Some Oregon State Hospital patients fear old problems will transfer to new facility

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.”