State hospital patients reflect on old, new facilities

From the Salem Statesman Journal, November 14, 2010

Patients in Oregon State Hospital’s forensic program are trying to overcome stark histories of mental illness and crime.

They were court-committed to the psychiatric facility for treatment, not punishment. Hospital care is expensive, costing taxpayers $211,932 a year, per patient.

For decades, patients have been housed in bleak facilities near Center Street NE — buildings described as crowded, obsolete and unsafe by state-hired consultants in 2005.

In January, patients will begin moving into a state-of-the-art replacement hospital that is being built on the OSH campus in central Salem.

Several patients recently spoke to the Statesman Journal about their treatment at the 127-year-old institution. They also shared their perspectives about the partially completed replacement hospital.

Meet some of the patients interviewed by the newspaper:

Christina Hogenson, 28

Housed in a maximum-security unit for female patients in the hospital’s century-old J Building, Hogenson has kept a close watch on construction of the replacement hospital.

“Actually, I can see it right outside our window,” Hogenson said by telephone from Ward 48W. “It’s being built right in our backyard.”

Plans call for Hogenson to move in January to “Harbors”— the name given to the first residential units within the new hospital.

Hogenson described the name as fitting and inventive, ticking off positive connotations: “A safe harbor. A lifeline between the ocean and the land. Maybe this will be a lifeline between the staff and the patients.”

Hogenson, 28, has a long history of violent and self-destructive behavior. But her behavior has mellowed in recent months.

The breakthrough came in the wake of last year’s opening of the hospital’s first maximum-security ward for women. It was created to provide specialized care for Hogenson and a few other highly aggressive female patients, who collectively committed a large share of the patient-on-patient and patient-on-staff assaults recorded at OSH.

Given extra attention by therapists and staffers on the maximum-security ward, Hogenson’s outbursts have waned.

During a recent interview, she took pride in pointing out that she had gone almost six months without committing any assaults and four months without harming herself.

“I attribute that to having fewer patients around, so there’s more one-to-one time with the staff and the doctors,” Hogenson said. “It takes out the drama of living with 30 other females, so I have time to work on myself.”

As a child, she was physically abused and sexually victimized by two babysitters before she was 6, hospital records show. She started receiving mental health treatment when she was 8, and spent much of her childhood and teen-age years institutionalized.

For three years, she received intensive care at the Christie School, a residential treatment program for severely emotionally disturbed children.

Her repeated assaults on staff members led to Hogenson being charged with several criminal assaults during her residency at the school. Her frightening rage was documented by therapists.

“In terms of her internal life, Christina appears to live in a rather frightening and nightmarish inner world where violence and aggression are commonplace and can easily turn ghoulish and bizarre,” stated a June 30, 1995, evaluation of the 12-year-old.

Following a short, chaotic stint in foster care, Hogenson spent three years at the state hospital in Salem, enrolled in a now-shuttered program for emotionally disturbed adolescents.

In April 2004, after time served in Oregon’s juvenile and adult corrections systems, Hogenson was returned to the state hospital — this time entering the forensic program — for more psychiatric treatment.

Between her 2004 arrival and August 2008, Hogenson reportedly was responsible for 154 acts of aggression, 75 percent of which resulted in staff members placing her in restraints, records show.

Her outlook and behavior have dramatically changed on the maximum-security ward, but Hogenson says that her stay on the unit has dragged out far too long.

Awaiting the move to “Harbors” in the new hospital, she asserted that therapists should reward her good behavior by assigning her to less restrictive quarters.

“To say I’ve grown by leaps and bounds is to me an understatement,” she said. “I’m not trying to brag. I’m saying give credit where credit is due. I don’t want to be treated like a maximum-security patient when I’m not a maximum-security patient anymore.”

Anthony Aldeguer, 52

Aldeguer has been a frequent and harsh critic of the hospital, contacting mental health advocates, federal investigators and news reporters to report various problems.

Last year, when a patient was found dead in his bed on a forensic ward, Aldeguer blew the whistle on alleged lapses in the patient’s care. A state investigation subsequently determined that the hospital had neglected patient Moises Perez by failing to provide him with adequate medical care in the months prior to his death from coronary artery disease.

Aldeguer also has criticized the hospital for failing to respond to written patient grievances. His claim recently was validated by state-hired consultants who determined that patient grievances frequently get stalled or ignored.

Aldequer maintains that systemic hospital flaws and failings will be transplanted into the new hospital, thwarting reform-minded aims.

“They’re rewrapping the old hospital in a fancy new building,” he said.

Aldeguer hopes to be released from the hospital before the time comes for him to move into the new facility.

His discharge ticket has to be approved by the state Psychiatric Security Review Board, a panel that monitors the progress of forensic patients and controls their discharge dates.

Like many patients, Aldeguer complains about the board’s stringent release practices.

Patients lose hope and become frustrated when they languish at the institution for excessive stints of hospitalization, he said.

“It sets us up to feel helpless and hopeless, so we regress into a setback, and we have an outburst,” he said. “They are perpetuating this cycle of setbacks. No wonder there’s so much violence that happens here. We’re having to deal with triggers day after day after day. It’s really disheartening.”

Aldeguer was placed under the PSRB for 10 years in September 2007, after he pleaded guilty except for insanity to charges of manufacturing methamphetamine and attempted assault of a public safety officer.

He landed in the state hospital on Dec. 31, 2007, following reports that he had skipped meetings with his mental health case manager.

According to a recent report in his treatment care plan, Aldeguer’s mental health symptoms “are stable and managed without psychiatric medication.”

The report notes that Aldeguer would like to be discharged from OSH and describes how he deals with frustration.

“It works well when Tony pays attention to his ‘red flags and triggers’ and keeps in touch with his higher power,” it says. “Daily meditation is very helpful and the amount of time he spends doing this depends on how agitated he is. He also describes coping skills that include taking walks, deep breathing and using binoculars to engage in bird watching.”

Aldeguer’s activism on behalf of himself and other patients received favorable mention in the hospital report: “He demonstrates leadership and initiative on the unit. Mr. Aldeguer is smart, articulate and organized. He is also personable and has the ability to empower others to advocate for themselves.”

Robert Erskine, 43

Depressed by news that his girlfriend had died while he was confined at the state hospital, Erskine attempted to hang himself with a bedsheet in a seclusion room on Ward 50F earlier this year.

He knotted part of a ripped-up sheet around his neck and attached the other end to a ceiling panel. Then he jumped off the bed.

“It yanked me up, then it just snapped,” Erskine said recently, recounting the April 8 incident. “Staff came running when I hit the ground. It made a loud thump. I wouldn’t be here today if that sheet didn’t snap.”

Erskine’s state hospital file indicates that he was born in Napa, Calif., grew up in foster care and has a long history of mental illness and criminal behavior.

Since the age of 18, he has had more than 30 admissions to psychiatric facilities. He has tried to kill himself at least three times.

Erskine was admitted to the state hospital in January after he burglarized a houseboat docked on the Columbia River.

He pleaded guilty except for insanity to the crime and was sentenced to a maximum of 20 years under the jurisdiction of the Psychiatric Security Review Board.

In retrospect, Erskine said, he would have been better off going to prison.

“My attorney made it sound like I was only going to do six months in the hospital, then I would be back in the community,” he said. “That’s why I went ahead and took the deal to come to the hospital. Three years in prison would have been better than going through this ordeal here.”

Erskine has had numerous altercations with fellow patients, his hospital file shows.

“I’ve been in seven fights in the last year — more than I’ve ever had in my life,” he said in a quote recorded in his treatment care plan.

In September, a staff check of Erskine’s belongings found a guitar string that had been fashioned into a garotte. The discovery prompted stepped up checks of his possessions.

“Case monitor will conduct a twice weekly environmental inspection paying close attention for contraband and items that could be used to harm himself or other people,” stated a note in his care plan.

Erskine has been sent to maximum security three separate times for fights and threats of violence.

In the latest incident, he was transferred to maximum-security Ward 48B after a fracas in which he stabbed another patient in the neck with a pen.

“It didn’t cause serious injuries, just a puncture mark,” he said.

Erskine considers the maximum security unit to be a refuge of sorts because the ward houses fewer than 20 patients — below the norm on medium-security units.

He takes comfort in attending small group therapy sessions on the ward, avoiding contact with large numbers of patients at hospital treatment malls.

“I feel a lot better off here,” he said. “Just less people, less hassle.”

Matthew Altstock, 27

Last month, Altstock savored a supervised outing that allowed him to leave the hospital for a few hours and spend time with his family.

His case monitor drove Alstock to his parents’ home in Albany, where he fixed a family meal consisting of steak and salad.

“It was really great, but a bit stressful, because I only had two hours to be in the house before we had to get back,” he said.

The fleeting break from hospital routines came as Alstock looks forward to forging a productive life outside the psychiatric facility.

He has been housed on a transitional, minimum-security ward since June and hopes to be granted a conditional release to live in the community early next year.

“I’m hoping to be out the door in six to seven months,” he said.

If so, Alstock likely will leave the hospital before patients on his ward move to their quarters in the replacement hospital.

“This ward, 35A, is slated to be one of the last wards to move,” he said. “I’ve heard all the way up to possibly one year from now. So I should be long gone before this ward moves.”

Depression has been a recurring problem for Altstock since he was a teenager, according to his hospital file.

Alstock first arrived at OSH in 2005 after he was charged with arson and assaulting a police officer, resulting in his sentence of 25 years under the supervision of the Psychiatric Security Review Board.

Alstock received a conditional release from the hospital and lived in Multnomah County for two years before a relapse resulted in his return to the hospital late last year.

His conditional release was revoked after he revealed that he had been cutting himself, acts of self-harm, and not taking all of his medications.

“At the time of admission he indicated that he had wanted to come back to Oregon State Hospital to get help because he did not feel he was getting sufficient help as an outpatient and said that he wants to stop cutting on himself,” states a report in his file.

Alstock criticized the quality of his hospital care, saying that it relied on psychiatric drugs and bypassed underlying issues.

“They sent me back here for scratching on my arms, cutting, whatever you want to call it, and nobody wants to talk about that issue,” he said. “I’ve been here one full year now, and the issue actually has not been addressed.

“I think the general conception of the public is we’re getting good help in here, and a number of us don’t think we are. I see this as more of a prison than a hospital. That’s honestly what it has felt like here.”

About two months ago, Alstock opted to stop taking two psychiatric drugs — lithium and Seroquel, according to records in his hospital file.

Since then, he said, his mind has cleared and his outlook on life has brightened.

“I take only anti-depressants now, and I’m frankly doing a hell of a lot better,” he said. “Huge difference, according to family and friends, too. They haven’t heard me sound better or look healthier.”

A recent progress note in his hospital file said that Altstock “has been appropriately managing his behavior, actively engaged in treatment, and is psychiatrically stable.”

Altstock is optimistic about building a new life outside the hospital. The former culinary school student said he envisions gaining employment as an entry-level cook and working his way up to become a chef.

“I’m not too shabby at it,” he said, referring to his cooking skills. “The thought that someone would pay me money to make people food is extremely appealing.”