Oregon State Hospital: Fed DOJ wants answers

From the Salem Statesman Journal, June 25, 2010

How long patients stay and where they go afterward is focus of concern in letter

Federal investigators are expanding a four-year investigation into the Oregon State Hospital, newly released correspondence shows.

The U.S. Department of Justice, in a recent letter to the state, signaled the agency’s intent to examine how long patients stay at the crowded mental institution in Salem, hospital discharge planning and the availability of community mental health facilities for patients deemed ready to leave OSH.

Hospital critics long have maintained that patients stay cooped up for excessive stints of hospitalization, partly because of stringent release practices by the state Psychiatric Security Review Board and partly because of a shortage of community facilities for patients deemed ready to leave OSH.

The Statesman Journal obtained the DOJ’s letter this week through a public-records request with the Oregon Attorney General’s Office.

Mental health advocates said Thursday that they were encouraged by the new development in the prolonged federal investigation of the state hospital.

“They’re asking the right questions,” said Chris Bouneff, executive director of NAMI Oregon, a chapter of the National Alliance on Mental Illness. “The truth is, you can make the nicest facility in the world but if you’re there year upon year upon year and not getting out, conditions will remain abhorrent.”

It’s crucial to examine how and why some patients move into community homes and facilities while others languish at the state hospital, Bouneff said.

“The mistake the state has made throughout this whole thing is to focus on the state hospital as if it exists in isolation and what happens within its walls is the only thing that needs to be tweaked,” he said. “I think the U.S. DOJ is clearly on the right path here. My hope is that a letter like this will shake people awake, but it remains to be seen.”

Tony Green, spokesman for Attorney General John Kroger, said the state plans to respond next week to the U.S. DOJ letter. He declined to elaborate.

The scope of the new line of federal inquiry was outlined in a June 9 letter from David Deutsch, senior trial attorney for the Special Litigation Section of the U.S. DOJ’s Civil Rights Division, to Micky Logan.

Itemized in the federal lawyer’s letter are 12 requests for state documents and data, including a statistical breakdown of the number of patients whose hospitalization falls within specific time periods.

About half of Deutsch’s requests centered on gathering information about community mental health programs, services and providers. He asked the state to provide:

-The names and capacity of community providers/facilities that have been used in the past two years for patients being discharged from OSH.

    A list and description of all available alternative community services and supports for patients being discharged from OSH, including locations, capacities, eligibility requirements and waiting lists.
    A list and description of mobile mental health services available in the community for patients being discharged from OSH.
    All current policies, procedures and guidelines related to participation of community mental health providers in hospital patients treatment and discharge planning.
    A list of any current OSH patients or guardians who have objected to patient placements in the community, and copies of the treatment plans for those patients.
    A description of all efforts undertaken by the hospital in the last year in accordance with the facility’s program for discharge planning and community integration.

Bouneff said the feds appear determined to dig into sluggish discharge practices that cause some patients to lose hope.

“I don’t necessarily see it entirely as how (the patients) fare outside, but I do see (the U.S. DOJ) asking about getting people outside,” he said. “Are they discharge planning? Are people who are deemed ready to be discharged getting out? Where do they go? What is the planning like? These are all important questions that have to be asked to figure out whether or not the hospital is actually doing its job.”

Wednesday is the U.S. DOJ-imposed deadline for the state to provide the requested documents.

Richard Harris, director of the state Addictions and Mental Health Division, said Thursday that the hospital has been gathering information to respond to all of the federal agency’s requests.

“They asked a lot of questions in there and both my office and the hospital right now are working to answer those questions,” he said. “When we send them an answer back that information will be available to everybody.”

The U.S. Department of Justice began investigating OSH in June 2006. The feds threatened legal action two years ago if Oregon did not fix numerous defects in patient care and hospital conditions. The state responded by launching new treatment programs, hiring hundreds of new hospital employees and moving forward with construction of a new 620-bed, $280 million replacement hospital in central Salem.

But mental health advocates have continued to criticize patient care. They think federal court oversight of the state hospital is necessary to hasten reforms and stop what they describe as a pattern of patient abuse and neglect at the 127-year-old mental institution.

Beckie Child, board president of Mental Health America of Oregon, said Thursday that the U.S. DOJ’s new line of inquiry is in keeping with the Obama administration’s aggressive handling of civil rights investigations.

“They have stepped up their civil rights enforcement,” she said, referring to the U.S. DOJ. “I think that they see the way to get people better is to get them the hell out of the hospital.”

READ – U.S. Dept. of Justice letter to Oregon Attorney General