Oregon hospitals suing state for 'abandoning' civilly committed patients on waitlist

When someone who’s civilly committed stays in a hospital for months while waiting to go to the Oregon State Hospital or another long-term facility, that patient and their caregivers both suffer, a PeaceHealth executive said.

PeaceHealth and other acute-care hospitals are designed to treat and stabilize patients in days, said Alicia Beymer, the chief administrative at PeaceHealth Sacred Heart University District and Cottage Grove Community Medical Center.

But multiple patients are staying for six to nine months, Beymer said, as they sit on the waitlist for Oregon State Hospital, which has faced capacity issues for years.

PeaceHealth has joined Legacy Health and Providence Health & Services to allege Oregon Health Authority has forced acute-care hospitals to provide long-term care for individuals who are civilly committed even though those facilities are not equipped to provide extended treatment.

The three health systems on Wednesday filed a civil lawsuit in U.S. District Court, arguing the state has violated the civil rights of Oregonians with severe mental illness and is taking hospitals' property without just compensation.

Long stays make it “increasingly challenging to provide care for individuals,” Beymer said, and she knows from conversations with some of those patients that it’s difficult on them.

“They have told me, ‘I want to find a place to call home,’” she said.

PeaceHealth and the other systems are trying to do the right thing for patients, Beymer said, which “really starts with advocating for them to receive the right level of care in the appropriate setting.”

The hospital systems argue the state has known about the problem for years but "done nothing to fix it."

"Instead, OHA has abdicated all responsibility for civilly committed individuals and done nothing to increase capacity to ensure these individuals have access to appropriate long-term placements," the legal complaint reads.

When the state leaves civilly committed patients in community hospitals indefinitely, those patients don't "meaningfully recover because they are denied access to long-term treatment," the complaint adds, and that "failure to provide the appropriate level of treatment violates patients’ constitutional rights."

A spokesperson for the Oregon Department of Justice, which represents state departments in lawsuits, said Wednesday afternoon that the agency is reviewing the complaint.

3 years of capacity issues

Under Oregon law, the state is required to serve three populations of mentally ill persons:

• Civilly committed individuals

• Those found guilty except for insanity in a criminal case (sometimes called GEI)

• Individuals who are arrested but not able to participate in their defense because of a mental illness (sometimes called aid-and-assist)

The lawsuit focuses on protecting individuals after officials pursue civil commitment, a legal process in which a judge can make a person the responsibility of the Oregon Health Authority, which operates the Oregon State Hospital and oversees Oregon’s mental health system.

But with none of the state hospital's 705 beds free and none available in community settings, civilly committed patients often end up at hospitals.

The Oregon State Hospital has been facing capacity challenges since 2019, when the wait times for admitting aid-and-assist patients began increasing beyond the federal requirement of seven days.

In recent years, the Oregon State Hospital has admitted fewer and fewer patients who are civilly committed, the hospital systems say, instead shifting admission priorities to focus “almost entirely on the aid-and-assist and GEI populations.”

So far this year, there were fewer than 20 civil commitment patients per month in the state facility, a press release says, leaving “hundreds stuck in community hospitals.”

While the other populations within the Oregon State Hospital have the right to be removed from jail for meaningful treatment, the hospital systems add, the state needs to achieve that “without abandoning civilly committed patients.”

More than 500 individuals with severe mental illnesses are civilly committed to OHA for treatment each year, the release stated. The community hospitals estimate that annually, hundreds of patients who are being kept in acute care hospitals should actually be in specialized long-term care facilities such as the Oregon State Hospital.

That means those patients can’t get the care they need, the hospitals said.

“It leads to a situation in which vulnerable Oregonians are denied the care that justifies their commitment in the first place and that they are constitutionally entitled to,” said Dr. Robin Henderson, chief executive of behavioral health for Providence in Oregon, in a statement.

‘Warehousing’ in restrictive, locked environments

Because community hospitals are designed for short-term treatment, it becomes “increasingly challenging to meet individual needs,” Beymer said.

That can be something as simple as getting a patient a haircut or as complex as helping them develop life skills they’ll need upon release, she said.

It’s also hard on the patients because they’re in a “very restricted environment,” Beymer said.

PeaceHealth and the other health systems argue the state is “warehousing” patients in community hospitals for months instead of transferring them to an appropriate facility, leaving them in a place that isn’t “equipped, staffed or designed to provide long-term mental health treatment for civilly committed individuals.”

The legal complaint adds the state doesn't "make even minimal efforts to locate appropriate long-term treatment facilities for civilly committed."

Behavioral health units in community hospitals are “highly restrictive, locked environments” where patients can leave only for a short time, if at all, a press release adds.

Security, private rooms, kitchens, physical exercise and other things patients need for successful treatment also aren’t feasible at those hospitals, the hospital systems said.

That means patients don’t receive needed care and, in many cases, slide back to unstable conditions, the hospital systems argue.

Watching that happen is distressing for staff, Beymer said.

The hospital systems committed to being compassionate while providing behavioral and mental health treatment, said Melissa Eckstein, president of Legacy’s Unity Center for Behavioral Health.

“We work hard to provide the best care possible, but acute care hospitals are simply not designed to provide long-term care,” Eckstein said in a statement.

Local lawsuits came first

Before turning to a federal lawsuit, the health systems have been filing individual lawsuits in local courts.

In six months, systems filed four cases in four different counties — Clackamas, Lane, Marion and Multnomah.

A Lane County judge in February ruled in favor of PeaceHealth, which had contested the placement of a patient in its Eugene hospital’s psychiatric unit, Willamette Week reported in June as part of a story on growing tensions between hospitals and the state.

The judge cited the Oregon Health Authority’s “deliberate failure to make any placement decision,” the publication reported.

That case brought awareness to the issue, Beymer said, but didn’t fix the problem.

“Unfortunately, we’re still in the same spot of trying to be able to transfer patients up to the Oregon State Hospital in a timely manner,” she said.

The hospitals aren’t seeking compensatory damages, but rather for a judge to declare OHA:

• Is violating the constitution through practices that "force community hospitals to house and treat civilly committed individuals indefinitely," effectively seizing hospital property

• Is violating the state's "legal duty to provide civilly committed individuals meaningful treatment during their 180-day commitment and place them in the facility best able to treat them or a suitable facility at the time of commitment"

The hospitals also ask for attorney fees but say change is their greater goal.

“Through the lawsuit, the hospital systems hope to ensure that OHA accepts its legally required responsibility to provide mental health services to civilly committed individuals,” the press release reads.

Hospitals v OHA by Megan Banta on Scribd

Contact city government watchdog Megan Banta at mbanta@registerguard.com. Follow her on Twitter @MeganBanta_1.

This article originally appeared on Register-Guard: Hospitals claim Oregon is 'abandoning' civilly committed patients