State hospital changes, but slowly

From The Oregonian, November 14, 2005 – not elsewhere available online

Despite warnings six months ago of dangerous conditions at the Oregon State Hospital, about 100 patients continue to live in decaying wards that could collapse during an earthquake.

State officials say it could take a year or more to find places for all the patients, most of whom have been convicted of crimes and require a locked, secure environment.

But some legislators are growing impatient.

“We’re not where we should be,” said Senate President Peter Courtney, D-Salem. “It seems to me that the state is on notice that we have a facility that pretty much puts patients at risk.”

Patients are housed in masonry buildings that do not meet state or national building codes. They occupy wards with single-paned windows and poor ventilation. The layout –long, narrow hallways and three- and four-bed rooms –is inappropriate for effective psychiatric treatment.

Although Oregon all but ignored the needs of its mental health system for years, the subject is now receiving high-level attention.

State leaders endorsed an overhaul of Oregon’s mental health system following a May 16 report by consultants hired to assess the sprawling 144-acre Salem campus. The consultants were asked to return in February with a long-term plan that includes recommendations on how Oregon can offer more community-based mental health services.

The plan also will address what to do about the crumbling Oregon State Hospital, where about 700 patients currently receive treatment and the newest building dates to 1955. One option is to rebuild a smaller, better-designed hospital to replace today’s wards, which look much like they did when the movie “One Flew Over the Cuckoo’s Nest” was filmed inside the hospital 30 years ago.

But state officials have not yet done what the consultants recommended last spring: Move the 100 forensic patients housed within the 122-year-old J Building complex, which is most at risk in an earthquake.

Department of Human Services officials considered moving the patients to another ward on the hospital campus; they visited mothballed private hospitals and considered the Wapato Corrections Facility in Portland.

None proved to be a timely or cost-effective option, said Bob Nikkel, who heads the agency’s Office of Mental Health and Addiction Services.

Nikkel said Human Services will look at another site this week. At this point, however, the best option may be to refurbish a vacant floor in a Portland building that the state leases from Legacy Health System. The space could accommodate 28 to 32 patients, Nikkel said.

The state also is looking at opening three new, smaller locked units.

“I think we’re at least a year away for all 100 (patients),” Nikkel said.

Gov. Ted Kulongoski had hoped to move more quickly. But the state is trying to resolve problems that have accumulated over 50 years, said Anna Richter Taylor, the governor’s spokeswoman. “You can’t just turn around in a day or a month and find the right solution,” she said.

Shuffling patients

Currently, about the only option available to hospital officials is to release minimum security patients who are ready for community treatment as quickly as possible to make room for those who need higher levels of treatment.

As of late last week, the Oregon State Hospital housed 687 patients, about 18 more than the number it is budgeted to handle. The numbers have been much higher, said Dr. Marvin Fickle, the hospital’s superintendent.

Reducing crowding also may ease pressures on the staff.

The Oregon Advocacy Center, a nonprofit legal group that helps people with disabilities, studied state hospital staffing and found Oregon “is nowhere near meeting national standards,” said Robert Joondeph, the center’s executive director.

Worker’s compensation data show staff injuries rose 20 percent between January 2004 and January 2005. Fickle said he expects injury numbers to decrease as the patient population drops.

The Legislature’s Emergency Board has asked DHS to give an update in January on staff injuries and a progress report on moving patients out of the most dangerous wards. Legislators also want to know how intermediate steps will fit with the long-term plan to revamp the mental health care system.

“We’re talking about people’s lives and the quality of people’s lives while they are living in the care of the state,” said Sen. Avel Gordly, D-Portland. “The conditions are deplorable. We know that. The working conditions for employees are unsafe. We know that. We’re not moving quickly enough.”