Changing Oregon State Hospital’s culture will be a challenge

Opinion editorial from Salem Statesman Journal, August 16, 2008

State facility needs to start improving conditions now

The news coming out of Oregon State Hospital has not been good lately. But there are signs of improvement.

New Superintendent Roy Orr has started articulating a clearer vision for the hospital. The critical question is whether he can move quickly enough to change the hospital culture.

The hospital is a big deal in Salem and the surrounding area. That’s partly because of the jobs it creates. But local residents and public officials also pay attention to problems at the hospital, including security lapses. And many people think the hospital has neglected its relationship with the community.

Despite stumbles, Orr appears to understand those concerns. He admits that the hospital erred by failing to inform the community and public officials before resuming outings by forensic patients.

That poorly executed decision may illustrate how difficult it will be to change the hospital culture: Last month, OSH officials initially stopped on- and off-campus patient outings in the 470-patient forensic program. That ban followed two escapes, including one from a locked ward.

The state responded to the escapes by launching internal and external security reviews. But the patient outings quietly were reinstated, albeit with closer supervision, before the security analysis was completed.

Hospital officials should have recognized the community ramifications of their decision — and the importance of letting people know publicly.

In the aftermath, Orr is saying the right things about wanting to change the culture: “We want to move the Oregon State Hospital out of its past.”

For example, he said that training has improved, resulting in less staff use of physical restraints and seclusion to handle difficult patients.

Orr favors creating an advisory board — as many community hospitals have — to provide ongoing examinations of quality, security, ethics and other issues. That sounds like a good concept if the board has the authority, expertise and dedication to dig deeply.

Orr also has been open in discussing another sordid incident, the arrest of an employee on charges of sexually abusing a state hospital patient at the Portland campus. Again, that incident reflects the building and staffing problems that plague OSH.

It took a federal investigation and impatient legislators, especially Senate President Peter Courtney, to get the state’s attention about the deplorable conditions at the chronically understaffed hospital.

The Legislature approved adding more than 200 positions, but hundreds more are needed. The state also approved construction of two replacement hospitals, in Salem and Junction City. Groundbreaking for the new Salem hospital is Sept. 3.

Orr’s challenge is to do more than limp along until the new Salem facility opens in 2011. Improved staffing, better training, better relations with the Salem-area community and modern treatment methods — constituting a change in hospital culture — must happen now.

Otherwise, Oregon will have new buildings housing an antiquated hospital.

OUR COMMENT – In 2007 Oregon state legislators, unwilling to confront complacent union bosses, instead offered a new $600 million dollar multi-location facility as the solution for the problems at the Oregon State Hospital. No doubt good news for those who live and work in the antiquated structures, but excellent mental health treatment can be provided in a wigwam. Focusing attention on new buildings has been political sleight of hand by Peter Courtney and others, misleading and misguiding the public to believe a clinical solution comes as a subset of bricks and mortar. The state hospital is not intended as a jobs program, not a prison, and currently not even much of a hospital – it is where effective, outcome-driven psychiatric treatment for those most unable to help themselves ought to be available on demand.