An independent expert has called on the Oregon State Hospital to step up discharges and admit patients waiting in jail more quickly to ease the continuing backlog of demand for beds.
The hospital is under a federal court order to admit aid-and-assist patients within seven days. They are patients in jail awaiting mental health treatment to enable them to participate in their defense.
The hospital is also under federal orders to correct multiple problems that were identified by an investigation of a patient who escaped late last year. At the same time, hospital officials are trying to fill dozens of jobs to ease a staffing shortage.
The recent recommendations on admissions and discharges came in the last report by an independent expert who was hired as part of an agreement among the health authority, which oversees the hospital; Disability Rights Oregon; a Portland-based public defense firm, Metropolitan Public Defenders Services; and patients. They took the state to court over delays in admitting aid-and-assist patients, who take up just over half of the hospital’s beds. The hospital had a court-approved suspension of the seven-day admission order during the pandemic but that’s been lifted.
The state hospital is near capacity, the report said. With about 750 licensed beds, nearly 710 are taken. They include about 560 on the main Salem campus and 145 in the Junction City campus.
Patients awaiting discharge who end up stuck at the hospital with nowhere to go continue to be a problem while aid-and-assist patients languish for days in jail.
The consultant, Dr. Debra Pinals, a Michigan psychiatrist who’s worked with other states on similar issues, filed her first report in January. The second, released Tuesday, contained multiple recommendations.
The director of the Oregon Health Authority welcomed them.
“I am encouraged by the thoroughness of Dr. Pinals’ work and her careful assessment of the capacity challenges the state faces,” Allen said in a statement. “I believe her recommendations are reasonable and achievable and I look forward to seeing them applied.”
Pinals said the hospital had improved admissions between her two reports but noted that recently wait times and the waitlist were starting to grow.
“The state is to be commended, along with the community, for all efforts to discharge individuals who do not need hospital level of care,” the report said, adding that that trend needs to continue.
As of May 1, nearly 70 aid-and-assist patients awaited admission with an average wait time of 16 days. That marked a drop from late January, when admissions were suspended because of a Covid outbreak.
The report calls on the hospital to better track the hospital census, admissions and discharges. It also called for more transparency, including the development of a public website with court actions, budgets and other documents and data. It said the hospital should develop a patient assessment process that includes people with mental health issues to make placement decisions consistent and transparent.
Many recommendations focused on reducing wait times to get in and out of the hospital. It said to comply with the seven-day order, the hospital should discharge aid-and-assist patients when they are deemed capable. Since the pandemic hit, the hospital has retained these patients for an extra 30 days when they contested their fitness determination.
“This has contributed to extended lengths of stay for many individuals,” the report said.
The report found that since 2012, 15% of aid-and-assist patients had stayed longer than six months at the hospital. If administrators limited these patients to six months, the hospital could serve 130 more patients annually, the report said.
Pinals said state employees should evaluate aid-and-assist patients in jail sooner to identify patients no longer needing hospital care and arrange treatment in the community.
At the same time, the report noted that more than one-third aid-and-assist patients had repeat admissions compared with 10% of those who were civilly or voluntarily committed.
Pinal recommended that the state establish better community support for patients once they’ve been discharged, an idea welcomed by Disability Rights Oregon.
“There is wide agreement that expansion of home and community based services – the full continuum in every county in Oregon – will allow people with disabilities to get the services and support they need to stay in homes,” said Emily Cooper, a lawyer for the organization. “We know that not only will that allow people to be served in their own homes, but it could also disrupt the revolving door of people coming in and out of the criminal justice system.”
Part of that support should consist of a “community navigator” who works with patients who’ve been discharged.
“You can think of it as a super-charged case manager – someone to help you navigate the hoops of obtaining and maintaining a continuum of services,” Cooper said.
The report said the state should have a community navigator pilot program ready by December.
Hospital officials also should also work with community providers to help other patients get discharged, Pinals said.
“The state hospital must be able to make room for new admissions to OSH and to have individuals who no longer need institutional care placed in a less restrictive setting,” the report said.
It called on the state to gradually dial back admission wait times, achieving the seven-day limit by next February.
Between Pinals’ two reports, an aid-and-assist patient died in Washington County jail. Cooper said that death might have been prevented.
“He had been waiting 10 days for admission,” Cooper said. “If the state was able to transport him within seven days, that patient might still be alive.”
He had stopped eating and drinking in jail, and died from malnutrition and dehydration, she said.
Washington County’s health department did not respond to a request for comment by late Wednesday afternoon.
She said Disability Rights Oregon is concerned about the potential harm associated with lingering jail stays. She said the organization will continue to consult with attorneys of patients locked up “to try to mitigate the harm from now until when the state is in compliance.”
The report also urged legislative changes. Pinals’ noted that Oregon statute has no time limits on hospital stays. The hospital keeps patients for the length of time that they’d be sentenced to or for three years, whichever is shorter.
Pinals said the stay for those accused of misdemeanors should be the maximum sentence for their crime or for 90 days, depending on whichever is shorter. Patients charged with felonies should be treated for a maximum of six months unless the offense involves “serious violence.” Those patients should stay longer, but not more than a year, the report said.
Cooper said the report comes at a good time. The health authority recently announced hundreds of millions of dollars in spending for behavioral health and addiction treatment services. Money will be used for workforce training, increased reimbursements to providers, treatment and housing.
“The state has had unprecedented amounts of funding for nearly a year to fund behavioral health – the whole continuum. They now have the resources in the state coffers. They now have a plan on how to prioritize their actions,” Cooper said.
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