Mental Health Association of Portland

A Voice for the Voiceless

Posted by CoffeeX3 on 14th April 2002

By Don Colburn, The Oregonian, April 14, 2002

Laddie Read at a Multnomah County mental health panel meeting in 2002.

Laddie Read at a Multnomah County mental health panel meeting in 2002.

The man in navy sweats and white sneakers perches on his motorized cart, listening hard. His left hand — the one that works — clutches a copy of an agenda he cannot read.

“Yeah! Yeah!” he bellows from the back of the room when anyone says something he likes.

“Spkup! Spkup! I deaf!”

“Sorry, Laddie,” a council member says, speaking up.

Someone mentions the need for low-cost housing, and Laddie Read nearly leaps off his cart. “Yeah! Housing! Yeah!” He pounds the handle bars with his left fist and delivers a thumbs-up to the audience, which has turned its attention to him.

He’s 56. Balding beneath his Portland Speedway cap, with short gray hair on the sides. Glasses.

He’s missing several front teeth. Laddie has trouble shaving, and sometimes his breath reeks. Occasionally, he drools.

For most of the first half of his life, Laddie lived in institutions, including more than 15 years at Oregon Fairview Home in Salem.

These days, however, Laddie’s singular voice makes itself heard in Multnomah County on every hot-button issue involving care of the mentally ill and disabled. As a self-appointed public watchdog, he weighs in on curb cuts and budget cuts, bus routes and bigotry, housing and police — even the width of county office doorways.

So Laddie is first up for public comment on the Multnomah County mental health plan. He walks unsteadily over to county Chairwoman Diane Linn, hands her a printout and points at her. Then he sits down at the committee table as Linn dutifully reads aloud.

“Stop!” he says suddenly. He’s up out of his seat, on his clumsy feet, waving his good hand. The words come out blurred.

Linn does her best to translate. “Why am I afraid?” she guesses.

“No!” He’s ranting.

Laddie Read at Multnomah County mental health panel meeting with Jim Gaynor in 2002.

Laddie Read at Multnomah County mental health panel meeting with Jim Gaynor in 2002.

“Five times!” Laddie shouts. People around the room try to interpret. “He’s talking about the police,” one says. “No, he means nobody ever calls him back,” somebody else offers.

Laddie alternately stabs the air and slams the table with his left hand.

“Sorry” he says. “Over-passionate.”

“That’s OK, Laddie,” Linn says, trying to wrap things up. He has overshot his time limit.

“No! Read all,” he insists, and Linn continues. His text brings up the shooting death of a Mexican national by police last year at a Portland psychiatric hospital.

Laddie interrupts again. “How feel about police?” he asks Linn.

“How feel?” he repeats. A murmur ripples through the room, as onlookers realize this unpolished outsider has the county’s top official on the spot.

“What gonna do?” He tries once more, then shrugs.

“Thank you so much for your statement,” Linn says.

Laddie totters back to his cart. He’s grinning, though it’s hard to tell if he’s pleased or furious.

He was born outdoors in the middle of a February night, a month-and-a-half premature.

His parents lived at North Portland’s Columbia Villa housing complex. His father was sick in bed with pneumonia, and his mother went outside to get coal for the furnace. As she lugged the bucket back, she recalled, she felt sharp pain and fell to the ground.

Moments later, she gave birth to her first child, Laddie Read Jr. He had a big blue spot on the left side of his head.

By the time Laddie was 6 or 7 months old, his mother knew something was seriously wrong. He couldn’t crawl. He struggled to move by lying on his back and pushing with his hands.

Laddie Read, born with cerebral palsy, has trouble talking, but he still makes his point on redesigning the county mental health system.

Laddie Read, born with cerebral palsy, has trouble talking, but he still makes his point on redesigning the county mental health system.

The doctors diagnosed cerebral palsy, a form of brain damage that occurs during or near birth. Today he would be called a child with special needs. During the late 1940s and 1950s, he was labeled a feeble-minded cripple.

Cerebral palsy occurs when something — a traumatic premature delivery, a seizure, a deformity — cuts off the brain’s supply of oxygen. “It’s the same thing that could happen to you right now if you got hit on the head or had a stroke,” says Bud Thoune, director of United Cerebral Palsy of Oregon, who has known Laddie since 1973.

The disability depends on which brain cells are destroyed. Slurred speech and difficulty walking are common.

Two public schools rejected Laddie. Other children, including his two younger sisters, teased him cruelly, Laddie remembers. “Call me cripple,” he says. “Retard. Idiot. Stupid ass. Worse.”

It was a different time. Mainstreaming was almost unheard of. Children seen as abnormal were routinely sent to institutions. On a doctor’s recommendation, Laddie’s parents sent him to a Eugene foster home and then to the Children’s Hospital School there. And in 1956, at age 10, he was committed to Fairview.

The psychologist who examined Laddie when he got to Fairview described him as a spastic quadriplegic moron with an IQ of 52 and a mental age of 6.

Yet even in the clinical lingo of generation-old medical charts are hints of the middle-aged Laddie. “Pleasant child with a sharp temper,” a teacher wrote. “Seems to have strong motivation.”

A few years later, his psychologist concluded: “From overall behavior one suspects that Laddie understands much more than he can readily express . . . He is easily frustrated by his own inarticulateness.”

But Laddie was destined to live the rest of his life at Fairview, the psychologist said, because it was “highly unlikely that he will display any appreciable increase in intellectual functioning.” Another called him “well institutionalized.”

Laddie Read reacts to revisiting former his home at Fairview in Salem. The sign in background says: "Hospital of the feeble minded. Erected 1919."

Laddie Read reacts to revisiting former his home at Fairview in Salem. The sign in background says: "Hospital of the feeble minded. Erected 1919."

As national attitudes toward mental disabilities and institutionalization changed, so did the tone in Laddie’s medical chart. By 1966, when he was 20, a teacher noted: “He is bright and ambitious and needs a better environment.” A psychologist found it “quite possible that on some of the things which we cannot measure with a psychological test he is not very far below normal.”

Yet at 22, Laddie still functioned at a first-grade level. And still languished at Fairview.

“His great asset is his friendliness and pleasant disposition and his indomitable spirit, prompting him to work and try hard in face of odds that would discourage many a brave soul,” a psychological evaluation found. But it also doubted he could ever live independently.

Laddie was expelled from a sheltered workshop in Corvallis because he fell often and bothered others by drooling. A doctor noted that Laddie’s “long period of institutionalization coupled with his physical limitations have resulted in a spoiled individual who is somewhat unable to accept the status quo.”

Five years later, Laddie’s caregivers reversed themselves. With deinstitutionalization in full swing, they decided that if Laddie was to make progress, he needed to leave.

Laddie’s Fairview file closed on July 6, 1973, with a note from the superintendent that he was “no longer a fit subject for this institution.”

He was 27.

He lives with his calico cat, Ollie, in a one-bedroom Southeast Portland duplex. There’s a Douglas fir in the front yard, a wooden ramp up to his porch and a computer printout of the American flag taped to the door.

It’s the first place Laddie could ever call his own. After Fairview, he lived in group homes and apartments.

The rent is $550. Laddie pays $114 and the Housing Authority of Portland pays the rest. His monthly income consists of $688 in Social Security disability payments, plus $24 in food stamps.

With Joy'e Wilman, Laddie Read reacts to revisiting his home at Fairview in Salem.

With Joy'e Wilman, Laddie Read reacts to revisiting his home at Fairview in Salem.

The living room serves as Laddie’s office and garage, housing his Dell computer and his wheels: a fold-up wheelchair and two battery-powered scooters, a big four-wheel model he uses for shopping and a three-wheeler that fits on the bus.

In his tiny bedroom, a triangular handle bar dangles like a miniature playground swing. He grips it with his left hand to hoist himself into and out of bed. Beside the bed is a Sony boombox and a 27-inch television. Four banners — Blazers, Globetrotters, Winter Hawks and Portland Pride — and two photos of the Blue Angels jets decorate the walls. Laddie likes war movies. His taste in music runs to oldies on KISN-FM.

Laddie gets a daily food delivery from Loaves & Fishes. He doesn’t cook, except in the microwave. The burners on his stove are covered for safety.

His paralysis is mainly on the right side. Laddie’s right hand is frozen in a fist. He walks with a sway-and-wobble, on tiptoe with his feet splayed. The bones in both feet were surgically fused when he was a teen-ager to keep the feet from flip-flopping, but Laddie still falls a lot because his footsteps don’t land flat.

He can recognize and print his name and read simple numbers. He tells time by his digital wristwatch.

“I’m not smart guy,” Laddie says. “But not stupid guy! Hard time words.”

Cerebral palsy sometimes causes significant cognitive impairment — trouble thinking and remembering. But Laddie’s cognitive loss is minimal and his intelligence average, says Douglas Koeckkoeck, his doctor.

“He’s got the words right there in his brain,” Koeckkoeck says. “He just has trouble coordinating his voice box and his mouth to make them come out.”

Because Laddie lived outside the mainstream for so long, it’s hard to sort out his physical disability from the effects of his confinement at Fairview. “He wasn’t taught,” says United Cerebral Palsy’s Thoune. “He was just kind of there.”

Even simple words are tongue twisters for Laddie. “Thank you” comes out “Ank woo.”

He speaks in idioms, delivered dead-on with keen facial expressions and left-hand gestures: “Off my back.” “Big deal.” “From Day 1.” “Heart on my sleeve.” “Catch-22.” “Old dog new tricks.” “You, me, lamppost.” “Hit nail head.” “Bark wrong tree.” “Dream on.”

And his favorite: “Walk my shoes.”

Laddie Read, right, and Multnomah County Chairwoman and Mental Health Panel Chairman Diane Linn at a meeting

Laddie Read, right, and Multnomah County Chairwoman and Mental Health Panel Chairman Diane Linn at a meeting

Joy’e Willman, his caregiver for the past five years, lives down the block. She has known Laddie since they were neighbors in the 1970s, when she was a teen-ager and he had just left Fairview. Seeing Laddie wheel by on his scooter, she’d say a little prayer to herself: “Help me find a way to help him.”

Willman spends about 15 hours a week with Laddie, paid by the state. She makes appointments for him and helps him with dishes, bills and e-mail.

What’s it like to walk in Laddie Read’s shoes?

“Strap down your right wrist so you can’t move your hand,” Willman says. “Put on knee braces so your legs barely work. Put marbles in your mouth, so your tongue can’t form words. Then take the Hawthorne bus downtown and try to get through the day.”

Ask county Chairwoman Linn. Ask any council member. Ask Human Services Director John Ball. Ask their staffs.

They all know Laddie, who rarely goes by his last name. They’ve all been harangued by this illiterate gadfly — and discovered he’s smarter than they thought.

“Laddie helps keep the system honest,” says Scott Snedecor, Multnomah County’s consumer liaison for mental health. “He brings people back to the idea that, as the meetings drag on and the bureaucracy moves at its own pace, there are people who need help now.”

Portland’s Metropolitan Human Rights Center named Laddie winner of this year’s Human Rights Award. In presenting the award, Linn called Laddie a “one-man truth squad,” a person with “as much dignity as anyone I know.”

Laddie helps the Portland Police Bureau’s crisis intervention team train officers to deal with the disabled. His role, coordinator Ed Riddell says, is to challenge officers: “What are you gonna do when you run into someone like me?”

Someone who walks and talks differently and overreacts. Someone loud and opinionated. Someone angry, afraid and mistrustful of police. Laddie still hasn’t gotten over being arrested years ago for drunk and disorderly conduct when police mistook his slurred speech for intoxication.

Some officers are put off by Laddie’s manner. Some say they can’t understand him.

Which is the point.

Laddie is on a county advisory committee aimed at improving access to care. He’s in a support group mainly for former Fairview residents. He’s on the board of directors for a private nonprofit program that links developmentally disabled people with state and county services. He’s a C-Span groupie, a regular Tri-Met rider and an e-mail addict who co-founded two Web sites.

And he attends more meetings than the committee members themselves.

Laddie Read, advocate.

Laddie Read, advocate.

He can be a tough audience. If a speaker drones on, Laddie yawns loudly and fans himself flamboyantly. Sometimes he laughs at inappropriate moments. “Bull crap!” he’ll mutter.

“Laddie is very passionate, and he sometimes gets frustrated,” says Jason Renaud, former head of the National Alliance for the Mentally Ill of Multnomah County, who has seen Laddie in action at scores of public meetings. “It’s the passion you or I would have if we were at the mercy of the public-health system and within a couple of fingers of going down the drain.”

Renaud calls Laddie the county’s most consistent voice over the past three years for saying, “The system is broke — now get off your butts and fix it.”

At first, when Laddie started showing up at public meetings, officials tried to ignore him. But Laddie’s hard to ignore. And a funny thing happened when — initially out of political correctness — leaders such as Linn started paying attention.

Laddie started to make sense.

“Laddie is my reality check,” says Mike Henderson, his former caseworker.

Before each session of the mental health coordinating council, members and visitors introduce themselves. They reel off their titles — bureaucratic, academic, lofty, lengthy. Laddie’s is simple:

“Laddie Read,” he says proudly, left thumb up. “Advocate!”

More than 28 years after his discharge from Fairview, Laddie asks to return for a day. He wants to go back because he has begun to doubt his own memory — and also needs to see firsthand that the place is shut down. It closed in 2000.

The man who has agreed to show him around is Jon Cooper, Fairview’s last superintendent.

“Hi, Laddie,” Cooper introduces himself in the parking lot. “I closed Fairview.”

Laddie falls silent and holds out his left hand to shake Cooper’s right.

“Ank woo,” he says, giving Cooper the thumbs-up.

Wearing a new T-shirt emblazoned “Our enemies have failed. America is strong,” Laddie settles into his wheelchair. They begin to tour the 275-acre campus, its abandoned buildings and broad lawns shaded by stately trees.

“Oh, God,” Laddie moans, pressing his left fist to his forehead. He chatterboxes, as the memories flood back.

“Know why? Now, gonna tell my friends. No bull.”

He wheels past the original Hospital for the Feeble-Minded, the nursery school, the laundry and the rows of dormitory “cottages,” many named after U.S. secretaries of state.

“Never forget! Appreciate.” Laddie tells Cooper. “Tell all my friends. Shut down!”

He starts to curse. The funny thing about Laddie’s speech, caregiver Willman says, is that no one has trouble understanding when he swears.

“Why you work here?” he asks Cooper. “Nice guy. Kind. Why?”

Cooper explains that Fairview became a better place in the years after Laddie left, and that many people needed care.

“Not my time,” Laddie says. Angry recollections spill out, laced with unprintable words.

“Hit me,” he says. “Not eat food — hit me.” He was spanked many times as a grown man. Once, he says, somebody rubbed salt in his eyes.

Willman asks him to calm down, and he apologizes. “Sorry. Over-passionate. Shock me.”

Laddie asks Cooper to unlock an old building that served as hospital, dorm and offices. He wrenches himself out of his wheelchair, totters through the trash-strewn doorway and struggles up the stairs in the semi-dark. Mouse droppings litter the steps.

“Beds in here!” He points to an empty room with chicken wire in the windows. “Like prison.”

Down a dark hallway is a large closet that Laddie says once was a locked time-out room. “Know why I stubborn?” he asks. “Here.”

He’s had enough. He works his way back down the unlit stairs, then rests and collects himself near the drug-free workplace sign.

“My heart,” he says, tapping his chest. “Know why? Feel like in jail.”

Laddie tiptoes out to his wheelchair. “Bye, bye, ghost town,” he says. “Not come back, no more!

“Not talking hat,” he adds bizarrely. It’s another of his idioms — three words to stand for “Now my friends won’t think I’m talking through my hat when I tell them about my experience at Fairview.”

On the way to the car, Laddie points to an older dorm, its yellow paint peeling, and starts to cackle. Willman translates the serious joke he’s concocting.

What if, Laddie says in his verbal shorthand, they turned Fairview into an old folks home — for parents who send their children away and anyone who mistakes “disabled” for “stupid”?

“One night!” he says. “Serious! Know why? See how feels!

“Walk my shoes.”

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Locking up the problems isn’t the solution

Posted by CoffeeX3 on 8th September 1996

By Robert Landauer – editorial columnist for The Oregonian, September 8, 1996. Not available elsewhere online.

Review these recent Portland scenes:

1. During Rose Festival, a woman was disrupting traffic, holding a baby doll, sucking her thumb and beating her head against trees, injuring herself.

2. He really thought he was Superman and would not stop lifting way too much weight for his safety at the Nautilus fitness club.

3. The turbaned woman, blessing everyone, released pigeons during mass at the Downtown Chapel. She was about to be evicted from her apartment, because she believed God called her to invite all of Portland’s homeless to live with her.

4. A man, filthy and shoeless, was found sleeping on a Parks Block bench. His toenails, 1 1/2 inches long and overlapped, had fused. He didn’t speak, only grunted. Eventually he hit someone and was jailed.

The episodes feed the perception that downsizing or closing state hospitals has few if any positive trade-offs and is causing the quality of life in our communities to drop.

Many want these unsavory people locked up in mental hospitals, out of sight.

Well, not so fast.

Another way to look at this is this: Could you solve these problems simply by reopening mothballed state hospitals or building new ones? No indeed.

If Oregon operated as it did 30 years ago, with the same ratio of people in mental hospitals as then, the state budget for the mentally ill would be close to $1 billion per biennium for 10,000 beds rather than $100 million for 760 beds statewide, says Barry Kast, administrator of Oregon’s Mental Health and Developmental Disability Services Division.

The patients then and now are the people with schizophrenia, major depression and bipolor disorder (formerly called manic depression), dementias and alcohol- and drug-induced psychoses.

The policy puzzle is easier to understand at Fairview Training Center in Salem. It has about 350 residents. That is 3 percent of Oregon’s 10,000 developmentally disabled. Yet Fairview gobbles dollars like an insatiable Pacman, consuming 37 percent of the budget for the entire developmentally disabled population as opposed to the mentally ill.

It doesn’t take long to calculate that the more people you serve in this institutionalized way, the fewer you serve in all.

Consider another piece of the mental-health puzzle. If you have a limited budget and treat people only in an acute phase, you will see fewer people who are more seriously ill, and they will be much more expensive to treat. So if you want to be both cost-effective and humane in preventing personal crises, you have to divert much of your attention and funds to intervening early.

The issue, then, is not just the number of state mental hospitals, but whether Oregon’s 50,000-60,000 mentally ill people are treated adequately in the communities.

A big difficulty is that the public sees treatment as incompatible with living on the street, says Kast, but budgets and how the mentally ill behave make street-level treatment inescapable.

The transition is happening, slowly. In Portland, for example, Project Respond operated like 9-1-1 and answered this column’s four mental -health emergencies right at the street level of crisis.

These mobile professionals, operating out of a van, work for the private, nonprofit Mental Health Services West. They give their own DNA — dogged nonjudgmental attention — to the mentally ill. This builds trust in people who hear the walls breathe and buttons talk. It helped the pigeon-releasing madonna of the Downtown Chapel to agree to move to the Bridgeview Community, a Mental Health Services West facility that offers services and safety to the chronically mentally ill.

The Parks Block derelict responded over months to Project Respond’s assertive outreach. Caseworkers say you can chat with him at the Broadway Deli “where he sits looking clean and dapper drinking tea with his pinkies up and his toenails clipped and inside a new pair of shoes.” He will eventually be able to maintain an apartment on his own.

Life is better than it was for the Superman weightlifter with manic bipolar disorder and for the woman who was so distraught during Rose Festival. The outreach workers carried them through their crises and out of emergency services’ revolving door by reconnecting them to treatment, housing, transportation, food and other social services.

Project Respond, helping to keep the clients stable, can assist a person to live in the community for $4,000. Institutionalized, the same person typically costs the public $75,000 to $100,000 a year.

Oregon tries to treat the mentally ill in the least restrictive setting possible. That is legally required, ethically proper and financially necessary. It is also far from perfect.

It is getting better, though, as acclaimed efforts like Project Respond help the chronically mentally ill to stay stable — and free.

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Inadequate staffing leaves mental patients unsafe

Posted by CoffeeX3 on 25th October 1987

Mind Games: Oregon’s Mental Health System

First of a five part series on the Oregon State Hospital

From The Oregonian – October 25, 1987. Not available elsewhere online.

Asylum: A place where one is safe and secure.” — Webster’s New World Dictionary.

When George Lewis Archer, 60, collapsed dead in a pool of blood by a nursing station in Oregon State Hospital’s general psychiatric ward last Nov. 6, staff employees took it in stride.

According to hospital records, no one at the time pressed to determine the cause of Archer’s bleeding or even suspected foul play. Two doctors at the hospital called it a natural death, from esophageal bleeding.

The Oregon State Police, which routinely looks into institutional deaths, asked for an autopsy. Four days later a pathologist discovered the true cause of Archer’s demise — he had been stabbed in the face with a butter knife.

A state police investigation would find that Archer had been stabbed by another patient in the ward’s visiting room while five staff members were on duty — none of whom noticed what happened.

Good gumshoe work solved one of the hospital’s secrets. Not all the secrets of Oregon’s mental institutions reveal themselves so completely.

The stabbing death is just one extreme example of what can happen in Oregon’s mental institutions. According to hospital records, Archer’s homicide was the second on hospital grounds in 16 years. One patient was killed in the hospital’s forensic unit for the criminally insane in 1985, and at least one other murder attempt has taken place there.

At least one other patient’s death, listed as from natural causes, should have been classified as homicide, according to Dr. Peter J. Batten, the Marion County medical examiner. Batten, who formerly served as a psychiatrist at the Oregon State Hospital, said a 68-year-old patient’s death of a heart attack in 1983 was sparked by another patient’s assault.

In contrast, the Oregon State Penitentiary, the state’s maximum-security prison, has had but one homicide in the last 15 years, although it houses nearly three times as many inmates as the hospital has residents.

Patient advocates and current and former staff members at the Oregon and Dammasch state hospitals for the mentally ill say patients are threatened by inadequate supervision. Similar problems also plagued the Fairview Training Center for the mentally handicapped until the state began a massive, $25 million plan of correction last spring — prompted by a federal lawsuit and termination of federal Medicaid and Medicare funding.

Injuries, rapes and, on occasion, even deaths continue to occur in the state’s mental institutions when patients hurt themselves or prey upon others, both patients and staff members. Sometimes the cause is determined, sometimes not — no one sees them, or no one will or can tell what he saw.

Consider the following:

  • In addition to Archer’s homicide at Oregon State Hospital, bizarre accidental and unexplained deaths have occurred. Two middle-age women patients at Dammasch have died of heat exposure after wandering onto the grounds in the last four years. Two older women died — one from complications arising from a broken hip — after one fell from a bed and the other from a chair at Oregon State Hospital last winter.A 24-year-old woman wandered off Fairview’s grounds in March and was found dead three days later, drowned in a creek nearby.
  • So ineffective is normal supervision that stopgap solutions must be devised. For example, Dammasch officials, frustrated by their inability to protect a middle-age woman from rapes, have put her in a thick plastic coverall secured by locks — a 1980s version of the medieval chastity belt. The ratio of staff members to patients is far below what the state says are federal standards.
  • Injuries to staff members, often caused by combative patients, have been so common in the state’s three largest mental institutions that they cause staff shortages and millions of dollars in workers’ compensation claims.
  • Federal certification has been yanked for almost all of the state’s institutions, at least temporarily, costing the state millions in lost federal aid.

Proud record tarnished

Oregon’s mental institutions once ranked among the best and most progressive in America. The state burnished its reputation for progressive thinking in matters of the mind 12 years ago when it permitted the filming in Oregon State Hospital of the movie “One Flew Over the Cuckoo’s Nest,” an indictment of inhumanity in mental hospitals; state officials believed that Oregon had nothing to hide.

But as the 1990s approach, the state has not fulfilled the promise of its progressivism, and the reputation of its institutions is tottering.

Oregon’s two main state hospitals for the mentally ill operate on the very edge of respectability. Fairview Training Center, the state’s largest institution for the mentally handicapped, also has had a history of safety problems.

Since the spring of 1986, Dammasch, Oregon State Hospital and Fairview Training Center all have been at least temporarily denied federal Medicaid and Medicare payments for substandard conditions.

The state last week announced new superintendents for all three of the state’s large mental institutions. Linda K. Gustafson, director of a mental health hospital in Lincoln, Ill., will become Fairview’s new superintendent Dec. 1. Stanley F. Mazur-Hart, the acting superintendent of Oregon State Hospital, will replace Dr. Victor M. Holm as superintendent of Dammasch on Nov. 23. Holm announced his retirement last week. George Bachik, director of the Idaho State Hospital South, will take over as superintendent of the Oregon State Hospital on Dec. 7, it was announced Friday.

Dammasch continues to operate without federal funding certification. Oregon State Hospital has regained partial funding but has chosen to forgo certification review for three of its five main sections, knowing that conditions in them do not meet federal standards for either adequate treatment or staffing.

In April, federal health-care inspectors concluded that too many Fairview patients were being injured, and they cut off funding. They charged that inadequate staff and poor procedures posed a immediate threat to residents’ health and safety.

The state regained federal funding for Fairview after a 14-week hiatus — and a $7 million loss — by agreeing to spend $25 million over two years to hire 500 new employees and move 300 of Fairview’s more than 1,000 residents into community care.

Health Care Financing Administration officials say that Fairview now meets standards for safety but barely complies with those for treatment. In a pending lawsuit separate from the financing administration’s review, the U.S. Department of Justice alleges that care at Fairview violates patients’ constitutional rights to safety, training, medical treatment and education.

Two smaller state institutions, Eastern Oregon Psychiatric Center and Eastern Oregon Training Center, both in Pendleton, continue to have federal funding certification. The state Department of Human Resources director, Kevin Concannon, said he thought both were doing well and, with a combined population about 150, were examples of his belief that “small is better.”

Violations of federal treatment standards, designed to prevent warehousing of patients, account for the continuing lack of certification of Dammasch and parts of Oregon State Hospital.

According to state officials, one of the key federal benchmarks not met by Oregon’s state hospitals is the ratio of staff members to patients. While the federal officials deny that they use a specific standard, top state administrators say they believe the unwritten expectation for state hospitals is about 1.2 direct-care staff members per patient. The state hospitals have only about 0.6 direct-care staff members per patient — half of what the federal government says is adequate. Only the children’s and geriatric programs at Oregon State Hospital approximate the federal staffing standard and are certified.

The federal expectation for training centers for the mentally handicapped is about 1.5 direct-care staff members per patient, state officials say. At Fairview the ratio is about 0.9.

Concannon, who took office Oct. 12 as director of the state Department of Human Resources after a brief term as mental health chief, said the state planned improvements at both state mental hospitals but not on the same scale as at Fairview, and not enough to regain federal funding soon.

The Legislative Emergency Board earlier this month appropriated $900,000 to relieve staff workload by shifting 50 long-term Dammasch patients into community care. It rejected a request to pay for more Oregon State Hospital employees, saying such a decision should wait for the 1989 Legislature.

The state hopes that a new law, designed to increase civil commitments by providing for closer monitoring of those with two or more commitments in the last three years, won’t increase the pressure on state hospitals. It has set aside $7 million to keep track of such chronic patients more closely and provide community programs for them, and it has made no plans for enlarging the hospitals.

Fewer patients

The overall number of people in institutions has dropped sharply for the last 30 years under the state’s policy of diverting patients into the community, called deinstitutionalization.

Despite that drop, the state’s institutions suffer from insufficient staff, inadequate programs and conditions that critics call not only unhealthy but also dangerous to inmates and staff members alike.

State officials attribute the problems of the three larger state institutions to their size, outdated buildings and a lack of staff.

“Standards have moved a considerable distance in 20 years,” Gov. Neil Goldschmidt said last year. “And our programs didn’t move enough in 20 years to keep up. . . . It’s going to take a little catch-up time.”

The amount of money needed to catch up may be great.

For example, Holm, Dammasch ‘s superintendent, said the hospital “ideally” needed a 50 percent staff increase. “It’s like an airplane: You can guarantee it’s safe, but it’ll never fly,” he said.

In addition, the state says it has had problems recruiting and keeping doctors, nurses and other professionals. Dr. Philip Shapiro, clinical director of Oregon State Hospital, said he had had one to four vacancies for physicians for three years and had a standing help-wanted ad in five psychiatric journals.

One reason given for the shortage, especially for doctors, is the relatively low pay, compared to private practice. The starting state maximum is $63,000 a year, and Shapiro said earnings can be far higher in private practice.

Concannon said he could not predict when or whether Dammasch and the decertified 70-patient general psychiatric section of Oregon State Hospital could regain federal funding. The state has no plans to comply with federal treatment standards for the forensics and correctional treatment programs. Those three decertified programs house 70 percent of Oregon State Hospital’s patients.

Assaults occur daily

Violent assaults by patients are a daily occurrence in the state’s three largest mental institutions.

The most violent and threatening patients in the state end up in the security ward at Dammasch and the forensic unit for the criminally insane at Oregon State Hospital.

But violence inside state institutions is not confined to these units.

For example, according to figures compiled by the state for The Oregonian, 4,469 assaults by patients on other patients and on staff members were recorded during the 20-month period from January 1986 through August 1987 at Oregon State Hospital — an average of more than seven per day.

By far the greatest number occurred in the five wards of the hospital’s 160-patient geriatric program, for mentally ill patients who are 65 and older. The program averages about five patient assaults on other patients or staff members a day.

Indeed, hospital employees say some of the most dangerous conditions exist on the 12 general psychiatric wards for both large state hospitals. None of the wards meets federal treatment and staffing standards.

Oregon State Hospital continues to accept patients who voluntarily check into its 70-bed general psychiatric program, but Dammasch has reserved nearly all its 345 beds for patients who have been committed by the courts.

Diane Neubert, the Dammasch nursing chief, said the hospital’s patients over the last five years had become much more difficult to handle, particularly since voluntary patients were shut out.

“We’ve condensed down. We have a totally different population. . . . People are sicker. Patients get injured more,” she said.

“We have a very poorly staffed facility. It needs more staff to be truly safe,” she said.

During the state employees’ strike in September, hospital workers complained loudly about patient-caused injuries to them and wore buttons portraying black-eyed employees.

About 340 injury claims were filed by employees of Dammasch and Oregon state hospitals last year — nearly one a day. At Fairview, 920 similar workers’ compensation claims were filed in 1986.

The cost to the state in workers’ compensation: nearly $6 million last year.

Jan Curry, Fairview’s former acting superintendent, said the addition of 500 employees in recent months had helped reduce the severity of injuries caused by accidents or patients, but not their number.

Curry and a spokeswoman for the Fairview workers’ union said they believed the new workers had improved the overall safety at the institution.

Even so, “We have enough to watch (patients), but not enough to provide active treatment,” said Colleen Moen, of the American Federation of State, County and Municipal Employees.

Archer’s stabbing death on one of the program’s two wards was just an example of conditions inside it, said Chuck Forward, a psychiatric aide who is president of the hospital’s Oregon Public Employees Union unit.

“It’s not a safe place,” Forward said of the general psychiatric program where he works. “When you got four (psychiatric) aides, it’s hard to cover 30 to 40 patients on all parts of the ward.”

The aides and two nurses typically cover each ward, a long corridor of single and double rooms that stretches roughly two-thirds the length of a football field and includes a large day room, porch, two bathrooms and a shower.

State police concluded that Archer was fatally stabbed while in the visiting room.

Batten, the Marion County medical examiner, said that the assailant, Daniel Edison Miller, 30, had time to stab Archer with a butter knife, hide the weapon and wash the blood from his hands, all without the staff’s knowledge. Miller later confessed and was found guilty except for insanity.

The inability of staff members to prevent such assaults also was demonstrated by the 1983 death of George Nosen, 68, who in 1947 mistook cockroach poison for powdered milk while helping prepare a dish of scrambled eggs and accidentally killed 47 fellow Oregon State Hospital patients.

Nosen died of an apparent heart attack that occurred after he had been in a scuffle with another patient in the hospital’s geriatric ward. The fight occurred while about seven ward employees were in a 7 a.m. staff meeting.

At the time, Batten said, he listed Nosen’s cause of death as natural — arteriosclerotic heart disease. He listed a “non-fatal assault” by another inmate as a possible contributing cause. Batten said he had since changed his mind, and that the death was actually an “inadvertent” homicide — a heart attack caused by an assault by another patient.

In addition to the three homicides at Oregon State Hospital, four accidental deaths have occurred there in the last two years, two in falls and two from choking on food.

One person, Wanda Jackson, 50, died of “complications” two days after surgery for repair of a hip that was broken in a fall from her bed in a general psychiatric ward at Oregon State Hospital in January. Batten said the hospital initially wanted to have an autopsy done but the woman’s family refused to give permission. He said the hospital then concluded it was “probably a routine death that should be handled in a routine manner” and did not advise his office of it until after the woman was buried.

Delores Perez, 77, died of serious head injuries after she fell off a chair onto the floor of the geriatric unit on Dec. 25.

Two other patients died after choking on food. Byron Jacobs, another geriatric patient, who had a history of swallowing non-edible objects, choked to death after gorging himself on a magazine page and breakfast on Dec. 9. 1986.

LeRoy Lancaster, 60, died after choking on food in the hospital’s forensic unit on April 12. 1987.

In the last 10 years, there have been at least two other bizarre deaths at the hospital. Joshua Goodman, 21, choked to death on a rope in July 1981 while climbing on a painter’s rigging. Hospital officials and state police concluded he had been practicing rappelling for a planned rock-climbing expedition.

In the other case, Mark Radke, 25, died in June 1979 of “undetermined natural causes” eight days after being arrested for failing to pay for a meal in a Marion County restaurant. Batten said Radke possibly died from a drug overdose, but that an autopsy could not confirm that or any other specific cause.

Assaults by patients and unusual deaths offer two examples of what employees of both state hospitals say are products of inadequate staffing. Patient advocates say staffing not only creates safety problems but also results in inadequate treatment for patients.

“State institutions are abominations,” said Steven H. Gorham, a Salem attorney, who represents mentally ill and handicapped clients. “The object now is to get patients out as fast as you can. What they are concerned about is doing it the cheapest way possible.”

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