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Feds find unsafe conditions at Oregon State Hospital — again

It’s the second time in two years that the federal government has found safety problems at the psychiatric facility following a patient’s escape
Oregon State Hospital in Salem. | JESSICA FLOUM/THE LUND REPORT
September 16, 2023

For the second time in two years, a patient’s escape has been followed by a federal inspection finding unsafe conditions at the state’s main psychiatric facility, the Oregon State Hospital.

A survey on behalf of the federal government found that conditions in the state facility are placing patients in “immediate jeopardy,” the Oregon Health Authority disclosed after 6 p.m. on Friday.

The warning is of the most serious kind issued by the Centers for Medicaid and Medicare Services, which says it “represents the most severe and egregious threat to the health and safety of recipients, as well as carries the most serious sanctions.”

The state was given 23 days to fix the issue or face decertification from federal funding, according to the state.

In a text message Friday evening, an agency spokesperson declined to release the “immediate jeopardy” warning, saying they did not have it.

The state press release did not disclose whether the inspection was triggered by the high-profile escape of Christopher Lee Pray, a man authorities characterized as “extremely dangerous” who stole a van while fully shackled on Wednesday, Aug.30. He was taken back into custody two days later. 

According to the state’s release, “the surveyor cited issues related to the secure medical transport of patients, including patients who are currently involved in the criminal justice system or are under the supervision of the state Psychiatric Security Review Board (PSRB).”

A May 25, 2022 inspection of the state hospital blasted the facility for myriad failures such as poor record-keeping and inattenion to safety, while faulting hospital leadership  for, among other things, failing to set “clear expectations for safety” and saying “the hospital failed to ensure that nursing services were organized and managed to ensure the provision of safe and appropriate care to each patient in the hospital.”

In response, the state vowed to fix the problems, but its proposed fixes were deemed “unacceptable,” requiring a beefed-up plan of correction.

On Friday night Oregon Health Authority vowed to correct the problem, issuing a statement attributed to Oregon State Hospital Superintendent Dolly Matteucci: “We are taking steps right away to reduce the possibility that an unauthorized leave could occur during transport and potentially put themselves, staff or members of the community at risk.”