From the Oregonian, December 31 2008

Another site, in Molalla, shut just six months ago

Low-income Clackamas County residents will have a harder time getting health care now that another clinic is closing.

The closure of the Sandy clinic today comes six months after the county closed the health clinic in Molalla. The county plans to close its remaining clinic, in Beavercreek, within the next year or two.

Mental health services and a nutritional program for women and children will continue to operate at the Sandy clinic. Other patients can transfer health care to Yakima Valley’s Rosewood Family Health Center, 8935 S.E. Powell Blvd. in Portland, 503-772-4335.

County officials say rising costs, falling revenue, a tight county budget and a need to upgrade inadequate buildings and equipment have forced the closures.

The clinics serve patients who lack private medical insurance, have low incomes or participate in the Oregon Health Plan. Patients are billed on a sliding scale based on income and household size.

Last year, the three clinics treated about 10,500 people, about 1,000 more than in 2006. The treatments included prescriptions, dental work, immunizations, family planning and mental health services. The clinic in Sandy had two full-time health providers until August, when it was reduced to one, said Janelle McLeod, the county’s primary care manager.

The county has said a nonprofit, Yakima Valley Farm Workers Clinic, would care for patients displaced by the closures.

The Yakima Valley clinics in Southeast Portland and Woodburn will be unable to immediately absorb all the patients from the closing clinics, said Yakima Valley clinic administrator Daniel Heindel, but will take in new patients on a rolling basis.

The clinics expanded their combined staff from 14 full-time medical providers to 16 full-time and one part-time provider, he said.

To date, the Yakima Valley clinics have not seen a big increase in the number of patients. That may be because low-income residents have trouble commuting greater distances or are finding help elsewhere, said Yakima Valley spokesman Glenn Cassidy. He said Yakima Valley has no plans to open new clinics in Clackamas County.

In 2007, the Clackamas County clinics operated on an $8.9 million budget with money from federal grants, patient fees, health insurance reimbursements and other sources. About $1.5 million came from Clackamas County’s general fund.

From the Oregonian, December 27 2008

On Portland’s streets, police say, James and Michael Johnson are known as the “Twin Towers” because the brawny brothers are always together and the sight of them strikes terror among the homeless.

Police said they have linked the 32-year-old twins to five unprovoked assaults against transients, all at Colonel Summers Park in Southeast Portland, where they’ve become known for their bullying and beatings.

“They’re always picking on people who are older and frailer. There’s no fair fights here,” Portland Detective Kevin Warren said. “For the most part, it’s just a beat-down. They’re just beating people up because they’re thinking they’ll get away with it.”

One man sleeping on a bench near the park’s gazebo was pounded with his own bicycle, police said. Another homeless man who yelled at the Johnson twins to stop the bicycle clubbing was then stabbed in the leg, police said.

One of the brothers last month threw a woman in her 50s down a flight of stairs at the park after she started to question why the pair kept hurting the homeless. A witness who tried to intervene was then assaulted.

“They seem to be able to do their acts with impunity,” Warren said. “I’ve never seen a couple of guys doing serial assaults like this with no apparent motivation … which got us motivated to find and locate other victims.”

A Multnomah County grand jury has indicted the Johnsons on second-degree and third-degree assault charges. Since their arrests Nov. 16, they’ve each pleaded not guilty to the charges. Since the brothers were taken into custody, other victims have come forward, encouraged by the knowledge their attackers are locked up, police said.

Detectives continue to reach out to the homeless at local shelters and church kitchens to determine whether others have been assaulted.

Marc Jolin, executive director of JOIN, a nonprofit agency that works to help the homeless into housing, said he learned about some of the beatings from staffers.

“People who are homeless are often victims of violence because they are vulnerable,” Jolin said. “They’re outside. They don’t have a lot of resources, and they’re not always comfortable going to the police and asking for help.”

In fact, many of those assaulted by the Johnsons never called police, but were found by officers some time after the attacks.

Court records show a lengthy criminal history for the brothers, dating to when they were juveniles, and prior alcohol, anger management and domestic violence problems. They haven’t had a steady address and have been described as transient at times. They have bounced among friends, listing addresses in Portland, St. Helens and Gresham over the past several years.

According to police reports, shortly after midnight July 19, a man sleeping on a bench near the gazebo in Colonel Summers Park awakened to one of the brothers pounding him with his bicycle. The homeless man, Jeffrey Paul Mason, 55, suffered a bloody nose and lost consciousness.

When a fellow transient, Charles Vaughn, 42, tried to come to Mason’s aid, one of the brothers turned on Vaughn and stabbed him in the leg, according to police reports.

Vaughn told police he limped off and watched the man who stabbed him return and continue beating Mason. Vaughn tied something around his leg to stanch the bleeding. When the bleeding didn’t stop after an hour, he went to a phone booth at Southeast 11th Avenue and Harrison Street to call an ambulance. Vaughn suffered a 2-inch gash on his right thigh and was treated at OHSU Hospital.

Vaughn told officers he usually spends his nights at the park and has seen the twin brothers assault others. “I can spot those guys from across the park,” he told detectives.

By August, detectives distributed a wanted flier to all Portland police precincts, seeking the arrest of the Johnson brothers.

Months passed. It wasn’t until Nov. 16 that patrol officers found the twins at Colonel Summers Park, arrested them and took them into custody on warrants stemming from the July beating and stabbing.

By then, investigators said, the twins had struck again.

In fact, a day earlier, police learned, the Johnsons had attacked a homeless woman who stood up for herself and others at the park. Witnesses told police the twins threw her down a steep staircase on the north edge of the park at Southeast 18th Avenue, off Belmont Street. She was found near the park’s gazebo the next day by police making routine checks. The officers found she had a warrant on a minor park violation. They drove her to jail but soon realized she had suffered a recent injury and called an ambulance to take her to a hospital.

The woman sustained a serious head injury, including bleeding in her brain, and was in the intensive care unit at OHSU Hospital for about 10 days, Warren said. “She’s fortunate to be alive,” Warren said.

Another man who witnessed the woman’s assault tried to intervene, police said. That’s when at least one of the brothers turned on him. The man suffered facial fractures, a broken left wrist and a cut to his forehead.

“None of these victims would be spoiling for a fight, especially against people who are younger and stronger than they are,” Warren said. “It’s pretty offensive.”

A 35-year-old man who lives on the streets and identified himself only as Jack said he’s seen the Johnson brothers in the city for several years. He described James Johnson as the more violent of the two. His brother, Michael, whom friends described as a few minutes older than James, always seemed to come to his aid. “One starts it, and the other one backs him up,” Jack said. The twins are each described as 5 feet 7 and 215 pounds, according to jail records.

When interviewed by officers, James Johnson denied any involvement in the July 19 beating. “I never beat up anybody,” he told police, “and I never stabbed anyone.”

James Lee Johnson has faced serious charges in the past, including a 1995 weapons conviction, a 1998 restraining order in an alcohol-induced domestic violence assault, and a 2004 harassment conviction after police say he spit on an officer. In 2004, court records show, James Johnson was ordered to complete counseling for domestic violence and anger management.

From the Roseburg News Register, December 23 2008

Winston, Oregon – After more than 20 years of providing mental health services to Douglas County children, the Riverside Center will halt its day treatment program next month.

As of Jan. 30, the center will offer only a few small therapeutic outpatient groups, sending 16 students in treatment back into public schools and leaving 10 employees without jobs, said Dan Strasser, executive director of the Riverside Center. Strasser said he will continue to look for other types of mental health services the center could offer.

“It’s kind of sad for me that this county’s decided — not due to lack of funds but their therapeutic philosophy — they’re going to allot the money elsewhere,” said Strasser, who has been director of the center for nearly two years.

For more than two decades, children and adolescents who have been diagnosed with serious mental health issues have attended the center daily — in place of attending a public school — to receive treatment, he said.

The day treatment program needs 24 students enrolled to keep it financially viable; currently, only 16 attend the center. Nine of the students are Oregon Health Plan recipients; they have to be authorized for the program by Douglas County Mental Health, Strasser said.

Despite the lower enrollment numbers, Strasser said he believes there is still a need for the treatment. In fact, he suspects the need has increased because of growing unemployment and poverty rates.

Statistics compiled by the U.S. Department of Health and Human Services show that 21 percent of children have a diagnosable mental illness, and 5 percent of those children have extreme functional impairment. By applying those percentages to Douglas County, Strasser estimates that 500 children have extreme functional impairment and more than 200 of them should be receiving some type of high-level services.

But lately, Strasser said the county has been authorizing fewer students for the program, which means denying families who want to use the treatment center. Strasser said he believes the funding is available but the county has decided to use the money for other programs.

Peggy Kennerly, Douglas County Health Department administrator, said the method of providing mental health treatment for children has shifted, which has resulted in the money being distributed to a wider range of services.

In 2005, 60 percent of mental health funding was being used to treat 6 percent of children needing care, Kennerly said. Most of that funding was going to day and residential treatment centers for children who had reached near-crisis levels, Kennerly said.

A state initiative implemented a couple of years ago, though, required health departments to create a continuum of care that would reach kids at levels across the spectrum, she said. More and more services are being created and funded at the lower levels of the spectrum in order to reach and treat kids before they reach crisis levels, Kennerly said.

As a result, Kennerly said fewer kids need the services offered at day treatment centers and residential care facilities. Now those students needing higher levels of care may have to look outside of the county.

Kennerly said Health Department employees will work with families with children at Riverside Center to create transition plans, but kids who need day treatment will have to find care in Eugene, Grants Pass or other areas in the state. But Kennerly insists that the closure of the center does not reflect the quality of services that have been provided by Riverside.

“We really appreciate what Riverside has provided for mental health services,” she said. “And we’re sad to see them not provide day services.”

EXTRA – Riverside Center in Winston quietly changing lives, April 11 2008, KPIC.com
EXTRA – Mental health care for kids, Roseburg News-Register, September 2 2008

From the Salem Statesman Journal, December 24 2008

Volunteers wrap donated presents, to be delivered on Christmas Day

Santa’s workshop runs on magic, but the gift-giving program at the Oregon State Hospital may operate with something just as good — efficiency.

“It’s a huge assembly line,” said Jeff Jessel, the director of volunteer services at the state hospital, as he double-checked the last of nearly 800 gifts wrapped and ready.

The gifts will be delivered Christmas Day to state hospital patients.

The operation is known as the Caring Tree Project, which has been an annual state hospital event since 1985. Each patient submits a wish list, and program coordinators work to match at least two to three gifts from that list — anywhere in value from $20 to $30 total.

The call then goes out to participating state agencies and community groups, which are given the wish lists and asked to provide donated gifts.

Despite a downturn in the economy, all of the patients’ requests for gifts were filled, Jessel said. The program also receives monetary donations, which go toward purchasing extra gifts for newly-admitted patients or exchanges.

More recently, the capricious winter weather has not kept volunteers away, Jessel said.

Since Dec. 1, the Caring Tree workshop has remained open every day and has run smoothly — and was even ahead of schedule Tuesday.

Many volunteers were state hospital employees who dropped by during breaks to wrap gifts.

Wendell Page, an education department trainer, was wrapping packages this year, but has witnessed the receiving end of gifts working in wards in past years. Page summed up those past Christmas mornings as “very busy, very hectic, very rewarding.”

State hospital outdoors coordinator Todd Trautner, otherwise dubbed “assistant elf,” prepared to deliver about 100 gifts to the Portland state hospital campus in a van Tuesday afternoon.

For the rest of the approximately 650 residents at the Salem facility, staffers will load carts with presents and deliver them through the underground tunnels of the state hospital.

“It’s just like loading up Santa’s sleigh,” Jessel said.

Pinup model Bettie Page died December 11, 2008 at age 85 after her family agreed to discontinue life support. She had been in a coma after a heart attack a week earlier.

Page had a long, well-documented and inconsistent career, marked by an ebullient personality, a wide variety of interests, husbands and new starts. She appeared in thousands of photo magazines, films, and personal appearances. A new generation became interested in Bettie Page the 1980s and 1990s; her photos and films were re-released and became instantly collectible. In 2006 Page was the subject of a critically acclaimed biopic, The Notorious Bettie Page.

“I think that she was a remarkable lady, an iconic figure in pop culture who influenced sexuality, taste in fashion, someone who had a tremendous impact on our society,” Playboy founder Hugh Hefner told the Associated Press. Page appeared as a centerfold model in one of Playboy’s earliest editions.

In 1979 Page was committed by a California court to the Patton State Hospital in San Bernardino, California where she she spent 20 months. She was given a diagnosis of schizophrenia. After a fight with her landlord, Page was court committed to state psychiatric supervision for eight years. Her final exit from Patton State Hospital was in 1992.

Page was a longtime believer in Christianity, and attended Multnomah Bible College in Portland, Oregon at one point. She worked in the 1960s for Billy Graham in Florida. Page’s funeral service was delivered by television evangelist Dr. Robert Schuller.

EXTRA – Official obituary page
EXTRA – Associated Press obituary
EXTRA – Pinup model Bettie Page dies in L.A. at 85, MSNBC.com

From the Portland Observer, December 2008


In the early 90s, Ryan Hamit had a “bad spell” and ended up in a hospital struggling with a personality disorder. He bounced from various social service agencies and hospitals, encountering counselors that talked down to him and seemed to make problems worse.

Things got better when he started using the Garlington Center, a longtime local mental health provider with multicultural roots, currently operated by Cascadia Behavioral Healthcare.

At Garlington, he found himself better respected by the staff and not talked to as if he was a confused child, like he had at other places. Hamit started to improve.

“I wouldn’t be near as well off if it wasn’t for the Garlington Center,” said Hamit.

But over the past year, Garlington has had its own bad spell. It almost collapsed financially when Cascadia fell into financial turmoil. Then the center had a devastating fire.

Named after the late Rev. John Garlington, an African-American minister who worked closely with the poor, the Garlington Center is one of the most culturally sensitive providers of mental health and substance abuse services in the area. It also connects people with stable housing and jobs.

“These are the folks, where if they don’t have these services, they’re going to be downtown costing the community a lot more money,” said Jim Hlava, Cascadia’s vice president of housing.

Essie Mae Morphis, an African-American client of the center for about 10 years, explained how Garlington has provided her with care that has no parallel in its cultural tactfulness.

“If I couldn’t get my meds I’d be somewhere in a state hospital,” said Morphis of the value she places on Garlington services.

Cascadia’s chief executive officer Derald Walker explained that the center helps people through group therapy, helping them develop a sense of stability, and assisting them in managing their own medication regimen.

Statewide, Cascadia has an operating budget of about $42 million, which comes from a patchwork of state, county, and federal funds, according to Walker. It services about 525 people, he added.

Last summer, the non-profit nearly collapsed financially due to mismanagement. According to reports on Multnomah County’s website, Cascadia was hemorrhaging money due to a faulty billing system (among other problems) that essentially didn’t charge the appropriate sources for services.

In April of this year, Cascadia informed the county that it was on the verge of defaulting on a $2 million line of credit from Capitol Pacific Bank, and was about to go under. The Garlington Center would have expired had it not been for a loud chorus of voices that rose in protest.

Gascadia was saved by a $2.5 million loan comprised of state and county funds. A nationally recognized consulting fire was called in to correct the problems with billing, among others.

According to Walker, Cascadia has implemented many of the firm’s suggestions and is steadily recovering.

“We’re cautiously optimistic,” said David Austin, spokesman for the county’s department of human services, which has worked closely with the Cascadia on its financials. He added that the mental health provider continues to provide an essential service to Portland.

Austin said that Cascadia is taking recommendations from the county and the consulting firm seriously, and appears to be stabilizing. He also pointed out that Cascadia has passed along two of its other clinics to other non-profits, which has been a huge financial relief.

The fire sparked last October in the Garlington Center’s Martin Luther King Jr. Boulevard location extensively damaged the building, a former NIKE factory outlet.

Currently, the center looks as if it’s the aftermath of a war. Its windows are boarded up. Yellow tape lines scorched walls and corridors. The sharp, sour smell of the smoke has marinated the air, and still lingers heavily. The floor of some rooms is pitch black and sprinkled with broken glass.

Since the fire, clients have had to go out of her way to an alternate Cascadia center on Southeast Division Street and 43rd Avenue.

“It’s a hassle,” said Morphis of having to make the trek to the alternate center.

The clinic’s director Tasha Wheatt-Delancy expects to have the MLK facility back up in about six months. Currently there are several trailers outside the building where clients will be served. They are not quite ready, said Wheatt-Delancy. But she’s hoping they’ll be ready soon.

Hlava isn’t sure how much the building repairs will cost.

The fire is considered “suspicious,” and is under investigation by local and federal investigators.

Walker said that Cascadia is taking great care not to allow the tumult facing the organization to interrupt services facing clients.

However, Cascadia’s problems aren’t entirely in the past. Walker said that the state budget cuts could affect the non-profit’s addiction treatment program, but isn’t entirely sure what could happen.

“Making sure we have stable funding is our biggest challenge,” said Walker.

From the AP wire service, December 23 2008

Mental patients sprinkled throughout the nation’s psychiatric hospitals are being locked up alone for years despite laws aimed at preventing the practice, because medical workers say they’re too dangerous to handle any other way.

Health officials call them outliers — rare, unpredictably violent people who don’t respond to medication or other treatment. Advocates call them victims of a system that has lost patience and creativity in caring for those who are most difficult to treat.

Loopholes in federal and state laws and impotent oversight allow hospitals to lock some patients away for the safety of staff and other patients. Some cases involving seclusion and restraints have resulted in costly lawsuits, yet they are so rare that many advocates had no idea there were similar situations in other states until The Associated Press inquired about it.

No one tracks such cases. However, through interviews and records from advocacy groups and state and federal agencies, the AP found at least a dozen patients who were held in seclusion for months or years at a time.

“I think it’s just a wink and a nod and some people are looking the other way,” said Charlie McCarthy, an advocate with Disability Rights Montana, who nevertheless said he understands what drives hospitals to work around the law.

“Everybody’s frustrated with what do you do with somebody like this? The patient has rights, but the other patients have rights to be safe and free from abuse.”

In Virginia, one man was locked in a three-room suite for 15 years and another patient was held in a similar setup for five years. Connecticut and Florida have paid millions over allegations that they tethered patients to furniture for years.

Federal law requires that seclusion or restraints — including drugs — be used on patients covered by Medicare or Medicaid only in emergencies to protect other patients and staff. Such measures can be used for more than 24 hours only if a physician deems it necessary, and only if a doctor updates that assessment daily.

Moreover, the U.S. Supreme Court has ruled it unconstitutional to restrain or isolate patients for extended periods.

The laws and court rulings don’t cap the consecutive days a patient can be isolated or restrained, though, so hospitals can hold a patient indefinitely by simply signing off on it every 24 hours.

The Supreme Court also has ruled that hospitals must treat people who are involuntarily committed. So Stuart Grassian, a psychiatrist who has studied the effects of solitary confinement on prisoners, and others question whether outliers are being held legally.

“Once a person is locked up, the state has to provide them with adequate and appropriate treatment, otherwise they lose any authority and any legitimacy to keeping the people locked up against their will,” Grassian said.

Seclusion, he said, can intensify patients’ paranoia, agitation and delusions.

Advocates insist that with proper training and sufficient staffing, hospitals can eliminate the need for seclusion and restraints in nearly all cases, not just outliers.

In 1997, Pennsylvania enacted stricter policies against those techniques, trained staff in crisis management and established minimum staffing levels for its psychiatric facilities. Today, the state does not seclude or restrain patients for extended periods and rarely uses either method at all, according to the state mental health agency.

Such efforts can be costly, but proponents cite them as proof that with the right support, any mentally ill person can improve enough to safely interact with others.

“People can make progress and they do get to a point where they can be reintegrated into the community,” said Deborah Dorfman, deputy director of the Los Angeles-based Disability Rights Legal Center. “You just need the right treatment and the right expertise.”

A spokesman for the Justice Department’s Civil Rights Division, which investigates complaints concerning institutionalized individuals, would not comment on the use of seclusion and restraint. According to its Web site, the division wrapped up two probes this year that found improper use of seclusion and restraint in Oregon and Georgia and recommended policy changes to the governors of those states.

At Oregon State Hospital, investigators found four patients who had lived in prolonged seclusion, some for at least a year. In a report, the Justice Department called the practice “unrefined and unlawful” and said it had never “encountered the use of continuous seclusion as a planned treatment strategy.”

Since 2006, the Justice Department has entered into settlements with California, Vermont and the District of Columbia over violations that include improper seclusion and restraint at mental hospitals.

At Western State Hospital in Staunton, Va., the state stepped in after staff placed Cesar Chumil in a three-room “limited containment suite” in 1993, where he has remained since. Chumil averaged 300 assaults against staff and another 100 against patients over seven years before he was placed in the suite, according to records from a closed administrative hearing obtained by the AP.

Hospital officials claim the 58-year-old has more freedom than before, when records show he spent thousands of hours in a small seclusion cell or restrained to a bed or chair.

“It’s a big step to put somebody in a room like this and say, ‘You can’t come out,’ but we had so many people getting injured and so many staff were out of work,” said Stephen Johnson, the psychologist on Chumil’s ward. “It just got to the point where it was just untenable … so we had this one solution.”

Last summer, a state oversight committee determined that the hospital should move Chumil out of seclusion. The hospital moved all other patients off Chumil’s ward this month and unlocked the door to his suite so he could go out into an activity room when he wanted. Hospital workers in padded gear and helmets must be present — for everyone’s safety, but also so that he is no longer alone and therefore no longer technically in seclusion.

In Connecticut, a 23-year-old man has lived in a two-room cell since 2001, said Nancy Alisberg, an attorney for the state’s Office of Protection and Advocacy. When he behaves, staff take him on walks around the grounds and sometimes take him to church and other places, she said, declining to identify the man because of privacy laws.

Often, the rooms where patients are held for months or years at a time are more pleasant than traditional seclusion rooms — usually tiny block rooms containing only a mattress. They have TVs and personal items. Chumil even has a phone.

“In a situation like that, the best you can do is to create a living environment that is as safe and contained as possible,” said Kevin Huckshorn of the National Association of State Mental Health Program Directors. “And while yes, you could call it seclusion, the only other options are going to be things like restraint, which is even more restrictive.”

Patients have been removed from long-term seclusion in other states, including Massachusetts, Oregon and Maryland, after advocates stepped in, some threatening lawsuits. Other states have paid millions of dollars for breaking restraint and seclusion laws.

In Florida, the state lost a lawsuit in 1998 and was forced to pay $18 million for strapping a man to a bed or wheelchair for 2 1/2 years.

Connecticut has paid $600,000 a year since 2002 to house a former patient at a special facility in California as part of an out-of-court settlement. He had been tied to a bed in a small, concrete room at Connecticut Valley Hospital in Middletown for more than a year, said Susan Aranoff, an attorney with the nonprofit Connecticut Legal Rights Project who fought for his transfer.

Wayne Dailey, senior policy adviser for the Connecticut Department of Mental Health and Addiction Services, denied holding any patient in restraints for such a long a time.

Federally mandated advocates in each state protect the mentally ill and disabled but don’t have the manpower or money for constant monitoring, said Curt Decker, executive director of the National Disability Rights Network, which represents advocates.

Like other groups that look out for the mentally ill, Decker said he didn’t know patients were being held in long-term seclusion but that it was something his organization will begin looking into.

“We put these people sort of out of sight and out of mind,” Decker said, “and bad things can happen.”

From OPB.org, December 18, 2008

LISTEN – County Changes Policy Of Sending Juveniles To Adult Jails

Multnomah County Commissioners voted Thursday to stop sending juveniles to adult jails. Instances of suicide and sexual abuse around the nation are prompting many jurisdictions to make similar changes.

With the wave of ‘get-tough-on-crime’ legislation in the 1990s, teenagers as young as 15, charged with ‘adult crimes’ like robbery, murder and assault, were tried in adult court.

Some ended up serving time in adult jails.

Shannon White, of the incarceration think-tank ‘Safety and Justice,’ says research by the Center for Disease Control now shows that those kids are more likely to re-offend and are at greater risk for suicide and assault.

Shannon White: “Well it’s a wonderful step for Multnomah County. While Multnomah County actually has embraced a policy that keeps youth out of the adult jails. There have been some loopholes and youth have, and are currently in adult jail here in Portland.”

There have been no recent reports of incidents between adult and juveniles in Multnomah County jails. But jurisdictions as varied as Illinois, Delaware, Connecticut and Los Angeles County have all changed their policies.

EXTRA – Lake Oswego teen kills self shortly after leaving jail, 11 6 2007, KATU.com
EXTRA – Oregon teen kills self after leaving jail, 11 6 2007, AP.com

OUR COMMENT – We remember the death of Joshua Overstreet, who committed suicide moments after being released from the Multnomah County Detention Center on November 6 2007. He was 18 years old and was acutely mentally ill.