The beleaguered Oregon State Hospital plans to hire more nurses to relieve overworked staff and improve care thanks to another $10 million appropriation by the Legislature.
The money will enable the institution to convert 134 temporary nursing positions into permanent jobs and create another 94 positions. Fifty-seven of them will be additional nursing staff, according to Dolly Matteucci, hospital superintendent.
“That gives us the opportunity to increase the number of individuals that are providing direct care and service to our patients,” which she said would strengthen “the heartbeat of that service.”
She is also pleased to add those 134 nurses.
“That is hugely significant for us because in the normal health care market, there is competition,” Matteucci told the Capital Chronicle. “Having a permanent position to offer versus a limited duration is very helpful.”
But the money – and green light for new hires – fell short of what hospital officials said they needed. Last November, the Oregon Health Authority, which oversees the hospital in Salem and its smaller facility in Junction City, asked the Legislature for $33 million for nearly 500 new positions.
The hospital currently employs 2,240.
The November request stemmed from recommendations of a study group made up of Matteucci, union members and managers.
The hospital “has been challenged over the years to provide appropriate staffing levels to achieve a high level of quality care while achieving patient and staff safety,” the agency said in its budget request. “This instability negatively affects the consistency of service delivery, cohesion across care providers and sense of responsibility to team and to the overall hospital.”
During the legislative session in February, Matteucci made a scaled-down pitch for money. This time she suggested an allocation of $20 million – about the same amount the Legislature had put aside last June for the hospital.
But lawmakers decided against allocating the full $20 million to an institution that’s been plagued by problems for decades.
State Rep. Rob Nosse, chair of the House Behavioral Health Committee, said the hospital has to prove that it can bring in the people it needs before the Legislature will give it more money.
“They have to be able to hire those positions,” Nosse said of the 94 new positions, “and get them to stay.”
Matteucci said the hospital is recruiting and has beefed up its hiring strategies. In the meantime, it’s plugged staffing holes in various ways.
It’s asked staff to work overtime shifts, sometimes mandating overtime. It also has hired professionals from staffing agencies. There are currently more than 100 contract personnel working at the hospital and all are getting higher wages than staff.
“OSH had to offer rate increases because they couldn’t get anybody from the regular contractors, due to workforce shortages and the fact that nurses could make much more money from other agencies,” said Aria Seligmann, hospital spokeswoman.
Five staffing contracts, totaling nearly $80 million, are ending Sept. 30.
The agency also has had help from National Guard members, including some with little or no mental health training. Thirty Guard members are still on duty at the hospital, most working directly with patients along with staff mental health technicians. They will be leaving at the end of the month.
“Losing National Guard members means the hospital becomes more dependent on voluntary and mandatory overtime,” Seligmann said.
Decades of problems
The state hospital has had problems for years.
Failing to meet its obligation to admit patients in a timely manner, it’s faced numerous lawsuits from advocates and patients, and has been held in-contempt of court again and again.
It has faced media investigations, like one in October by the Salem Reporter that revealed that during the pandemic administrators were moving some of the least stable patients to units ill-equipped to handle them. That report, and others, have revealed high levels of violence among patients and against staff and a poor retention rate among employees.
“People go there, find out it’s a hard place to work and they quit,” Nosse said.
Two decades ago, the watchdog group, now known as Disability Rights Oregon, sued the hospital over its failure to admit “aid-and-assist” patients who were ordered by a court to be treated in the state hospital so they could stand trial. The U.S. Ninth Circuit Court of Appeals ordered the hospital to admit them within seven days. The hospital has also faced contempt charges from municipal courts for failing to admit aid-and-assist patients as ordered. Administrators argued in those cases that the hospital lacked the staff to comply.
In June 2019, with aid-and-assist patients held in jail while waiting for a hospital opening, the Ninth Circuit ordered the hospital to get in compliance. It did – for a time. But the pandemic hit, the state won a reprieve and admissions slowed.
In a separate case in November 2021, the hospital faced a court order to admit patients judged guilty except for insanity within seven days following a suit by two men who’d been in jail for months.
The two sides reached a truce in December, with the hospital, Disability Rights Oregon and public defenders, the Metropolitan Public Defender Services agreeing to a court-appointed expert to investigate the hospital’s capacity issues and offer solutions so that patients would not be stuck in jail when they need treatment.
“Jails are designed to punish and to confine,” Emily Cooper, legal director of Disability Rights Oregon told the Capital Chronicle. “Their job is not to treat or to create a therapeutic environment. So if you’ve got serious and persistent mental illness and are exhibiting self harm or worrisome behavior, a jail’s only option sometimes is putting you in solitary confinement or stripping you of your clothes and putting you in a suicide smock. It can be very dehumanizing, very isolating, and together it only exacerbates your mental health.”
Last year, 11 mentally ill people in jails in Oregon who were awaiting trial committed suicide, Cooper said. None had been deemed unable to stand trial but Cooper suspects that’s only because they had not yet had a hearing or seen an attorney where that would have been obvious.
“Based on the severity of mental illness that we saw in the records of the 11 people who died, it’s likely that they would have been found not able to assist,” Cooper said.
Patients stuck in hospital
The admissions problem at the state hospitals continues.
At the end of February, 91 aid-and-assist patients were awaiting a bed. The average wait time was 24 days, with the longest wait stretching to 46. Six others deemed guilty except for insanity had waited an average of 17 days for a bed, with the longest wait of 33 days.
Seligmann blamed the delays on a pause in admissions the first week in January due to Covid, saying it had caused “wait times to be longer.”
Last year, the hospital saw a dramatic increase in aid-and-assist orders, from an average of 55 a month in 2020 to 72 in 2021, according Matteucci’s testimony to legislators in February. On a low month, 58 people in jail were ordered to the hospital for treatment; that rose to 100 on the highest month.
The hospital also has a discharge problem.
In mid-February, about 230 patients at the hospital were ready to be moved, mainly to a lower level of care, according to data she presented. Patients end up stuck in the state hospital because Oregon lacks behavioral health facilities in the community. Legislators recently allocated another $100 million for behavioral health residential facilities, which could help with the hospital’s discharge problem.
Matteucci said she was heartened by that $100 allocation.
“I am seeing progress being made across the continuum, and that is wonderful and that makes me hopeful,” Matteucci said.
But the public – and patients – won’t see any improvement in community treatment for months and more likely years. Counties have to apply for the money, buildings need to be constructed and people hired. That’s proven difficult during the pandemic.
Matteucci estimates it will take the hospital 14 months to hire those 94 people. She said they won’t necessarily create more patient openings. All of its 683 beds – which include two new 24-bed units in Junction City – are full.
But more staff will help the hospital provide better care, she said.
That sentiment was echoed by union leaders.
“These investments in staffing at the state hospital will go a long way to help stabilize the workforce so we can provide the best treatment and environment possible,” said David Lynch, president of the American Federation of State, County and Municipal Employees Local 3925. “While there is still a long way to go based on the staffing solutions report, we know that adequate and stable staffing is essential to support the clients we serve and ensure all programs and opportunities are available.”
Matteucci expressed hope that the hospital is now on the right path.
Cooper agreed, pointing out that representatives of her group often meet with hospital officials.
“I sincerely believe that better days are ahead,” Cooper said. “We’re not in court right now. We’re not litigating. We’re really focused on solutions. And that in and of itself is promising.”
Oregon Capital Chronicle is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity.