfers. The hospital recently updated its policy so clinicians can escalate concerns and highlight a patient’s medical treatment needs.

Those processes were reviewed in late August and the hospital has a Nov. 15 target date to implement that latest revisions, the letter said.

Discharge planning: Matteucci said the hospital works hard to release patients when they can get help through community treatment programs and don’t need hospitalization.

However, resources are scarce and counties rely heavily on the hospital, including in aid-and-assist cases, the letter said.

“Too many Oregon counties look to the state hospital to commit mentally ill people who have fallen into the justice system because of a lack of appropriate treatment in their communities,” Matteucci wrote. “While Director Allen and I continue to make it a top priority to solve this issue, these problems will not be resolved until advocates and other stakeholders work to hold county officials accountable for their aid and assist decisions, not just the state.”

The letter also said the health authority has received $38.6 million to invest into community-based treatment options for people in aid-and-assist cases for the 2021-2023 budget cycle.

Questions Remain

For Disability Rights Oregon, the watchdogging will continue.

“We are pleased to see the state has taken some steps to address the serious concerns we raised about staffing shortages and the impact on patients at the Oregon State Hospital,” Jake Cornett, executive director of Disability Rights Oregon, said in a statement to The Lund Report. “While the hospital points out that the Legislature provided $38.6 million in funding, we remain concerned about the state failing to meet its obligation to patients and the lack of a clear timeline to use that funding to address root causes and immediate concerns. We need leadership, not finger pointing at counties. For now, the State Hospital is going to remain under Disability Rights Oregon’s microscope as we continue to conduct unannounced, unescorted monitoring of conditions on the ground.”

OSH superintendent acknowledges ‘profound larger crises’ at psychiatric hospital

Oregonian – October 21, 2021

The leader of Oregon’s state psychiatric hospital on Tuesday acknowledged concerns raised by advocates about staffing shortages and dangerous conditions.

Oregon State Hospital Superintendent Dolores Matteucci wrote a seven-page response to the advocacy group Disability Rights Oregon, addressing concerns raised in its own letter last month. It was among the most comprehensive public acknowledgements of the facility’s problems from the hospital’s top executive.

The Sept. 27 letter from the advocacy group’s director, Jake Cornett, called on Gov. Kate Brown and Patrick Allen, director of the hospital’s supervising organization, the Oregon Health Authority, to act on the “deteriorating conditions” at the hospital. It raised concerns including strain on staff from an ongoing worker shortage, an extended pause on family visits for patients, and transferring patients between units that may not be compatible with their needs.

Matteucci said the entire state’s behavioral health and healthcare systems had been “seriously battered” by the ongoing crises. She said that the hospital had addressed the issues with “urgency and transparency,” but that they had more work to do to support staff and patients. She attributed many of the problems to obstacles that the entire state’s healthcare system — not just Oregon State Hospital —is facing.

And she defended her hospital’s response to the pandemic, including the pause on family visitations and the transfers of patients between units, which she said allowed for newly admitted patients to quarantine before mixing with other patients and staff. Those precautions, she said, had helped keep COVID-19 cases under control, and she pointed out that no patients have died from the virus.

Matteucci also cited the steps they’ve taken to alleviate the staffing problems, such as training 68 new nurses, nursing assistants and mental health technicians at the beginning of October, expanding recruitment efforts, and securing $38.6 million from the Legislature to fund community-based mental health care for some patients.

State Rep. Rob Nosse, D-Portland, the vice-chair of the House Behavioral Health Committee, said his committee has received frequent updates from Matteucci about the hospital’s staffing and COVID-19 plans. He called her letter “an appropriate response” to a difficult situation.

“It was already a hard job,” he said. “Coming out of the recessionary part of the pandemic, everyone is struggling to get workers.”

In an email to The Oregonian/OregonLive on Tuesday afternoon, Cornett said he was glad to see the state taking some steps to address the concerns. But he said he remains concerned about the state failing to meet its obligation to patients and the lack of a clear timeline to address both immediate concerns and the root causes of the problems.

“We need leadership, not finger pointing at counties,” he said. “For now, the state hospital is going to remain under Disability Rights Oregon’s microscope as we continue to conduct unannounced, unescorted monitoring of conditions on the ground.”

The nonprofit was granted federal authority in 1977 to access the state hospital and other private and public facilities at any time because it is the official protection and advocacy system in Oregon. They have “reasonable, unaccompanied, unannounced access,” particularly if they are investigating reports of abuse or civil rights.

Matteucci’s letter also addressed some of the most challenging problems that Cornett raised in his letter: diminishing treatment options for patients and the transfer of patients between the hospital’s two facilities.

A lack of treatment opportunities, including fewer opportunities for substance abuse treatment and some types of group treatment.

Matteucci said treatment options have been strained by the pandemic and subsequent staff shortage. Many behavioral health staff members who provided those types of treatment were reassigned to work in direct patient care during the first stage of the staff shortage.

She said groups of clinicians have since begun providing group treatment to patients in certain units. She said when COVID-19 risks decrease they hope to return to their previous system of treating patients, in which patients live on their units and attend therapy in different parts of the hospital. She also said patients have continued to receive appropriate substance abuse treatment.

She also addressed Cornett’s concerns about patients being transferred between campuses.

Cornett said staff had been alarmed at patients being transferred between the hospital’s Salem campus and its Junction City campus without any notice. He said staff worry patients would suffer from being taken away from their regular care teams.

Matteucci said the hospital had to move patients through the hospital quickly in order to implement their COVID strategies and make room for patients, but it is not the hospital’s policy to move patients without clinical consideration. Per a new policy to be implemented in November, clinicians must highlight any medical concerns and treatment a patient needs before they get transferred.

She said despite the challenges, she was confident the hospital would continue to provide patients with “the best possible safe and therapeutic environment.”

“I know it has been a hard time for many of our employees, and we have much work to do to fill our vacancies and re-energize morale,” she said.

The hospital faces headwinds, though. Like most health care providers in the state, it faces a broader shortage of workers that will make rebuilding its staff difficult.

And it will soon have to contend with a steady flow of new patients. It had won a court’s approval last year to delay the admission of patients who were accused of crimes but found unable to participate in their own trial because of mental illness. U.S. District Judge Michael Mosman signaled last month that his pandemic-era accommodation would likely expire Dec. 3, and the hospital would have to resume timely admissions.

State hospital superintendent defends pandemic record in response to outside complaints

In a letter to Disability Rights Oregon, Dolly Matteucci acknowledged efforts to prevent the spread of Covid among the hospital’s 500 Salem patients have put more stress on staff and meant fewer treatment options for patients, but said the decisions were necessary to prevent outbreaks.

Salem Reporter – October 19, 2021

Oregon State Hospital’s superintendent acknowledged administrators’ handling of the Covid pandemic put more stress on staff and meant fewer treatment options for patients.

In a letter sent Monday to Disability Rights Oregon, Dolly Matteucci defended the hospital’s record over the past year and a half, saying decisions she and hospital leaders made successfully prevented the spread of the virus.

“Our efforts have worked. While COVID-19 tore through other congregate settings across the nation and Oregon – from nursing homes to state correctional facilities – OSH did not record a single positive patient case until eight months into the pandemic. To date, no patients at the state hospital have died from COVID-19,” Matteucci wrote.

Matteucci wrote in response to a Sept. 27 letter from Disability Rights Oregon’s executive director, Jake Cornett, who raised concerns about patients receiving adequate care and legal assistance in light of staffing challenges.

The organization has long played a role in motoring patient care and conditions at the hospital, which cares for about 500 Oregonians with mental illnesses and disabilities who are court-ordered to receive treatment.

“During our investigation into the conditions and treatment of people with mental illness during the pandemic, staff and providers paint a picture of a State Hospital in complete disarray and an agency that is unwilling or unable to confront just how bad things have gotten,” Cornett wrote.

The letter was addressed to Gov. Kate Brown and Pat Allen, director of the Oregon Health Authority, which runs the hospital.

Matteucci’s response confirms several findings from a Salem Reporter investigation into conditions at the hospital, published Oct. 12.

That investigation, based on interviews with employees and hospital records, found employees and patients were paying a steep price because of a hospital decision early in the pandemic to spread some of its least stable patients across the hospital to make space available for Covid quarantine and isolation.

The result was employees on units that had previously treated mostly stable, longer-term patients saw a large increase in so-called “aid and assist” patients. Those patients are admitted to the hospital because they are facing criminal charges and determined to be unable to aid and assist in their own defense because of a mental illness or disability.

While hospital records showed fewer recorded patient assaults on employees since the pandemic began, Salem Reporter found other data suggesting violence and aggression in the hospital was more serious and widespread. Incidents of patient-to-patient aggression and assault, internal alarms for behavioral emergencies and accepted worker’s compensation claims for injuries caused by patients all increased over the same period.

Matteucci addressed the shift in patient populations in her letter.

“All of these steps have had necessary and unavoidable consequences. Creating a COVID-19 isolation unit meant asking staff to move to other units to manage new patients with higher levels of acuity,” Matteucci wrote.

She said patients had fewer treatment options as the hospital closed its “treatment mall,” a place where patients from multiple units mixed together for help ranging from cooking classes to therapy groups. Instead, patients received care on the units they live on to avoid mixing between groups.

“The unit-based group treatment model lacks the variety of treatment opportunities we can offer in the treatment mall. Suspended visitations have meant that patients have less connection with family and friends. While we regret these consequences, we stand by the interventions we’ve taken. I am convinced our efforts have prevented patients from becoming sick with COVID-19 and saved patient lives,” Matteucci wrote.

She said providing treatment to patients on units meant less time dedicated to treatment, a concern employees also raised with Salem Reporter.

“Unit-based clinicians dedicated additional time to providing individual and group treatment. But because these clinicians are also responsible for other critical work – assessments, discharge planning, and individual therapeutic interventions, for example – it was not possible to entirely replace the treatment hours and variety of group options provided by the deployed staff,” Matteucci wrote.

She said the hospital has recently resumed some treatment activities mixing groups of patients from several units, and plans to return to its prior treatment model once the risk of Covid infection waves has diminished.

Matteucci also acknowledged training employees on the skills needed to help patients aid and assist in their own defense had lagged as patients were reassigned.

“Staffing our Legal Skills groups has presented a particular challenge during the pandemic. OSH relies on Behavioral Health Specialists to teach most of these groups. The process for training new staff is robust and takes considerable time. Staff efforts to shorten the training time was interrupted … because most of those staff who could train other clinicians were deployed to other priority assignments. These challenges our staff have faced in delivering our Legal Skills groups have largely affected units whose patient populations have not historically been focused on serving aid and assist patients. We continue to work to improve this situation and ensure all (aid and assist) patients have timely access to Legal Skills groups,” she wrote.

Matteucci said the hospital continued to struggle with staffing into the summer even after a state Covid leave policy had expired.

“We thought staffing levels would return to normal when the special COVID leave expired at the end of June. Unfortunately, that time coincided with the beginning of the Delta variant surge, which infected more staff during the summer of 2021 than all the months prior. Stress due to illness, contact tracing notifications, and fear of infection played a large role in staff resigning over the summer, in addition to the reasons mentioned above,” Matteucci wrote.

She reiterated steps hospital administrators have taken in recent months to bolster staffing, including a second deployment of National Guard soldiers and airmen, hiring temporary workers and advocating for money for community mental health treatment so fewer patients are referred to the state hospital.

“At the same time, I am proud of the results we’ve achieved for our patients, and the staff who’ve produced them, even as they have weathered unprecedented trials, including a global pandemic,” Matteucci wrote. “Despite our current challenges, state hospital staff and administrators have prevented large outbreaks of COVID-19, reduced incidents of patient assaults on staff and continued to provide effective, recovery-oriented treatment to an increasing number of patients with higher levels of clinical acuity.”