Mental Health Association of Portland

Our Two Cents – Perhaps the most positive and optimistic report in a long history of dour and dingy documents plopped out of the Oregon State Hospital this week –

Excellent! All fixed. Turns out bricks and mortar, charming lists, graphics and more gobbledegook faux-business lingo evoke good psychiatric care. Everyone go home – watch TV. Go home – watch TV.

Here’s the truth. We don’t believe in or expect miracles. There are still many people at OSH who should – by Federal law – be in far less restrictive quarters. Decades of mistreatment branded the OSH a dangerous place – not a safe place – for persons sick with mental illness. Good things seem to be happening after over 100 years of lies and abuse – but it will take more than PR fluff to change Oregon minds.

OSH gets a clean bill of health, Salem Statesman Journal, July 23, 2011

Improvements at the Oregon State Hospital are placing the hospital on track to rebound from its troubled history and become a world-class psychiatric facility, state-hired consultants said in a new report.

Kaufman Global, an Indiana-based consulting firm, said the Salem psychiatric facility “has taken great strides over the past seven months and is improving with each passing day.”

READ – Oregon State Hospital Excellence Report – by Kaufman Global

In a final report capping the $2 million consulting project, the OSH consultants said: “The picture that emerges is of an organization that has come a long way in a short time, and is now firmly on the path to improvement, headed toward excellence.”

The consulting report points to a dramatic turnaround in the workplace culture at the 128-year-old institution — long plagued by revolving-door leadership, turmoil and other chronic problems, including obsolete facilities, understaffing and high-profile cases of patient abuse.

“Hope is displacing despair, praise is offsetting criticism, and possibilities are supplanting impossibilities,” the report said.

With solid leadership, OSH now has the tools, talent and “playbook” necessary to evolve into a world-class organization, according to the consultants.

However, they also cautioned that it won’t be easy for the hospital to maintain the current momentum.

“The next phase in the project will present an equally large hurdle,” the report said. “Building on the foundations that have now been laid, but without the on-site presence and counsel of Kaufman Global, and — barring anything unforeseen — without the ‘burning platform’ provided by public controversy or leadership change, Oregon State Hospital will now be expected to continue its drive toward Hospital Excellence using internal resources and learned processes. In our experience, this is a critical juncture in the transformation of any organization.”

Hospital chief touts ‘lean’ tools

OSH Superintendent Greg Roberts, who took the hospital reins in September, links much of the hospital’s recent progress to the consulting team’s push for improvements based on “lean” tools and techniques.

Initially devised by Toyota, lean methodology widely is used in the private sector to streamline processes and cut waste.

It took time for the hospital’s work force to embrace lean techniques, Roberts told the Statesman Journal in an interview last week.

“We struggled a bit to figure out how the principles of lean methodology applied to a state psychiatric hospital,” he said.

The turning point came around February or March, Roberts said.

“There was a moment in time when it just clicked,” he said. “People got it, they understood it, they liked it, they valued it, all the way down to the unit level. From that point on, things really began to take off pretty quickly.”

Roberts touted the success of various projects spurred by lean methodology — from an accelerated hiring process for psychiatrists to streamlining how patient privileges are determined to pruning the number of hospital committees from more than two dozen to about six or seven.

In the wake of Kaufman Global’s departure, Roberts said, the hospital plans to create an in-house team to spearhead further improvements, applying methods instilled by the consultants.

“I think we’ve really accomplished a lot of significant things in a short period of time, but we have a lot more to do,” he said. “I think we should all be excited about what’s coming.”

New hospital nears completion

The reported turnaround comes as Oregon’s main mental hospital is entering the home stretch on a parallel improvement track: construction of a new 620-bed, $280 million replacement hospital.

In mid-August, more than 200 patients are scheduled to move into Trails, a three-story, 183,344-square-foot section of the new hospital.

Plans call for the entire facility, totaling 870,000 square feet, to become fully operational by the end of the year.

Gone are dozens of run-down, outdated hospital structures — stark symbols of decades of neglect. The old buildings were razed to clear the way for the new hospital, located south of Center Street NE on the sprawling OSH campus.

The first 104-bed section of the new hospital, called Harbors, opened in January.

By some accounts, Harbors got off to a rocky start.

Patients grumbled about irritating noise levels in the new building; staff vented about poor planning, patient outbursts and excessive reliance on mandated double shifts to plug staffing gaps.

Roberts said most of the early kinks in Harbors have been ironed out.

He envisions a much smoother start up in Trails: “First of all, we have the benefit of learning from the process of moving into Harbors to make the necessary changes for Trails. It’s all come together very well. In fact, the decision was made to move in one day because the preparation has been so thorough.”

Aug. 16 is the designated move-in date for 216 patients who are scheduled to occupy nine residential units in Trails.

These patients will leave behind cramped quarters within an outdated 1950s-era structure, called the “50 Building.”

In some areas of the obsolete building, as many as five patients are jammed into rooms designed for two.

Patient privacy and living conditions will markedly improve in Trails, which has one-person and two-person rooms, hospital officials said last week while leading a tour of the facility.

Trails is designed to provide patients with expanded treatment hours at centralized malls and offer them relaxing features, such as sensory rooms equipped with comfortable chairs and soft lighting.

Patient Kathryn Gerke, housed on Ward 50I in the dreary 50 Building, said she looks forward to a fresh start in Trails.

“The whole situation at the Oregon State Hospital just has a sense of doom about it,” she said. “It’s depressing. If you come here with a depression diagnosis, it’s really not going to help you.”

In contrast, the new facility promises to “make that go away” because it will have “more of a care overtone to it,” Gerke said.

“I’m hopeful about it,” she said. “It’s a real hospital.”

Though many patients are eager to pack up and move to Trails, they also fret about adjusting to new routines.

The top patient concern, as revealed by a recent survey conducted by the hospital: Who’s going to be my roommate?

Progress amid federal scrutiny

A multitude of flaws and failings at OSH were spotlighted in January 2008, when the U.S. Department of Justice issued a scathing report that criticized nearly every facet of patient care and hospital conditions.

The Civil Rights Division of the agency called for the state to make sweeping improvements or risk being hit with a federal lawsuit that could place the hospital under court control.

In November, on the eve of the dedication of the new hospital, federal officials put the state on notice that they were expanding the investigation to examine how long patients stay at OSH and whether the state provides adequate community-based mental health programs and services for people coming out of the hospital and those at risk of being institutionalized.

Federal officials have not publicly commented on the current status of the investigation.

However, the U.S. DOJ’s top civil rights official, Thomas Perez, came to Salem recently to discuss Oregon’s approach to mental health care with Gov. John Kitzhaber.

“The primary focus of the meeting was community mental health,” Christine Miles, Kitzhaber’s press secretary, said last week in an email to the Statesman Journal that confirmed the meeting.

Kitzhaber’s private meeting with Perez at the Capitol marked a departure from the stance taken by former Gov. Ted Kulongoski, who snubbed a request by the feds for a high-level meeting.

In back-and-forth correspondence between state and federal lawyers, Oregon attorneys have touted concerted efforts to improve both the state hospital and the community mental health system.

The new consulting report could bolster the attorneys’ assertions about a new and improved OSH.

It describes how hospital workers vented frustration, anger and resentment, then rolled up their sleeves and got to work on reform-minded initiatives.

“From the beginning there has been no silver bullet capable of transforming the entire organization,” the report said. “Out of necessity, Oregon State Hospital was forced to attack every cultural issue head-on, concurrently, with all its energy.”

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From the Salem Statesman Journal, April 25, 2011

Oregon State Hospital has been in the crosshairs of federal civil-rights investigators since mid-2006, and there appears to be no end in sight to the long-running inquiry.

From Library of Dust, but David Maisel

The first visit occurred in February when lawyers from the U.S. Department of Justice met at the state hospital with a number of patients to hear their concerns and complaints.

Patients vented frustration about long stints of hospitalization and restrictive release practices that keep patients cooped up on psychiatric wards after therapists have found them fit to be released.

During the second trip to Salem, visitors from the U.S. DOJ spent three days, April 6-8, conducting interviews with at least 10 state mental health administrators. The talks took place in a conference room at the Commerce Building.

State officials briefed the federal contingent on various mental-health programs, state hospital release practices and funding issues that loom as the state faces a $3.5 billion shortfall in its budget for 2011-13.

Ten administrators were listed on a roster of scheduled participants for the three-day series of interviews. Among them: Richard Harris, director of the Addictions and Mental Health Division; Mary Claire Buckley, executive director of the Psychiatric Security Review Board; and Nena Strickland, deputy superintendent of the state hospital.

Heading up the federal team was Robert Koch, a trial attorney for the Special Litigation Section of the Civil Rights Division of the U.S. DOJ.

The Statesman Journal obtained back-and-forth correspondence between state and federal lawyers through a public records request filed with the Oregon Department of Justice. The email traffic stretches from January through the middle of last week.

Much of the correspondence focused on scheduling matters and other arrangements for the two recent visits.

Other exchanges pointed to a potential meeting between Gov. John Kitzhaber and Thomas Perez, head of the federal Justice Department’s Civil Rights Division.

State and federal lawyers expressed mutual interest in setting up such a meeting, potentially opening up a new, top-level line of communication in the protracted investigation.

Former Gov. Ted Kulongoski previously spurned an invitation for a face-to-face meeting with federal officials investigating OSH.

As it stands, no date has been set for a meeting between Kitzhaber and Perez.

“We’ve always been open to a meeting, but we continue to discuss when it should occur,” Tony Green, a spokesman for Attorney General John Kroger, said last week in an email to the newspaper.

The state has placed a pre-condition on any meeting between Kitzhaber and Perez, as outlined Wednesday in an email sent to the feds by John Dunbar, the attorney in charge of the Special Litigation Unit of the Oregon Justice Department.

Dunbar wrote: “I have checked further about a meeting between Tom Perez and Governor Kitzhaber. We think it would be best to hold the meeting after we learn more about USDOJ’s specific concerns and any findings … .

“Of course, we believe that given what USDOJ learned about during its most recent visit, including the AMHI program (Adult Mental Health Initiative), the Oregon Health Plan, the child wraparound program, and other Oregon programs, USDOJ should not issue findings. In any event, we look forward to hearing from USDOJ about follow-up information.”

This June will mark the fifth anniversary of the beginning of the federal investigation of the state hospital.

In 2008, the feds threatened legal action if Oregon did not fix numerous defects in patient care and hospital conditions. The state responded by launching new treatment programs, hiring hundreds of new hospital employees and moving forward with construction of a new 620-bed, $280 million replacement hospital in central Salem.

Despite reform-minded efforts, the federal Justice Department put the state on notice in November that it was widening the investigation, digging into concerns beyond patient care and hospital conditions.

The expanded investigation has been scrutinizing how long patients stay at OSH, the availability of mental health services for people coming out of the hospital and those at risk of being institutionalized, and whether the state is complying with federal law, which requires that government dollars support the most appropriate care for people with disabilities in the least restrictive settings.

Mental health advocates maintain that Oregon spends too much on hospitalization for people with mental illnesses and not enough on community programs.

Legislative action will occur soon on budget cuts that loom for the state hospital and other parts of the mental health system. Kitzhaber’s proposed budget for 2011-13 called for $36 million worth of general fund spending cuts at OSH. Mental health administrators are putting together a package of specific cuts for upcoming review by the Legislature’s budget-writing committee.

Opinion editorial from the Salem Statesman Journal, December 26, 2010

Governor-elect John Kitzhaber must tackle the issue head-on

There is much on John Kitzhaber‘s to-do list as he prepares to return to the governor’s office. Yet, it’s evident that the governor-elect is well aware of the U.S. Department of Justice’s interest in the Oregon State Hospital.

Kitzhaber has indicated he might meet with U.S. justice officials, who have been closely monitoring the state hospital for the past four years. If that meeting happens, it won’t take place until February at the earliest, according to a Statesman Journal report by Alan Gustafson.

Any meeting would be an encouraging sign, given that outgoing Gov. Ted Kulongoski steadfastly has refused to meet with federal investigators. That stalemate in discussions hasn’t deterred the U.S. Department of Justice, which recently announced plans to expand its investigation to determine if the state is adequately providing community-based mental health services.

In 2006, federal investigators began examining whether patients were jeopardized because of poor conditions at the state hospital. The state, thanks to a big legislative push by Senate President Peter Courtney, has responded by finishing the first phase of a new Oregon State Hospital in Salem.

Federal investigators remain skeptical that the state has delivered, which is why a settlement hasn’t been reached between the U.S. Department of Justice and the state.

No settlement creates the possibility of a costly lawsuit, which wouldn’t help Oregon’s financial cause.

Kitzhaber likely recognizes that the state doesn’t have much flexibility because of the state’s economy and budget challenges.

It’s also significant that Oregon Attorney General John Kroger is involved in these discussions – another sign that the state is taking a different approach to dealing with the feds’ concerns about mental health programming.

Why Kulongoski’s administration wasn’t more proactive during the investigation remains baffling, but that’s less important now. Kitzhaber must recognize that it doesn’t hurt to have a face-to-face meeting to hopefully resolve this long-simmering dispute.

From the Salem Statesman Journal, December 18, 2010

Current governor had refused to meet with federal lawyers, but Kitzhaber might agree to a first face-to-face in February

Talks between state officials and the U.S. Justice Department are planned for early next year, opening a new, high-level line of communication in the expanding federal investigation of the Oregon State Hospital, records show.

Federal authorities have been investigating Oregon State Hospital for the past four years. The inquiry into conditions at the facility and care of patients is ongoing.

But state lawyers said the timing wasn’t right, and they persuaded the feds to delay the talks until after Kitzhaber takes office in January.

“I expect the governor-elect and his policy team may want to conduct a review of the state hospital matter that could have a significant impact on your investigation,” Kroger wrote in a Dec. 8 letter to Samuel Bagenstos, deputy assistant attorney general for the Civil Rights Division of the U.S. Justice Department. “However, no such review can take place until January at best, given the governor-elect’s need to appoint a new administration, deal with a massive state budget deficit, and develop a plan to jump-start the state’s ailing economy.

“Delay of these interviews until February will provide the Governor with sufficient time to get his administration started, to conduct any necessary review, and to identify senior members of his public health team.”

Amy Wojcicki, spokeswoman for the team that is working on Kitzhaber’s transition to the job he held from 1995 to 2003, declined to comment on Kitzhaber’s potential participation in the upcoming talks.

“While the governor-elect is paying attention to the issue, all of the correspondence and contact has been between the Oregon DOJ and the U.S. DOJ,” she said. “So I would have to refer you back to Kroger’s office for any comment about what is happening.”

Kitzhaber, a medical doctor, has made health care a priority in his two previous terms as governor and during this year’s campaign.

Should he opt to meet with federal officials, Kitzhaber will break new ground in the protracted investigation of Oregon’s main mental hospital.

A history of warnings

Outgoing Gov. Ted Kulongoski previously turned down a federal invitation for a face-to-face discussion of the investigation, which began in June 2006.

In 2008, the Justice Department warned Oregon that patient care and conditions at the state hospital violated patients’ rights and jeopardized their safety. State and federal lawyers have been in negotiations since then to reach a settlement on hospital reforms and head off a lawsuit. But no agreement materialized.

Last month, on the eve of the dedication of the new Oregon State Hospital being built in Salem, federal officials indicated they are expanding the investigation.

In addition to scrutinizing care and conditions inside the hospital, the Justice Department plans to look at community-based programs and services for people coming out of the hospital and those at risk of being institutionalized.

Early this month, federal officials informed the state that they wanted to spend Dec. 13-17 in Oregon and meet with a handful of state officials including Greg Roberts, OSH superintendent; Richard Harris, director of the state Addictions and Mental Health Division; and Mary Claire Buckley, director of the state Psychiatric Security Board.

As another part of their visit, federal officials planned “a listening tour to meet with a wide spectrum of stakeholders of Oregon’s mental health system.”

State lawyers nixed any high-level talks until Kitzhaber takes office.

“Oregon will not produce state officials for interviews next week,” John Dunbar of the Oregon Attorney General’s office stated in a Dec. 7 e-mail to the U.S. Justice Department.

“As we’ve discussed, given that a new governor is about to take office, we believe that the interviews should take place in February,” he said. “Going forward, we also request more notice than was provided last week. Like you, we desire a cooperative relationship as we move forward, and we look forward to having one.”

Oregon’s snub prompted a chilly response from the feds.

“Regrettably, the state now refuses to schedule any meetings with any state officials at any point during our weeklong visit,” Robert Koch, an attorney in the Special Litigation Section of the U.S. Justice Department wrote in a Dec. 8 letter. “Instead, the state asked that we delay our trip until February 2011.”

Kroger stepped in to the back-and-forth correspondence Dec. 8. He thanked federal officials for delaying the talks until February.

The next day, Kroger e-mailed Thomas Perez, head of the Justice Department’s Civil Rights Division, offering to meet with Perez in January, either in Portland or Washington, D.C., to discuss the investigation.

“It would be very helpful to me to get a better sense from you of the concerns that drive the investigation and the types of outcomes you would like to see, so I can have more productive conversations with our new governor and legislative leadership,” he wrote.

Kroger is taking a role in the case because “he wants to do what he can to resolve this issue and help the incoming governor get up to speed,” Tony Green, Kroger’s spokesman, wrote this week in an e-mail to the Statesman Journal.

‘A bit more hopeful than I was’

Mental health advocates, who have criticized Kulongoski for his refusal to meet with federal officials, said they are encouraged by new prospects for talks between state and federal officials.

“I hope this does signal a change,” said Chris Bouneff, executive director of Oregon NAMI, a chapter of the National Alliance on Mental Illness. “(Kulongoski) was so adverse to even talking that it’s led to nothing being done or things being done in a segregated manner.”

Bouneff and other advocates for people with mental illnesses maintain that the state spends too much money on hospital care and not enough on community-mental health services, such as outpatient care, intensive case management, supported housing and employment programs.

Bouneff pointed to a recent settlement between the U.S. Justice Department and the state of Georgia as a model for resolving the federal investigation of the Oregon State Hospital. Settlement terms called for Georgia to expand its community mental health services during the next five years.

“The agreement DOJ got in Georgia was perfect for what that state needed,” Bouneff said. “I’d love to see something for Oregon that’s comprehensive, too, and meets our needs. One of the attorneys who wrote the Georgia settlement is now assigned to Oregon, so I’m a bit more hopeful than I was.”

From the Salem Statesman Journal, November 20, 2010

Now what? That question looms for Oregon leaders in the wake of a letter sent last week to Attorney General John Kroger by a top lawyer in the Civil Rights Division of the U.S. Department of Justice.

The two-page letter, which arrived on the eve of Thursday’s dedication ceremony for the new Oregon State Hospital in Salem, delivered a bombshell. It served notice that the feds are expanding a four-year investigation into Oregon’s main mental hospital.

Until now, the investigation has focused on patient care and hospital conditions. As outlined by the federal lawyer, the widening investigation will examine community-based programs and services for people coming out of the state hospital and those at risk of being institutionalized.

On Friday, state officials pledged to cooperate with the federal investigators — echoing a vow they made when the U.S. DOJ began investigating OSH in June 2006.

Amid uncertainty about the scope and duration of the new investigation, this much is clear: the U.S. DOJ has used its clout in other states to force improvements in community-based services for people with mental illness.

“What just happened in Georgia with the settlement there proves that the Department of Justice is serious about seeing that people are treated humanely,” said Chris Bouneff, executive director of Oregon NAMI, a chapter of the National Alliance on Mental Illness.

Like the situation now unfolding in Oregon, a federal investigation of Georgia’s mental health system started with flaws and failures at its psychiatric hospitals, then branched out to scrutinize community-based services.

Last month, Georgia and the U.S. DOJ reached a settlement that resolved a federal lawsuit filed against Georgia, alleging the state segregated people with mental illness and developmental disabilities in state facilities in violation of the Americans with Disabilities Act.

Settlement terms call for Georgia to expand its community mental health services during the next five years. In part, the state agreed to provide community treatment, intensive case management, supported housing and employment programs to serve 9,000 people with mental illness in community settings. Services also will be expanded to help people in mental health crisis without admitting them to a state hospital

Bouneff and other mental health advocates hope the expanded federal investigation into Oregon’s mental health system will spur increased state funding for an array of community programs and services, such as outpatient care, crisis counseling, job training and affordable housing options.

As advocates for mentally ill Oregonians tell it, the state’s community mental health system has long been poorly funded and fails to deliver services needed by thousands of Oregonians.

The U.S. DOJ signaled its intent to delve into such assertions and determine whether the state is violating the Americans with Disabilities Act.

In his letter to the state, Jonathan Smith, chief of the Special Litigation Section for the U.S. DOJ Civil Rights Division, wrote: “We have received information from the State and other sources that indicates that Oregon is committing funds to increase institutional capacity while simultaneously making substantial cuts to the budget for community mental health programs. Such budgetary re-allocations in favor of institutional care would appear to run afoul of the ADA’s integration mandate.

“We also have received information that indicates that Oregon fails to serve individuals with mental illness, both those confined to and discharged from OSH, as well as those at risk of being institutionalized, in the most integrated setting appropriate to those individuals’ needs. It appears that the lack of appropriate community-based services may be a primary cause of these problems, and our investigation will include an examination of these issues.”

Richard Harris, director of the state Addictions and Mental Health Division, said in a Friday interview that he disagreed with certain aspects of the letter written by the federal lawyer. But he concurred with its main thrust: Oregon hasn’t adequately funded community-based services.

“I think it’s got some slightly misleading points to it,” Harris said about Smith’s letter. “But, in general, it points us in the direction of how we need to perhaps make a bigger investment in the community services.”

Harris added: “Sometimes, people think the only interest this office has is in the hospital. I have a wide interest in making sure we have adequate community-based services because the hospital in many respects, although important, is not the correct tool to deal with mental illness in the community. Truly, an effective mental health system has to be in the community. We can’t have the hospital as the only tool.”

Any proposals to spend more money on community mental services could face a challenge next year in the Legislature because of stark budget realities. Lawmakers face a projected $3 billion shortfall in the 2011-13 budget cycle, which starts July 1.

Deep cuts in community services were outlined in budget-cutting scenarios recently drawn up by mental health administrators at the request of outgoing Gov. Ted Kulongoski.

Harris described the proposed cuts as a starting point for upcoming budget talks, not the final word.

“Look, we have a huge budget problem to cope with,” he said. “The governor’s requested budget, which has these 25 percent reduction scenarios in them, is one budget. The Legislature is going to ask us to produce another budget. Gov. (John) Kitzhaber is undoubtedly going to give us direction about how to do these reductions. So I’m not banking on those reductions as the final word on this. We’ve got a lot of road to travel.”

Advocates for the mentally ill say Kulongoski and state legislators have neglected community mental health programs amid the state’s push to build two new psychiatric hospitals to replace the dilapidated and obsolete 127-year-old institution in Salem.

The Oregon State Hospital bell choir performed at a dedication ceremony in the new building.

“Give us some credit here,” he said. “We’ve really made a good-faith effort to start to move in so many directions. There’s only so much time and money, and only so much you can do given how far behind you were. There was no conscious decision to neglect anything. We know we have a major community mental health component we have to deal with, have to fund, and make sure we’re doing it right.”

Courtney hedged his assessment when asked whether the new governor and the 2011 Legislature would increase funding for the community mental health system.

“I’m just going to say, obviously, community mental health is going to be a focus,” he said. “The new hospital in Junction City is going to be a focus. And completion of the state hospital (in Salem) is going to be a focus.”

Bouneff sees it differently. He hopes the expanded federal investigation will prompt state officials and lawmakers to cancel construction of the planned Junction City hospital.

As it stands, state plans call for building a 360-bed hospital on state prison land in Junction City after the new hospital in Salem becomes fully operational late next year.

Combined construction costs for the two new hospitals are $458 million. Bouneff contends that state money required to operate the Junction City hospital, estimated at more than $110 million a year, would be better spent on community programs and services.

“Frankly, we have an opportunity here, in the midst of a budgetary crisis, to think differently,” he said.

Bouneff criticized Courtney’s staunch backing for the Junction City hospital.

“There are good things about Sen. Courtney being hard headed. One is certain things get done,” he said. “Certainly the new Oregon State Hospital got done in large part because he was hard headed. But then you wonder about his tenacity in going after Junction City when he and others will not stop and ask the question that is most pertinent: Do people in the state hospital really need to be there?

“I don’t hear the senator talking about those things, and it’s very frustrating. We just keep building institutions, and the federal government is going to come in here if we keep going down that path and force our hand. And then we don’t have control.”

The story so far

The basics: The new hospital in Salem that will replace the 127-year-old Oregon State Hospital is the first of two new mental hospitals planned to replace the existing facility, which was deemed obsolete and unsafe by state-hired consultants in 2005.

Phased construction of the 620-bed Salem hospital, described as “world class” by state officials, will be followed by construction of a 360-bed or smaller hospital in Junction City.

What’s new: Federal investigators have notified Oregon officials that they are expanding a four-year investigation into patient care and conditions at Oregon’s main mental hospital. The widening federal investigation will examine community-based mental health programs and services for people coming out of the hospital and those at risk of being institutionalized.

What’s next: State officials have pledged to cooperate with the federal investigation.

The costs: Budgeted costs for building the two hospitals are $458 million.

As approved by the Legislature, state financing for construction costs comes through the sale of certificates of participation, or COPs. COPs commonly are used in Oregon to pay for new public buildings. COPs are sold to investors whose interest income is exempt from state and federal taxes.

Unlike construction costs, operational costs draw on the state’s general-fund budget, which pays for a wide range of programs and services, including schools, prisons and social services.

Critics say: Mental health advocates have criticized the state’s two-hospital construction program, saying that staffing and operating costs for two new hospitals will drain the mental health budget, leaving scraps for long-underfunded community mental health programs. Advocates also doubt the new hospitals will produce lasting reforms in patient care.

Junction City debate: Advocates plan to take their case for canceling the Junction City project to the 2011 Legislature, which convenes in January.

From the Salem Statesman Journal, November 14, 2010

State officials will gather in Salem on Thursday for a ceremony hailing the looming opening of a “world-class” psychiatric facility that will replace the aged and obsolete Oregon State Hospital.

Officials tout a new era of progressive care —changes that could resolve a four-year federal investigation into alleged violations of patients’ civil rights at the long-troubled mental institution.

But inside the existing, 127-year-old hospital, patients have strong doubts and divided opinions about whether reforms will materialize at the new hospital — now slated to start housing patients on Jan. 10, instead of the originally scheduled Nov. 29.

Some predict that persistent flaws and failings at Oregon’s main mental hospital — cases of patient neglect, stagnating stints of confinement and eruptions of violence — will spread like a virus to the new hospital, thwarting reform-minded efforts.

“You can build all these new, wonderful places, but if you have the same old culture, what’s really’s going to change?” Anthony Aldeguer said by telephone from a medium-security ward in the hospital’s crowded forensic program.

Other patients are guardedly optimistic, envisioning better conditions, more privacy and expanded treatment in a 620-bed, $280 million psychiatric complex, which is being built on the OSH campus south of Center Street NE.

Christina Hogenson is hopeful but cautious.

“It’s one of those wait-and-see-things,” she said from a maximum-security ward for women. “You can’t just go by looks alone. A lot of it really depends on how staff reacts to working in a new environment that is geared more towards individual treatment.”

Pessimism and discontent

The first section of the new hospital, dubbed “Harbors,” will house as many as 104 patients in five units within a three-story building consisting of 114,300 square feet. Another unit eventually will house as many as 20 state prison inmates who will come to the hospital for short-term psychiatric care, then return to the prison system.

The Harbors section is part of the phased construction of the new hospital that will continue into next year, with patients moving to the new facility in staggered fashion. Full patient occupancy is planned for late next year.

Approximately 90 forensic patients are due to move into the Harbors facility in January. They currently occupy three maximum-security wards in the century-old J Building, and one medium-security ward in another building that’s more than 50 years old.

Forensic patients make up the lion’s share of the patient population at OSH. In all, about 455 forensic patients are housed at OSH, making up about 75 percent of the total patient population.

Most forensic patients committed crimes and were judged guilty except for insanity, resulting in stints of hospital treatment instead of prison terms. A smaller number are criminal defendants, admitted to the hospital for evaluations to determine whether they are mentally fit to stand trial.

Some patients and patient advocates contend that the forensic program functions more like a prison than a hospital, warehousing patients without effective treatment.

Aldeguer can’t wait to leave the hospital after almost three years of treatment. He linked long stints of hospitalization to patients’ frustration and despair, what he described as “a climate of helplessness and hopelessness.”

He doubts the new facility will lead to reforms.

“It’s going to be business as usual: hide our imperfections; if it hasn’t seen the light of day, keep it under spectral light before it gets exposed; once it gets exposed, slow-play the fix,” Aldeguer said.

Minimum-security patient Matthew Altstock questioned whether the new facility will live up to its “world-class” billing.

During walks on the hospital grounds, Altstock has peeked through windows of the facility. He summed up his initial impressions: “Very sterile, very institutional. It doesn’t look very friendly. It looks like everything is pretty well bolted down. It looks a lot like the Hollywood version of a two-man prison cell with a slightly larger window.”

Minimum-security patient Richard Laing offered a bleak assessment: “They’re going to move the old system into a new hospital, and it ain’t going to work.”

Echoing criticism voiced by mental health advocates, Laing said the cash-strapped state can’t afford to build two new psychiatric facilities. Plans call for building a smaller psychiatric facility in Junction City after the Salem hospital becomes fully operational. Combined construction costs for the two hospitals are $458 million.

“Why are they going to build a new hospital in Junction City?” Laing asked. “They should put the money into community placements and get people out of the hospital. It costs $4,700 per month to keep you in a group home and $17,600 per month to keep you in a place like this. It’s costing them a fortune to keep people here, and a lot of them don’t need to be.”

Worries and uncertainties

Gov. Ted Kulongoski, Senate President Peter Courtney and other state officials are scheduled to attend Thursday’s dedication ceremony for the new hospital, which still will be held despite a six-week delay in the launch of Harbors.

Superintendent Greg Roberts confirmed Monday that nearly 100 patients previously were scheduled to shift to the new facility on Nov. 29. They now are scheduled to move on Jan. 10.

However, it remains to be seen whether delayed opening of the first units will push back opening dates for other units.

Roberts, who assumed leadership of the hospital on Sept. 20, said the delayed start was needed to fully prepare staff for their new duties and to make sure that Harbors gets off to a smooth and safe start.

Courtney, one of the leading proponents of the hospital replacement project, told the Statesman Journal that he frets about the project getting bogged down by further delays.

“We know the conditions out there need to dramatically improve everywhere, and here we are delaying the opening of units,” he said. “That’s what frightens me. How many other delays are out there?”

Also uncertain is the outcome of the federal investigation into patient care and hospital conditions.

The U.S. Department of Justice Civil Rights Division launched the investigation in June 2006. Most recently, federal investigators requested — and received from the hospital — reams of data last summer, much of it pertaining to length of patient stays.

Since then, the feds have not publicly signaled their next step in the long-running investigation.

The U.S. DOJ previously warned the state that failure to make sweeping reforms in patient care could result in legal action that potentially could place the state-run institution under federal court control.

Mental health advocates question whether the new hospital will deliver improved care.

“We can point to these new series of buildings and congratulate ourselves on our common humanity in that it only took decades to do something about people living in unacceptable conditions,” Chris Bouneff, executive director of NAMI Oregon, a chapter of the National Alliance on Mental Illness, wrote in an e-mail to the newspaper.

“But we haven’t solved anything. The way you get in and out of the hospital is fundamentally flawed. The new OSH will simply be a nicer warehouse.”

Reasons for hope

In contrast to the grim assessments provided by some patients, Hogenson looks forward to aspects of the new hospital, including single-person bedrooms. She said that feature will provide much-needed privacy for patients. In parts of the existing hospital, as many as five patients sometimes are packed into one bedroom.

Expanded treatment malls in the new hospital will provide another boost for patients, Hogenson said.

Treatment malls are a key component of the state’s push to improve patient care. Hundreds of patients currently attend pilot malls that were launched in the past two years in the old hospital.

Instead of being cooped up on dreary wards, patients gather at the malls every day for group therapy, rehabilitation classes, exercise, book-club discussions and other activities.

The idea is to promote patient choice, rehabilitation and growth within a learning atmosphere akin to a bustling community college.

Hogenson currently leaves her maximum-security ward two days each week to attend a treatment mall. In the new hospital, she will spend four hours per day engaged in treatment mall activities.

“In general, I think it’s going to help a lot of patients that are on maximum security,” she said. “It will give them something to do that will work their treatment.”

Don’t tell that to Robert Erskine, a maximum-security patient now housed in the creaking J Building. He dreads the prospect of expanded treatment mall hours.

“It has not worked for me at all,” he said, recounting his anxiety-inducing visits to the treatment mall. “It’s too crowded, people bumping into you all the time. I’m not used to that kind of setting. Just too much overwhelming anxiety.”

Erskine, who is scheduled to be in the first wave of patients relocating to Harbors in January, is reserving judgment on the new hospital.

“I’ve heard both sides,” he said. “We’ll see. We’ll see if it’s going to be better or worse for us.”

From the Salem Statesman Journal, August 12, 2010

Governor, DHS director reject legislator’s appeal to cancel days for front-line hospital staffers

A state legislator has called for Gov. Ted Kulongoski to cancel furlough days for workers on the front lines of patient care at the Oregon State Hospital.

But Kulongoski and Human Services Director Bruce Goldberg nixed the idea outright, saying it’s not warranted at this time.

Rep. Carolyn Tomei, D-Milwaukie, who serves on the State Hospital Advisory Board, said in a recent letter to the governor that the money-saving furlough program, applied across-the-board to state workers since October, has backfired at the Salem psychiatric facility.

“Not only will this measure NOT save the state money but it further exacerbates the already troublesome mandatory overtime situation and also threatens patient safety,” she stated in a July 19 letter to the governor.

READ – Carolyn Tomei’s letter to Ted Kulongoski, July 19, 2010

READ – Ted Kulongoski’s response to Carolyn Tomei, August 9, 2010

In May, Tomei, chairwoman of the House Human Services Committee, conducted a legislative hearing that delved into OSH problems, including lapses in patient care and worker complaints about mandatory overtime.

In her recent letter to Kulongoski, Tomei said: “Imposing furlough time on front-line workers at the hospital forces other workers into more mandatory overtime, increasing salary costs and placing additional stress on workers and their families. Often, trained caregivers are forced to work shifts of 16 hours straight, twice per week.

“Furlough time also increases the use of temporary hires who are unfamiliar with the patients on the wards,” she wrote. “Because of their mental health conditions, OSH patients are especially fragile and need well-trained, consistent caregivers. Moreover, at least one of the recent deaths at the hospital may be attributed to untrained staff filling in during furlough time.”

Tomei urged the governor to grant furlough exemptions for OSH employees who provide direct patient care.

“I hope you will give thoughtful reconsideration to the imposition of furlough days on direct patient care personnel at the Oregon State Hospital,” she said.

This week, Kulongoski said in a response letter to Tomei that OSH is rapidly hiring new front-line workers and taking other action to reduce mandatory overtime.

+++

Front-line staffers in Oregon State Hospital’s forensic program logged 17,162 hours of mandatory overtime in the months of April, May, June and July, compared with 4,452 hours during those same months in 2009.

A monthly breakdown of the forced OT hours:

2010
April: 4,104
May: 5,493
June: 5,116
July: 2,449

2009
April: 507
May: 1,359
June: 1,065
July: 1,521

From the Eugene Register-Guard, June 26, 2010

The proposed facility in Junction City faces declining support from lawmakers who are worried about the cost

Opponents of a proposed psychiatric hospital in Junction City are gaining traction in their push to scrap it, because of a flagging state budget outlook that calls into question Oregon’s ability to pay the cost of staffing and running the big facility.

Advocates of community-based mental health services have for years been critical of the state’s planned hospital, the smaller of two such institutions that are part of a master plan to replace the 127-year-old Oregon State Hospital in Salem.

A consulting firm hired by the state recommended the two-hospital plan in 2006 to replace the Oregon State Hospital. A majority of legislators voted in 2007 to authorize the state to borrow money for construction of both the 620-bed Salem facility, which is being built and is to open next year, and a 360-bed hospital in Junction City, which is in the planning stage and is to begin operating in fall 2013. The state has since scaled back the Junction City hospital’s size to 270 beds, with a construction cost of $186 million.

Now, with a decade’s worth of state budget shortfalls on the horizon, some lawmakers are increasingly attuned to the arguments from longtime critics of institutionalized mental health care.

“Everybody acknowledges the fiscal reality has changed since the concept of the proposal was first put forward,” said House Speaker Dave Hunt, D-Gladstone.

The operating costs of the Junction City hospital are estimated at $214 million per biennium.

The proposed hospital, with a staff of 1,000 or more, would be good economic news for a county badly bruised by the recession. Lane County area job seekers have swamped the state with inquiries about positions at the Junction City facility.

But the groups Mental Health America of Oregon, National Alliance on Mental Illness (NAMI) and Disability Rights Oregon, along with community-based providers of mental health services, have been meeting with Hunt and other House members, seeking to convince them to reconsider plans for the hospital.

Chris Bounoff, the NAMI Oregon executive director, said the strategy — raising the issue of tight budgets as a reason to stop a facility his group has long opposed — appears to be paying off.

“People are realizing we can’t afford it, so I suspect we’ll be having more conversations about that,” he said.

Advocates, including the two legislators who represent Junction City, say the increased scrutiny is important. Even so, said Rep. Val Hoyle, D-Eugene, it still makes sense to proceed with the facility.

“If this wasn’t needed, I wouldn’t support it,” said Hoyle, whose district includes the future hospital’s site. “There’s no way around the fact that we need the beds and since we need them, Junction City is the right place to build it.”

For now, the hospital continues to have the support of many powerful officials. Senate President Peter Courtney, D-Salem, has been a champion from the start. Gov. Ted Kulongoski maintains his support for the Junction City hospital as part of the state’s comprehensive approach to mental health care, said spokeswoman Anna Richter Taylor.

But Beckie Child, board president of Mental Health America of Oregon, said Hunt and other House members have been receptive to the push to cancel the Junction City facility.

She said a meeting with Hunt gave her the impression that “he gets it.”

“He said if we had a good plan, he’d be willing to take Courtney on,” Child said. “The Senate has taken the lead on this for so long. It’s time for the House to stand up and do something.”

Hunt didn’t dispute Child’s characterization. “There are a large group of House members who have been more interested in getting more engaged in this issue, and they are. Appropriately so.”

Project needed, official says

No one is questioning the need for the new 620-bed hospital in Salem to replace the decrepit Oregon State Hospital. The new facility has roughly the same capacity as the existing one.

But Dr. Bruce Goldberg, head of the Oregon Department of Human Services, said it would be problematic to cancel the Junction City hospital plans. Oregon leases 90 psychiatric care beds in Portland and runs a facility in Pendleton with residential care for 60 mental patients. Both are scheduled to shut down by the time the Junction City hospital opens in the fall of 2013.

The new hospital in Salem won’t be able to accommodate the Portland/Pendleton patients once those 150 beds are eliminated, so the state needs the Junction City hospital, Goldberg said.

He also said the net state cost of operating the Junction City facility will be less than the $214 million projection. The $56 million Oregon currently spends biennially to house and care for those patients in Portland and Pendleton would no longer be spent, so the Junction City facility would only represent a net spending increase to the state of $158 million, he said.

Many of those skeptical about the Junction City hospital say they worry its increased operating dollars will drain money from Oregon’s community-based system of caring for people with mental illnesses.

“I don’t see how, given our budget situation, we can open a new hospital,” said Rep. Sarah Gelser, D-Corvallis. “It does not make any sense to me to fund more institutional settings when we have not adequately funded our community-based system of support.”

Kevin Campbell, CEO of Greater Oregon Behavioral Health, said the state should move away from institutions to more community-based services, such as those his company provides in Eastern Oregon and in Douglas and Clatsop counties.

“Let’s reconsider the Junction City necessity and let’s look at what a right-sized state hospital and care system would look like and ultimately put those dollars into community-based treatment operations, instead of simply sticking them in a state hospital,” he said.

Mental Health America of Oregon’s Child said ongoing problems at the Oregon State Hospital underscore the importance of moving away from the institutional model.

The U.S. Department of Justice is expanding its four-year investigation of patient care at the Oregon State Hospital and the lengthy patient stays there. This month, the state disclosed that five hospital employees were reprimanded for providing inadequate care for a patient who died there last fall.

Forensic patients an issue

Over time, Oregon State Hospital has become the destination primarily for “forensic” patients — those who committed crimes and were either unable to assist in their trial because of mental illness or were found guilty except for insanity.

The movement of these forensic patients from the state hospital into community-based treatment has been slow, limiting the space that is then freed up at the hospital for new civilly committed as well as forensic patients.

The state Psychiatric Safety Review Board holds jurisdiction over these “guilty-but-for-insanity” patients. Because the board’s statutory mission explicitly prohibits it from releasing patients who pose a danger to themselves or others, many of these patients are committed for the full length of their sentences — decades or the remainder of their lives.

That worries both critics of the state’s system and those who run it.

Goldberg said a state panel is examining the possibility of changing the statutory mandate in order to reduce the housing of forensic patients at the Salem and Junction City facilities.

Even if that happens, he said, both hospitals are needed and should not be paid for at the expense of community-based mental health budgets.

Goldberg noted that the master plan drawn up by consultants and being pursued by the state called for both components of Oregon’s system of mental health care to be improved.

“We’ve got to fund both parts of the system,” he said. “We can’t be pitting mental health in one place against the other.”

Goldberg questioned how realistic it would be to create the 16-bed community-based facilities that some hospital critics have called for in place of a large institution. He said neighborhood opposition would be fierce if the state were to site one or two dozen such facilities.

So far, the state has spent or committed about $1.5 million to $2 million for planning, design and other costs related to building the Junction City hospital on a 240-acre state-owned parcel that’s also the planned location for a prison complex.

Junction City’s city administrator, David Clyne, said the state committed to paying $30 million of the city’s $34 million cost for the first phase of adding infrastructure to serve both the hospital/prison site and nearby land the city has for years sought to develop as an industrial park.

When the cost of the wastewater treatment facility is factored in, he expects the state’s overall infrastructure cost to be as much as $50 million, with about $20 million in expenses falling to the city.

Clyne said Junction City was prepared for the possibility that both the hospital and the prison fail to materialize. He cited language in the intergovernmental contract assuring that Junction City’s costs would be shifted to the state if it decides against building its planned institutions.

“We would walk away not happy about losing the two facilities and all those jobs,” Clyne said. “But at least we won’t be responsible for any of the infrastructure development if they don’t come.”