Oregon State Hospital must limit stay times for some patients

Oregon State Hospital must limit hospital stay times for patients receiving treatment to restore their ability to defend themselves against criminal charges, according to a recent federal ruling.

The limits Judge Michael Mosman imposed regard treatment of “aid and assist” patients, individuals charged with a crime who are determined unable to aid in their own defense because of a behavioral health condition.

The ruling requires the hospital to release aid and assist patients with misdemeanor charges within 90 days, felony charges within six months, and “violent felony” or “person-centered” charges within a year.

Patients will be discharged to the county from which they were referred to the hospital. Oregon State Hospital will give counties 30 days' notice to create a plan for care post-release, said Amber Shoebridge, State Hospital communications officer.

Currently, the hospital has about 100 patients ready for discharge under the new restoration limits. These patients will be released to their counties over the next six months.

Disability Rights Oregon, a statewide disability advocacy group that requested this order along with Metropolitan Public Defender, believes the hospital will be able to comply with these new requirements.

“They agree with the request, and they understand to get into compliance, this is a necessary step,” Emily Cooper, legal director of Disability Rights Oregon, said.

3 years of capacity challenges

The 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.

That requirement was established by a 2002 court order, OAC v. Mink, which was aimed to end “the practice of keeping defendants in jail for months awaiting mental healthcare.”

In June 2019, the federal court ordered Oregon State Hospital to comply with the seven-day admission requirement within 90 days. While they were able to meet this deadline initially, the COVID-19 pandemic brought new challenges, and the state requested a “pass” on complying with the Mink Order.

Since the court approved this pass in 2020, Oregon State Hospital has consistently struggled to meet wait time requirements.

This latest ruling was issued after Oregon State Hospital failed to meet August admittance wait time benchmarks set by Dr. Debra Pinals, a neutral expert chosen by the Oregon Health Authority, Metropolitan Public Defender and Disability Rights Oregon to create a plan to address capacity challenges.

The August benchmark required the hospital to admit aid and assist patients within 22 days, on average. But as of Aug. 1, the average wait time was 40 days, Cooper said.

“We were worried that they were not going to meet the future benchmarks as well,” she said.

In Pinals’ second report, submitted in June of this year, she recommends limiting restoration time to free up beds for those waiting in jails to be admitted.

There are currently more than 75 people statewide waiting to be admitted, Shoebridge, the Oregon State Hospital communications officer said.

Since 2012, 15.5% of aid and assist patients stayed in the hospital for longer than six months, Pinals reported. Decreasing that percentage could have made about 40 more beds available each year, serving approximately 130 additional patients.

Of the 706-bed capacity at the state hospital's Salem and Junction City campuses, there were 401 aid and assist patients as of May of this year.

“There are outliers, people who are there for almost two years on misdemeanor charges,” Cooper said.

The goal of aid and assist hospital commits is to restore the ability of a patient to aid in their own legal defense. If after two years they are still unable to do so, they may be classified as “never able.” The new ruling would limit these lengthy stay times.

Never able patients typically face three options: Their charges may be dropped; they may be recommitted to the hospital as a “civil commit;” or they may be committed to a behavioral health facility because they pose a danger to the public.

“You can’t try to convict someone who is too sick to stand in their own defense,” Cooper said.

Investing in community behavioral health

Limiting restoration time not only helps get patients in and out of the hospital faster, but also is aimed at investing in consistent community behavioral health services.

Though some patients need continued care after release from Oregon State Hospital, they often do not need hospital-level care, Cooper said. Instead of continuing to stay at the hospital, their case can be managed within their communities through treatment such as therapeutic services and medication management.

“What we do not want is for the hospital to just become a warehouse,” Cooper said.

Community restoration will be aimed at meeting individual needs by working with a community mental health provider and the county court to determine what level of care is most appropriate for patients who are released.

Disability Rights Oregon and other advocates hope this process will encourage investment in community behavioral health programs and resources, which they say have been lacking in recent years.

Outside of Oregon State Hospital, the care of individuals like aid and assist patients has typically fallen on the criminal justice system, which is not set up to provide the type of treatment these people need for recovery.

These individuals need quality treatment aimed at recovery, not punishment, Cooper said.

“They’re not getting off from being held accountable, what they are getting is the treatment they always needed to be happy, healthy, productive members of society,” she said.

The Oregon Health Authority, which is in charge of State Hospital operations, is in the process of working with the State Hospital and Disability Rights Oregon to come up with a placement plan that keeps the best interest of patients in mind.

“I look forward to working with our community partners to find the best solutions for people returning to the community,” Patrick Allen, OHA director, said in a prepared statement.

Sydney Wyatt covers healthcare inequities in the Mid-Willamette Valley for the Statesman Journal. You can contact her atSWyatt@gannett.com, by phone (503) 399-6613, or on Twitter@sydney_elise44.

The Statesman Journal’s coverage of healthcare inequities is funded in part by the M.J. Murdock Charitable Trust, which seeks to strengthen the cultural, social, educational, and spiritual base of the Pacific Northwest through capacity-building investments in the nonprofit sector.

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This article originally appeared on Salem Statesman Journal: Oregon State Hospital must limit stay times for some patients