Advocates report dire conditions at Oregon State Hospital

Oregon State Hospital is in “disarray” with overworked employees, patient transfers against recommendations and complaints of untrained staff. This is according to Disability Rights Oregon, which performed an unsupervised walkthrough using Oregon’s Protection and Advocacy System. The group wrote a letter to Gov. Kate Brown on what they saw and the “lack of urgency” from OSH administration. Emily Cooper is the legal director of DRO and joins us to share what she saw on this walkthrough.

This transcript was created by a computer and edited by a volunteer.

DAVE MILLER:  The Oregon State Hospital is in disarray. Staff are overworked, patients are being transferred against recommendations and state leadership is not showing urgency in dealing with the Hospital’s many problems. All of that is according to Disability Rights Oregon which recently performed an unsupervised inspection of the Hospital and then wrote a pretty scathing letter to Governor Kate Brown and the Oregon Health Authority. Emily Cooper did this walkthrough. She is the Legal Director of Disability Rights Oregon and joins us now to talk about what she saw. What prompted this most recent visit?

EMILY COOPER:   We have maintained a presence at the State Hospital for years. But we’ve maintained that through the pandemic and increased our visits because of the deployment of the National Guard. Not once but twice we’ve had untrained National Guardspeople going into the state psychiatric hospital, which has us very concerned.

MILLER:  We’ve talked about this before, but it’s been a little while. Can you just remind us what kind of authority the federal government gives your organization to do these walkthroughs, these official inspections?

COOPER:  For over 40 years, Disability Rights Oregon has been the designated protection and advocacy agency for Oregon. In short, we’re the watchdog for any person with a disability here in Oregon. And part of our federal authority gives us permission to have unaccompanied access to any place that a person with a disability in Oregon resides or is being kept.

MILLER:  And that means you can talk without having minders and you could talk to staff. Can you also talk to patients?

COOPER:  Yes. The purpose for unaccompanied access is so that we can have unfettered access to both patients and staff so that we can determine if there are credible abuse, neglect allegations for other issues that we want to try to mitigate broadly at the heart.

MILLER:  How is the Hospital different during the pandemic than it was in the kinds of visits you would do before?

COOPER:  When I was there in June, I was stunned. In my previous visits to the state hospital, what you saw was people sent there for treatment and so they have a unit where they live, they sleep and sometimes eat, but they get to spend the better part of their day down at the treatment mall. And that treatment is individualized and it’s based on what they need. But it can be a substance abuse treatment, psycho educational groups, groups on symptom management, and legal skills for folks who are sent there for competency restoration to stand trial. And you also saw patients out on the ground walking around. You saw patients visiting with family.

And we didn’t see any of that. When I was there in June patients were essentially locked down in their units with little to no access to treatment, little to no access to the outside or to their family. And it was alarming. This was days before the National Guard was to be deployed.

MILLER:  What exactly are the staffing issues at the hospital? I mean this is directly connected to the National Guard being brought in at two different times to help out?

COOPER:  There’s been a staffing crisis at the Hospital since at least last year. And that was part of the reason we sent the firm letter that we did. This is not a new problem. And the solution cannot be that we’re the only state in the union that has sent untrained non clinical National Guardspeople into our state psychiatric hospital. That can’t be the plan. That can’t be the only option the state’s considering to address the staffing crisis.

MILLER:  I’m glad you brought up other states.  I’m curious how other states are dealing with their forensic hospitals or state psychiatric hospitals? Are these the kinds of problems broadly that Oregon is seeing? Are they being seen in other states? Even if the National Guard is not the solution in other states?

COOPER:  No. In the conversations I’ve had with the legal directors in other states, they are seeing staffing issues, but not to the level that we have here in Oregon. So for example, in Michigan their waitlist for what we call dialysis patients (people waiting for competency restoration) is like five or six people.   And they have the clinical staffing at their state psychiatric hospital to timely admit those people and treat them. And so one solution could be that our state looks to the states that have figured this out and sees what they’re doing.

And based on my understanding, what those states are doing are things like increasing wages, making conditions of work better. What we’ve heard from the clinicians at the State Hospital here is that the conditions at the Hospital are just really horrible. You have patients being transferred to units when their own clinical teams say they shouldn’t. You have people being discharged home without a good plan. And so it’s one of those times when, as advocates, we may be alarmed. But when the clinic clinicians who are treating these patients are also alarmed, we know we’re in a real crisis.

MILLER:  This is an important point because it’s not like the staffing shortage is a problem in and of itself. It’s your documenting the ways in which the staffing shortage is directly impacting, in a negative way, patient care right?

COOPER:  That’s right. And so, as I mentioned earlier, patients are sent to the Hospital for treatment. And if they’re not able to get off their essentially residential units to go get treatment or the staff that are there like the National Guard aren’t treating clinicians then what we worry about is it’s just people with mental illness being warehoused and not getting the treatment that the court has ordered them to get.

MILLER:  What are National Guard personnel actually doing at the hospital?

COOPER:  Based on our very several requests for information, it varies. Part of what we worry about is we don’t really know. It could be transporting patients who want to go out to the grounds when they’re able to go out and that may be a valid way to use the National Guardsperson. But we also know they’re doing groups and they’re having one on one interactions with patients. And the worry I have with that is these are not clinically trained people. These are National Guardsmen and women. And while very well meaning and stepping up to the plate to do their job, they’re being asked to do beyond their job.

MILLER:  Maybe this is not the most important point here. But do you know if the National Guardmembers are wearing their uniforms when they’re in the mental hospital? And if so, what effect could that have on the patients at the Hospital who are there, as you said, and it’s worth repeating, are there for treatment?

COOPER:   We pushed back hard in June on that and we were able to get the state to agree to not have the National Guardsmen and women in uniform or to have weapons. However, alarmingly, we learned that in addition to not being clinicians and not being appropriately trained, half of the National Guards members weren’t even vaccinated. So you have unvaccinated people going into a congregate care facility with people who are vulnerable and that was appalling.

MILLER: And they have been able to do that because even though they are in a healthcare setting, they themselves, are not healthcare providers, so they are not subject to the mandate?

COOPER:  Well, the mandate doesn’t go into place for another six days. And so I think, that’s the situation, where they were able to bring in unvaccinated National Guards members. But again, we thought it presented an untenable risk to patients.

MILLER:  You did note in the letter to the Governor and Patrick Allen, the head of the Health Authority that earlier, when you had brought up staffing issues with those same state leaders, you were told you were assured that those staffing shortages would be handled and that more people were hired, they were on the way. In fact not only did that not happen that more people weren’t hired, but more people actually resigned. How do you explain that?

COOPER:  You know, it’s hard to understand because in addition to everything you just said, we also know that the state has gotten millions of dollars to open two additional units at the Junction City campus. And we have promises that those units would open on October first. And instead of those units being open on October first, it’s been pushed back to hopefully November first. And so the state Hospital can’t maintain its current staffing, much less expand its capacity to admit the people that are languishing in jail for their services. And in terms of why they can’t hire and retain staff, we don’t know. That’s part of the reason we sent this letter is that we’ve been in the dark. It’s been completely opaque about what steps they’re taking.

And so we’ve asked for increased transparency. We’ve asked the state to consider the staffing crisis a true emergency and that they implement a robust hiring and retention plan that includes when the deployment of the National Guard will end. And we haven’t gotten a response to this letter. We did have a meeting set up last week that was cancelled at the last minute. And so we still do not have a clear answer as to why the staffing crisis is as bad as it is and what the state’s plan is to fix it.

MILLER:  Has that meeting been rescheduled?

COOPER:  No.

MILLER:  One of the themes that comes up in, quote after quote, from staff in the letter you sent to state officials is about transfers both within the Hospital from one ward or one part of the building to another and also people being sent outside the state hospital to Junction City or back again and just being moved around. It seems often, you note, with no warning to patients or very little warning and sometimes, against the recommendations of doctors or hospital staff. What did you learn about the reasons for these many transfers?

COOPER:  Based on the information that we’ve gotten from the clinicians, it’s to make numbers look better. According to one clinician, moving patients back and forth between Junction City campus and Salem makes the numbers of admission look better because it looks like there are more admissions to the State Hospital that are timely. And so the numbers then look better from a public appearance perspective. Again, this is just based on the input of a clinician. But that’s our understanding of one of the reasons why these transfers are happening.

MILLER:  You also feel that a lot of specific complaints for people who were sent to the hospital because they were unable to aid and assist in their own defense in trials. Can you give us a sense, and you touched on this briefly, but this has been an ongoing, serious issue that people have flagged and that courts have flagged for, I was gonna say for months, but I think literally for years now, what exactly is happening with these aid and assist patients?

COOPER:  They’re languishing in jail. There are dozens of people being warehoused most often in solitary confinement or punitive conditions in jail because, as many listeners may know, jails are designed to punish. That’s their job. When people break the law and they go to jail, they store people who are dangerous and it’s for punishment purposes. Aid and assist patients have only been charged. There’s been no conviction. If that in fact, the only thing that’s been determined by a court is that they’re so ill, they can’t aid and assist in their own defense. And because they’re so ill, they’ve been court ordered to receive mental health competency services.

And the other thing that’s really important to think about is generally about half of the aid and assist referral population are people who are houseless, people who are chronically ill and their crime is to have a disability. And so it keeps me up at night knowing how many people are in jail in harmful conditions where they could get hurt because they are waiting, not just days, not just weeks, but months for admission to the State Hospital so they can get the treatment they need to get better.

MILLER:  You know, your letter and the focus of this conversation today is obviously about the State Hospital, It’s about this one facility in Salem. But in the bigger picture, how much of what we’re talking about is actually about a statewide deficiency, lack of mental health resources and treatment options as opposed to the conditions at one particular hospital?

COOPER:  It’s a fantastic question and I will say this, having been to the State Hospital and met the patients, met the staff. They are working hard.  But you cannot put the burden of an entire system of care onto one entity, one Hospital. What we need to look at and what is imperative in our state and every state is that we look at why these individuals go through the system to begin with.

These are people with chronic, sometimes severe, persistent mental illness, traumatic brain injury, intellectual or developmental disabilities. These are people who can and often are safely treated in their own homes and communities. That’s the end answer to this, We can’t build our way out of this. We can’t create another campus of Oregon State Hospital. That’s not going to solve the problem. The problem is, unlike the medical system, the mental health system has not gotten out ahead of the curve and provided the continuum of services so people can get the services and the treatment they need to stay home to recover and have the supports they need to be safe.

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