From The Oregonian, May 2, 2011
Lawmakers must carefully balance patient care, taxpayer cost and public safety
It’s clear that some patients spend too long in the Oregon State Hospital, where a year of care and confinement costs $200,000. It is less clear why that’s so, and what the Legislature should do about it.
There’s a rush on in Salem to lay blame for the lengthy hospital stays and extraordinary costs onto the Psychiatric Security Review Board, which decides when a forensics patient — someone who has pleaded guilty except for insanity to a crime — is ready for release from the hospital to less-restrictive community facilities.
It’s true that the PSRB has a long history of erring on the side of confinement. That’s what Oregonians apparently wanted when they established the pioneering PSRB in 1978, and wrote into law that the board’s primary responsibility was to protect public safety. It’s done that. Over the past three decades fewer than 2 percent of conditionally released patients committed new crimes. That’s a remarkable figure, but it’s come at a high cost to patients and taxpayers.
It’s also contributed to a damaging kink in Oregon’s mental health system, with patients stacking up at the overcrowded and expensive hospital, while little or no care is available to many other persons with mental illness. The crowded conditions and lengthy stays are part of an ongoing federal civil rights investigation of the hospital.
Given all this, it’s appropriate that lawmakers are debating legislation that would reduce the number of patients sent to the hospital, and, in theory at least, shorten the length of stay for some of those who are hospitalized.
We’re strongly in favor of Senate Bill 3100, which would reduce the number of patients coming in the hospital’s front door. It would require an evaluation by a state-certified psychologist or psychiatrist before a person could successfully plead guilty except for insanity. It would also exclude from the hospital persons who plead guilty except for insanity to misdemeanor crimes.
Senate Bill 420 is a more complex, difficult question. That bill proposes to take the responsibility for deciding when a hospital patient is ready for release away from the PSRB and give it to the Oregon Health Authority. Supporters, including patients and advocates for those with mental illness, strongly support the bill, arguing that decisions about the fitness of patients for release belong with physicians and the health authority.
That makes sense. But SB420 may have less impact than many people expect. In recent years, as scrutiny on the state hospital has grown, the PSRB has been more accommodating about moving people out of the hospital. In fact, it’s hard to find many recent cases in which state hospital physicians have recommended a patient’s release, and a community facility were ready and willing to accept that patient, and yet the PSRB denied the release.
Shifting responsibility for release decisions from the PSRB to the health authority will not magically open up more community beds for patients prepared for release from the hospital. We’re not opposed to the shift, but if the Legislature makes this change, it should be done with clear eyes. In the end, the only way to move people more quickly from the state hospital is to ensure that they have a place to go, one that provides an appropriate level of care and protects the public safety.
In recent years, as scrutiny on the state hospital has grown, the PSRB has been more accommodating about moving people out of the hospital. In fact, it’s hard to find many recent cases in which state hospital physicians have recommended a patient’s release, a community facility was ready and willing to accept that patient, and yet the PSRB denied the release.
I’m not sure what you mean by it’s hard to find many recent (recent being the key word here) cases in which the state hospital physicians have recommended a patient’s release, a facility was willing and PSRB denied the release. BUT they have been under the gun since the DOJ looking into their practices…in fact very recently…say in the past six months they had a 60 in 60 days they wanted to move out of the hospital, which would definitely look like recently they hadn’t denied anyone. Makes you wonder about available beds…if they found 60 beds in 60 days….that’s quite a feat….makes me wonder anyway….if maybe there are more beds available to folks….but this PSRBoard doesn’t want to release them where the beds are available rather than the other way around. (No beds available that we want them to go to) At one time I heard M.C.Buckley say there weren’t beds available and shortly after I saw Derald W. from Cascadia and he said they had many PSRB beds available….Hmmmmm
Let’s imagine the physicians (who are the ones treating the patient at the hospital) say a patient is ready to leave and the PSRBoard decides not…. Well, let’s take a look…. The PSRB gets written reports….Hears the doctors testify, Sees the patient and her attorney for an hour or 3 at the hearing…Hears testimony from the DA who definitely wants the patient to stay locked up, and they also hear from the victims, (it must be very hard not to sympathize with their emotionally charged testimony) so….Hmmm again….papers look good….patient looks good….doctors say patient good…..BUT the PSRB thinks NOT! Sumthin’ doesn’t add up to me. Who is treating the patient? Who has more exposure to the patient? Who finally decides when the patient gets to leave? Where they get to move to? PSRB?
I am pleased the PSRBoard is cautious YES….but not so pleased they appear punitive? Is that their role to punish people? NO….it’s to protect society…. that doesn’t mean keeping people (that have been in recovery for long lengths of time behind locked doors). What is it all about Alfie?….Healing and Recovery or PUNISHMENT? I guess that’s what it comes down to….Healing and Recovery or Punishment. In my way of thinking it’s about…Healing and Recovery for both the patient and any victims. What I would like, is for you to see my point of view and agree!
OK I’m rambling a bit…I hope I make some sense.
And Senate Bill 3100….I know when my friend pleaded GEI the first state psychiatrist to assess her said she was fine, thought there was no illness, no problem….but all the other experts…like psychologists, psychiatrists, and the finally the state hospital doctors all recognized there was a PROBLEM. So let me ask about SB 3100 if this certified person said they didn’t think a GEI plea was in order…when in fact it was….what would happen then? I don’t know what might have happened to my friend if she had been denied the opportunity to plead GEI….and if she was sent to prison instead of a hospital.
I’ve always thought of a hospital as a place to recover, to repair, to be healed. Some go there and die…but I’ll tell you….they don’t try and keep you there, unless of course you are in the forensic ward under the PSRBoard at OSH.
I’m done for tonight. Thanks for listening/reading.