Oregon State Hospital, Jan. 27, 2022.
Kristyna Wentz-Graff / OPB
Last week, a federal judge ruled that time limits for how long someone charged with a crime can stay at Oregon State Hospital will continue. This means the September order requiring the psychiatric facility to release patients facing misdemeanor charges in 90 days, felony charges in six months and more violent felonies within a year, will remain.
The Oregon State Hospital also received news that it passed its federal inspection. However, investigators noted that the facility still faces issues over food safety, medication storage and hygiene. Ben Botkin is the criminal justice and health reporter for the Capital Chronicle. He joins us to share what this ruling means for the future of the state and the details of the inspection.
The following transcript was created by a computer and edited by a volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Last week, a federal judge ruled that the time limits he has imposed limiting the lengths of stay for many patients at the Oregon State Hospital will continue. This means that patients at the hospital cannot stay longer than 90 days, six months, or a year, depending on the severity of the criminal charges they’re facing. The judge made this ruling over the objections of a lot of folks: local prosecutors, sheriffs and hospitals. Meanwhile, the state hospital also received news that it passed a recent federal inspection. Investigators did note issues with hygiene and food safety.
Ben Botkin has been covering these stories as the criminal justice and health reporter for the Capital Chronicle. He joins us now for an update on the state’s only state-run psychiatric facility. Ben, welcome back.
Ben Botkin: Thank you.
Miller: To understand what’s happening now, we should probably go a little bit back into recent history. Can you remind us what federal judge, Michael Mosman, ordered back in September?
Botkin: Yes. Back in September, Judge Mosman ordered that the state hospital needs to have expedited, quick timeframes and deadlines for when it treats and discharges patients. These are the patients who have been found to need mental health care so that they can return to court and face criminal charges. Those time frames, which you already mentioned, are something the state hospital has to abide by because you’ve got a backlog of people in jail waiting months to get to the state hospital and get the treatment they need so that they can then face charges.
Miller: These so-called ‘aid and assist’ patients, they’re supposed to get treatment at the hospital so that they can aid and assist in their own defense. They can actually take part in trials, constitutionally. How long had some of them been staying at the state hospital?
Botkin: Actually, the interesting thing is that most of them are already discharged on the time frames of the judge’s order. However, you do have outlying cases where they’re in the state hospital for many months, if not even close to a year or longer in some of the more extreme cases.
Miller: So this is the background for the judge’s order, based on an agreement between the Oregon Health Authority and disability rights groups. What has the result been? What’s been happening to these patients when they’re being released?
Botkin: It’s a really interesting story just because it’s been going on for a couple of decades now. What you now have is that the outside expert originally set a goal of, by March, you need to be discharging patients from jails to the state hospital within seven days. The expert now says that that’s not going to happen by March because you have an increase of referrals from the court system to the state hospital. It’s really an interesting situation where the state hospital is treading water because, on one hand, they are discharging patients through the system quicker than they were, say, a year ago, but they’re also getting more referrals from the court system that’s a similar number. So really, this is a situation you’re going to see play out for another year or so.
Miller: What have you heard from either people in the criminal justice world? I’m thinking about, say, sheriffs who run local county lockups or district attorneys. What have they said about the current situation?
Botkin: They’ll say a couple things. One is, they agree with the disability rights advocates that you do not want people sitting in jail waiting for mental health care. On the other hand, there’s also concern that when you put a deadline for how long the state hospital has to treat people before they’re returned to communities, they then have public safety concerns about what will that mean if people aren’t ready yet, where will we put them? So, the thing to keep in mind here is really that, beyond the state hospital, you have all these other parts of the mental health system, and how can they then treat patients after they leave the state hospital.
Miller: That also gets us to local hospitals. What role do they play in this really complicated situation?
Botkin: Keep in mind, at the state hospital you don’t just have the aid and assist cases in the court system, but you also have civil commitments. These are the people who are found to be a danger to themselves or others. They need to be somewhere, but they don’t face criminal charges. It used to be that the state hospital would take more civil commitment cases, but that’s increasingly rare now because of the court orders where they have to take aid and assist cases instead. Those patients are now being increasingly sent to private hospitals, who have asked the federal judge in this case, ‘Hey, we want to have a say in how the state hospital decisions are made because we’re taking civil commitment cases, and they should really be at the state hospital because our hospitals aren’t set up to care for them in the same way that the state hospital is.’
Miller: So these were the variety of arguments that were made to this federal judge – different people saying, ‘Hey, we know you had good intentions here, but this is not working in a variety of ways.’ How did the judge explain his decision to keep his order from September in place?
Botkin: Really, the crux of the decision is: ‘Hey, we need to give this time to work. We need to see where this takes us before we start taking additional action.’ So really the order confirms, hey, we’re going to keep doing what we’re doing and give the system a chance to make changes.
Miller: I want to turn to the other bit of news that you’ve been reporting on, which is the results of the latest federal inspection of the state hospital campuses, both in Salem and in Junction City. What was the reason for this inspection?
Botkin: This really dates back to an issue that happened in December of 2021. You had a group of patients who were out on an outing with staff outside the Junction City facility. One of those patients managed to escape and was missing for a couple of days. That was then reported to federal regulators who then came in, did an inspection and found additional issues and told the state hospital, ‘You need to address a number of problems related to patient safety and care, the quality of care.’ That then led to this follow-up inspection, which found that they were in substantial compliance but, like a lot of inspections show, still have issues that they need to work on.
Miller: Can you give us a sense for the issues that were identified in this follow-up inspection?
Botkin: Sure. Some of these issues were just basic cleanliness and safety related things. There was medication that was not labeled properly or labeled at all. You had food containers that weren’t labeled with the expiration dates. You had cases of cleanliness, where patient rooms weren’t as clean as they should be. You also had paperwork issues, where patient grievances were not followed up on or documented properly. So there was a mix of things.
Miller: How did the hospital respond to the results of this latest inspection?
Botkin: They’ve made different changes to documentation requirements, labeling requirements for food and medication, and say that they’ve taken steps to address those.
Miller: Finally, Oregon’s legislative session is now underway. What might lawmakers do with respect to the state hospital?
Botkin: Keep in mind the state hospital is part of a bigger system of mental health care. Another component of that is community mental health programs, which can treat patients before and after they’re in the state hospital or even treat patients who don’t need the state hospital. So you’re going to see more investments, more funding put towards community mental health programs. You’re also going to see more efforts to put up residential treatment facilities in the state. These can be facilities usually with up to 16 beds to treat people who may not need state hospital level care, but maybe they’ve left the state hospital and they need somewhere to stay. You’re going to see this play out over the next few months, as far as how much money, what the solutions are and how can you actually help someone to the point where they’re prevented from needing the state hospital in the first place.
Miller: Ben Botkin, thanks very much.
Botkin: Thank you.
Miller: Ben Botkin is the criminal justice and health reporter for the Capital Chronicle. He joined us to share with us some recent news about the Oregon State Hospital.
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