Coos County’s continuing inability to treat people with mental illness – illustrated

Bay Area Hospital turns away man despite hold order

The Coos Bay World Dec 6, 2016

COOS BAY — The Bay Area Hospital on Saturday turned away a Coos Bay man as too dangerous to hold despite a hold order being placed on the man by the director of Coos County Health and Wellness.

Coos Bay police apprehended a 25-year-old man Coos Bay Toyota, 2001 North Bayshore Dr., after the man allegedly used a knife to threaten people at the dealership. Police took the man to the hospital after a hold was placed on him, “but the hospital still did not hold him,” City Manager Rodger Craddock said.

Craddock said the hospital held the man for just a few minutes before determining he was too dangerous.

“We don’t have a mental facility in this part of the state,” Craddock said. “The hospital has a mental ward.”
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Police took the man to Coos County Jail, where he was held while officers sought an emergency commitment from a judge in order to get the man into the state hospital in Salem. Police Chief Gary McCullough said Monday afternoon they still haven’t had the emergency evaluation.

“The hospital has refused to hold some people in the past,” McCullough said. “They are a private entity so ultimately have their own policies they operate under, which means they don’t have to take people they don’t want.

“I don’t necessarily agree with that since they are the only mental health lock-up facility in the county, but those are the parameters we operate under.”

However, Bay Area Hospital Director Paul Janke said the fact that they even take mental health patients is unusual.

“To put this whole issue in context, we’re one of the few hospitals outside of Portland, Salem and Eugene, in a community this size that even has an in-patient mental health unit,” Janke said. “We think it’s important and necessary, and that’s why we do it. As a hospital, we take our role and responsibility, especially caring for people with mental health issues, very seriously. I think we do a good job with that.”

Craddock said people whose mental illness causes them to be a danger to themselves or others need to have a hold placed on them.

“This is a great concern to us,” Craddock said. “The hospital seems like an obvious location, a place to sedate and maintain them. The jail, if a crime isn’t committed, doesn’t hold them because they don’t have the space and they aren’t a mental ward. It’s a difficult situation for the community.”


Mental subject still in custody

Bay Area Hospital says it handled situation “appropriately”
The Coos Bay World Dec 10, 2016

COOS BAY — The man who walked into the Toyota Dealership a week ago is still at the Coos County Jail awaiting an emergency evaluation from a judge.

But the Saturday, Dec. 3 incident spotlighted the problem local authorities have when dealing with the mentally ill who become violent.

Coos Bay police took the 25-year-old man into custody last week after threatening in the car dealership at knife point. He was ordered to be placed on a director’s hold from Coos Health and Wellness, but stayed only a brief time at the region’s only mental facility at Bay Area Hospital.

“We don’t have a mental facility in this part of the state,” Coos Bay City Manager Rodger Craddock said. “The hospital has a mental ward.”

Hospital workers called the police to take him out after he continued to be combative.

Police took the man to Coos County Jail, where he was held while officers sought an emergency commitment from a judge in order to get the man into the state hospital in Salem.

“The hospital has refused to hold some people in the past,” said Police Chief Gary McCullough. “They are a private entity so ultimately have their own policies they operate under, which means they don’t have to take people they don’t want.

“I don’t necessarily agree with that since they are the only mental health lock-up facility in the county, but those are the parameters we operate under.”

The hospital disagreed with the statement, announcing through a press release that the decision to turn the mental subject over to police was the “most prudent decision under the circumstances.”

Hospital manager of psychiatric services Kera Hood spoke with a representative from the Oregon Health Authority following the incident, stating that Keith Breswick, civil commitment coordinator, reviewed the situation and agreed that the hospital acted appropriately.

Breswick has not returned several calls from The World for an interview.

In the hospital’s press release, Hood explained that on the day the subject was brought to Bay Area Hospital at 9:09 a.m., he was evaluated and determined to meet hold criteria. But when he was transferred to the in-patient psychiatric unit at 11:30 a.m., he “immediately presented as aggressive, agitated and threatening. He was placed in seclusion due to his aggressive nature at 11:45, and a team meeting was called at noon.”

According to the release, the hospital can’t legally restrain and medicate an individual against his will except per individual acts of aggression.

“This unfortunately shows just how far we still need to go as a community to manage our mentally ill patients in a way that protects and serves all involved,” Hood said. “We have come a long way, but this shows we have a long way still to go in working to resolve a true community issue.”

“This is a great concern to us,” Craddock said in an earlier interview. “The hospital seems like an obvious location, a place to sedate and maintain them. The jail, if a crime isn’t committed, doesn’t hold them because they don’t have the space and they aren’t a mental ward. It’s a difficult situation for the community.”


Our mental health quagmire

The Coos Bay World Dec 10, 2016 – OPINION EDITORIAL

Hopefully, our story earlier this week about authorities juggling with the fate of a mental patient upset you.

An obviously disturbed man, wielding a knife, walked into the Coos Bay Toyota dealership last Saturday morning. Coos Bay police did as expected and subdued the man, then determined he was mentally disturbed. Instead of charging him with a crime, they sought mental health care for him. The county health director concurred and ordered a mandatory hold.

The only facility on the South Coast with a mental health ward is Bay Area Hospital. But after his initial admittance, the hospital refused to hold the man, saying he was too violent for them to handle.

So, a man clearly in need of psychiatric intervention ended up in Coos County jail, where there’s not even enough room for the sane people who need to be behind bars.

What’s wrong with this picture?

It would be easy to simply blame Bay Area Hospital, especially with the initial antiseptic response of hospital director Paul Janke.

“To put this whole issue in context, we’re one of the few hospitals outside of Portland, Salem and Eugene, in a community this size that even has an in-patient mental health unit,” Janke said. “We think it’s important and necessary, and that’s why we do it. As a hospital, we take our role and responsibility, especially caring for people with mental health issues, very seriously. I think we do a good job with that.”

Contrast that response with the reality. The hospital apparently isn’t equipped to handle patients like the man police encountered last week. And according to Coos Bay police Chief Gary McCullough, this isn’t the first time the hospital has turned away patients it determines it can’t handle.

We are reminded, too, of the bludgeoning death earlier this year of 64-year-old Richard Perkins, allegedly at the hands of his 36-year-old nephew Lucas Perkins. The arrest records say that the older man had tried repeatedly over the years to get the mental health care his nephew so desperately needed – and many would argue, he deserved. But the system currently in place allowed him to walk away from Bay Area Hospital after being placed there on a hold just weeks before the uncle’s murder.

Richard Perkins had told authorities: “Lucas will have to kill me before he gets any help.”

Again, who’s to blame here, realistically? Our current system doesn’t allow for people to be summarily held against their will for an indeterminate length of time. People with mental disorders still are entitled to the rights we all enjoy.

But when these cases become public health and safety issues, we need a better response.

We’ve written about this issue frequently over the years and we get the same responses from agencies we assume should be responsible. Public health and safety officials seem to sincerely want to be more effective, and have had monthly meetings for apparently a long time now, according to a hospital press release issued in response to our repeated inquiries four days after this incident. The press release was delivered with a comment from the hospital spokeswoman, saying, “You should have waited” for the official statement.

Despite the meetings, something is always in the way — funding, leadership, creativity in finding solutions, lack of coordination, etc. The list goes on. You should get upset about that.

Another disturbed person is going to walk into a public place somewhere here on the South Coast sooner than we’d like to think, and this whole scenario is destined to play out one more time.

You should be upset about that, too.

More than that, you should be pressuring leaders to focus on solutions. They exist, but it will take leadership, community resolve and a realization and acceptance that resources and effort must be steered toward those solutions.

Meetings and four-day response times don’t solve the issue. Actions do.


Bay Area Hospital takes exception with stories on mental patient

By Paul G. Janke, chief executive officer of Bay Area Hospital
The Coos Bay World Dec 26, 2016

As chief executive officer of Bay Area Hospital, I’d like to add my perspective regarding the recent mental health-related incident covered in multiple articles in The World. Bay Area Hospital staff takes pride in what we do. As a publicly-owned facility, we strive to be responsive to a wide variety of health needs in our community and the region. Offering psychiatric services is one challenging, yet vital, part of that mission. As one of the very few acute care hospitals in Oregon that offer inpatient psychiatric services, we take our responsibility seriously.

Situations such as the one currently under scrutiny by The World lead to frustrations from all involved. It can also lead, as it has in this case, to uncovering problems with communication among groups that need to be doing a better job working together. That miscommunication can snowball into bigger issues and to societal finger-pointing. Mental health is a community issue that requires a tremendous amount of collaboration. This is a community problem that needs to be solved by the community.

The World intimated that you should be upset with the status quo. In that, I believe, we are all in agreement. But, getting upset is only beneficial if it inspires action. Hopefully, this incident will compel all key agencies including the city, law enforcement, district attorney, the courts, county and state mental health and Bay Area Hospital to work more collaboratively. I am committed to doing my part to help make this happen. It is easy to assume the problem is lack of mental health resources. In this situation I do not believe resources to be the problem. What was lacking was effective communication, cooperation and problem solving.

To improve in that area we need to start by clarifying several specific statements and factual inaccuracies from the series of articles related to this incident. Specifically, the World articles stating “BAH turned away” this man, when nothing could be further from the truth. References were also made to the effect that BAH held the man for only a few minutes. Again, that is completely inaccurate. In truth, he was screened in the emergency department before being admitted to the inpatient psychiatric unit. He was cared for at BAH for 3 ½ hours before being transferred back to police custody.

An issue addressed in our press release that, for some reason, was not included in any of the follow-up stories by the paper was an explanation of why we felt that decision had to be made. BAH psychiatric unit staff determined that jail was a safer alternative based upon the population of patients who were on the BAH psychiatric unit at that time and the aggressive nature of the patient.

Workplace violence has become a huge concern for hospitals in Oregon and across the United States. Nearly 60 percent of all non-fatal assaults and violent acts that occur in the workplace occurred in the healthcare industry. Level of violence is also the reason 26.6 percent of emergency nurses have considered leaving their department for another unit. Patient and staff safety simply must be factored highly when making these types of determinations.

The articles also suggested a developing pattern of Bay Area Hospital turning patients back to the police. To put this incident in perspective, since January 2016, BAH has had 513 inpatient admissions to our psychiatric unit. 132 of these admissions were mental hold orders. Of that number, there was only one other time in the past year where we felt it more prudent to turn the patient over to police. It is very, very rare that we have taken the position we cannot safely care for patients in a mental health hold status.

There are other technical inaccuracies in the reporting, but I want to take this opportunity instead to focus on one additional factor I believe contributed to this situation. The man was placed on a mental health hospital hold and due to his violent behavior he was subsequently turned over to Coos Bay Police. It is my understanding that the patient involved has been placed on mental health holds at least twice in the past two months, including the weekend of the case in question. Each time the court chose not to commit. Bay Area Hospital cannot, by law treat a patient’s mental illness in the absence of a court order without the patient’s consent.

Finally, I feel a need to say I’m disappointed this matter is being litigated in the World. This is simply not an effective form of collaborative problem solving.

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