Oregon State Hospital must limit how long it treats patients who need care before it can defend itself against criminal charges, a federal judge ordered this week.
The new order requires the public hospital to treat and restore patients within strict timelines, based on the severity of the charges rather than the progress of their treatment.
While disability advocates hailed the ruling as a move that will help patients avoid additional jail time while awaiting hospital admission, it drew criticism from county prosecutors, l one of them calling it the result of a “complete failure of leadership”. Limiting treatment for these patients — in some cases to 90 days — district attorneys say, could lead to premature discharges that pose a public safety risk to their communities.
Most people, statistically, will complete their treatment within these new timeframes. Proponents hope this will encourage more investment in community mental health programs and resources, so that the criminal justice system is not the safety net. The idea is that if there is more community resourcespeople can get help before they are arrested.
Monday’s order by Judge Michael Mosman marks a significant milestone stemming from a 20-year-old federal case. The current and landmark case centers on the same issue: the public psychiatric hospital’s failure to admit patients in a timely manner after a judge determined they needed treatment before they could help their own defence. These cases are called “help and assist” cases.
This order is the culmination of a new campaign to get patients in and out of the hospital faster. The change in hospital discharge policies is intended to help patients who help and assist avoid long prison stays while waiting to be admitted to Oregon State Hospital.
When patients’ admission to hospital is delayed, they can remain in jail for a month or more with delayed proceedings and no convictions for pending charges.
The judge’s decision aims to bring the hospital into line with an earlier court ruling from 2002 that required it to admit a patient for help and assistance within seven days of receiving a court order. The 62 aid and support patients who were admitted to the public hospital in May this year had an average waiting time of 31 days, according to a report by Dr. Debra Pinals, a neutral external party with a background in behavioral health engaged as part of a legal settlement between the state and Disability Rights Oregon. The hospital could comply with the seven-day requirement as early as February 2023 with the changes.
The move paves the way for the overcrowded hospital to refer about 100 patients to county mental health providers, which would help it admit those waiting for treatment sooner, Oregon Health Authority officials said. This week, more than 75 aided and assisted patients are waiting to be admitted to Oregon State Hospital for treatment.
“We have an end in sight to this constitutional crisis and that’s promising,” said Emily Cooper, legal director of Disability Rights Oregon, a federal watchdog and advocacy agency that has sued Oregon over the matter with the Metropolitan. Public defender.
The order is based on Pinals’ recommendations to the public hospital and attorneys.
The timelines for treating and recovering patients are:
- For patients facing only a misdemeanor charge, the hospital will have up to 90 days or the maximum sentence allowed, whichever is shorter.
- For patients facing a crime, the public hospital will have up to six months, or up to a year if it is a violent crime.
Deadlines to help more patients
Aided and assisted patients make up the bulk of Oregon State Hospital’s population. The state hospital currently has 409 patients served and supported and a total capacity of 705 beds between its main hub in Salem and a satellite campus in Junction City.
Historically, most aided and assisted patients have completed their treatment within six months. But outliers, sometimes processed for a year or more, consume resources, according to Pinals’ report.
Since 2012, 15.5% of patients receiving help and assistance stayed longer than six months, according to the report. This represents 909 patients who accounted for 321,375 days of hospitalization over a decade. If a six-month limit had been in place during that time, the hospital would have had the equivalent of about 40 more beds each year for more patients, the report said.
Meanwhile, as people wait for treatment in prisons, they are often in solitary confinement despite being presumed innocent, Cooper said, calling the additional wait times a “disastrous” situation.
“Prisons try really hard, but they’re designed to punish, not to treat,” Cooper said.
Under the new order, when the state hospital fails to restore the patient’s competence within the specified time, it will send the patient back to their county. Counties will receive 30 days notice to schedule patient placement.
The Oregon Health Authority, which runs the state hospital, declined to make anyone available for an interview with The Lund Report.
In an email, agency spokeswoman Amber Shoebridge said the roughly 100 discharge-eligible patients will be discharged to their counties on a staggered basis over the next six months. Community mental health providers in counties will determine where they go.
“I look forward to working with our community partners to find the best solutions for people returning to the community,” OHA Director Patrick Allen said in a prepared statement.
A 20 year struggle
The original 2002 order, which required Oregon State Hospital to admit patients within seven days of receiving the court order, was called the Mink decision.
Disability Rights Oregon, which filed the original lawsuit as the Oregon Advocacy Center, went to court again in 2019 when the state failed to comply with the ruling. In June of that year, the federal court ordered the state to comply with the Mink ruling within 90 days.
The state achieved that goal, but asked for leeway in court when COVID-19 hit in 2020, saying it needed flexibility to prevent the virus from spreading. Disability Rights Oregon opposed it on constitutional grounds. In 2021, the state and Disability Rights Oregon negotiated an interim settlement agreement, which resulted in Pinals’ recommendations and ongoing reports.
The final stage is promising, but not the last, Cooper said. Pinals’ report makes other recommendations, such as more investment in community mental health programs and alternatives to the public hospital.
“I think it’s reasonable to expect that it will take a lot of action and a lot of money to fix this problem,” Cooper said. “Ultimately, I strongly believe in and support Dr. Pinals’ report.”
Disgruntled county prosecutors
The case has drawn the attention of counties that run the criminal justice systems and prisons that flow through patients helping and assisting.
Three district attorneys – Clackamas County DA John Wentworth, Marion County DA Paige Clarkson and Washington County DA Kevin Barton – have teamed up to ask the judge in this case to let them appear in federal court on the matter, given the impacts for Oregon communities.
“Any legal remedy will directly impact the prosecution’s docket, and the prosecution’s docket will in turn impact the effectiveness of any legal remedy,” their motion said.
In a separate statement, district attorneys said they are concerned that the reduced processing times for defendants could lead to their premature release from public hospitals.
In an interview, Washington County District Attorney Kevin Barton said the changes at the state hospital are creating uncertainty for counties and prosecutors. For example, Barton said, he doesn’t know how many of the roughly 100 people scheduled for release statewide will return to Washington County or who those people are.
“One of my main criticisms is the lack of transparency, coordination and information to enable security, planning and smooth deployment,” he said. “A lot of people are left in the dark.”
The main concern is cases involving people facing serious charges of rape, murder, sodomy and sexual abuse, Barton said.
“They are the ones who keep me up at night,” he said.
His main concern is where people will go, especially if they face a pending violent crime charge, Barton said, adding that the system must also remember the rights of victims of crime.
“How do you deal with them in the community in an unsecured facility and make sure the victim is safe and the people around them are safe. How do you protect people? ” He asked.
Barton said he agreed with plaintiffs that defendants should not endure long waits in jail without timely admission to the state hospital. “I see this as a complete failure of leadership,” Barton said. He pointed to a letter from the Oregon Health Authority sent to officials regarding changes to treatment durations. The letter says the hospital has seen an “unprecedented increase” in admissions since 2018.
“They had a lot of time,” Barton said. “They’ve known that for years now.”
Barton said the hospital needed to increase beds and staff to address the issue.
At this point, it’s unclear whether the prosecutors’ input will change how the judge deploys the plan. The federal judge allowed the outside expert’s recommendations to begin, but also granted a request from the counties to provide the court with legal information on the matter in a brief.
That brief must be filed by September 28, and then plaintiffs and defendants in the case can respond by October 11.
Editor’s note: This story was produced by The Lund Report, an independent, not-for-profit publication focused on health news in the North West. You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.