Oregon State Hospital advisory board left out of loop

From the Salem Statesman-Journal, February 26, 2010

A blistering federal critique of patient care at the Oregon State Hospital wasn’t shared with a new hospital advisory board before it appeared this week in the press, prompting anger and complaints from members of the governor-appointed panel.

“I was pretty disturbed that I read it in the Statesman Journal, and that as a board member I didn’t hear about it in advance,” said Robin Henderson, the director of behavioral health services at St. Charles Medical Center in Bend. “As a board member, I have a right to see those types of reports. It’s part of my responsibility. Otherwise, what am I?”

Board member Mike Adelman, a former state hospital patient, said he fears that the panel is being kept in the dark about lingering problems at the Salem psychiatric facility.

So far, he said, the panel has mainly received rosy reports from hospital officials during three meetings held in October, December and January.

“If we’re going to be worth our salt, we need to do something other than just listen to them talk about how well they’re doing, when obviously, according to the feds, they’re not,” Adelman said.

Amid the flap, OSH Superintendent Roy Orr said Thursday that “there’s no cover-up going on here, there’s no sweeping anything under the rug.”

The hospital chief said he didn’t share the federal critique of OSH with the board until after it was reported in the press because of confidentiality ground rules set by the U.S. Department of Justice.

“From the outset of our relationship with the Department of Justice, they’ve been very clear that they do not want any of their correspondence, which I would emphasize is attorney to attorney, made available publicly,” Orr said.

“I’m very respectful of the somewhat fragile nature of our current relationship with the DOJ. … If we don’t abide by some of the ground rules they have given us, we will become one of those state hospitals around the country which has gone from being under their watchful eye to being sued in federal court.”

The feds have been investigating Oregon’s main mental hospital since mid-2006.

The 2009 Legislature created a state hospital oversight board after patient care and hospital conditions were assailed in a report issued by the U.S. DOJ’s Civil Rights Division in January 2008.

The report alarmed state officials and spurred reforms, ranging from the hiring of hundreds of new hospital employees to the opening of centralized treatment malls designed to give patients better treatment.

New criticism of the 127-year-old institution surfaced in a federal review of care for patient Moises Perez, who was found dead in his bed Oct. 17 at the psychiatric facility.

Perez, 42, died in a secure treatment unit in the hospital’s forensic psychiatric program. An autopsy determined that he died from coronary artery disease.

A federal review of the deceased patient’s care, conducted by scrutinizing hospital records in the year leading up to his death, found that therapists, nurses and staffers consistently failed to provide him with adequate supervision, nursing, medication, medical care and psychiatric treatment.

Shanetta Cutlar, chief of the Special Litigation Section of the U.S. DOJ’s Civil Rights Division, outlined the care defects last month in a letter to the Oregon Department of Justice. She said the gravity of the case triggered federal alarm about the overall health and safety of OSH patients.

Cutlar’s Jan. 7 letter to the state arrived before the hospital advisory board’s latest meeting, held Jan 21.

Orr talked about aspects of Perez’ care at the meeting but made no mention of the federal critique.

“He didn’t even bring it up,” Adelman said. “That’s very troubling. It’s like he’s hiding stuff from us.”

State Rep. Carolyn Tomei, D-Milwaukie, a non-voting member of the hospital advisory board, said she was taken aback by the newspaper report that detailed the federal critique of OSH.

“We did talk about the young man’s death at the last advisory committee meeting, but I had no idea that the feds were looking into that, nor did I have any idea they had written this letter,” Tomei said. “I guess I would have appreciated knowing that there was such a missive from the federal government.”

Tomei said she was dismayed by the litany of care defects cited in Cutlar’s letter to the state.

“That’s terrible,” she said. “That’s very discouraging.”

Senate President Peter Courtney, D-Salem, who has championed the Legislature’s financial support for hospital reforms and is a non-voting member of the advisory board, did not return a phone call seeking comment on the new federal criticism of OSH.

After this week’s newspaper story, Orr e-mailed to all the advisory board members Cutlar’s Jan. 7 letter and a Feb. 12 state response letter written by Micky Logan, a senior state assistant attorney general. The e-mail stated: “From the onset, the USDOJ has asked that none of its correspondence be disseminated. Our attorneys will continue to honor that request. By law, however, we are bound to release records that are public when a request, such as the one from the Statesman Journal, is made.”

The newspaper recently obtained Cutlar’s letter and Logan’s response to it through a public records request filed with the Oregon Department of Justice.

Orr assured board members that he is committed to providing them “with timely information about OSH, and whenever possible, advance notice of news coverage.”

But several board members said they intend to raise concerns about what they perceive as a lack of critical information coming before the board. They plan to bring it up at the board’s next meeting, set for March 18.

Henderson, a veteran administrator at psychiatric hospital units in Oregon, said it’s essential for the board to delve into problems affecting patient care.

“Those are things that need to see the light of day,” she said. “I’m intimately familiar with how things work in inpatient psychiatric units, and I’m very concerned that we’re not privy to pieces of information that would help us be of assistance, real assistance, at the state hospital.”

Bruce Rogers, a Salem City Council member who serves as chairman of the advisory board, said the panel still has to figure out its role and determine what information can and can’t be discussed at its public meetings.

“I think that’s the dilemma we’re working through,” he said. “We’re not a confidential committee. Everything that comes to us is in the public arena.”

The Oregon State Hospital Advisory Board is not competently chaired. Eight months after its formation no roster of members has been released to the public, no meeting announcements, no agenda, no minutes from meetings have been issued. The scope of work of the Board, the names and contact information of staff, it’s objective and powers are entirely obscure. Until these basic organizational tools are implemented by chair Bruce Rogers, participation breeds contempt.