Disability Rights Oregon staff have found Oregon State Hospital in dire condition and heard repeated warnings from hospital staff and providers about a facility stretched to the breaking point that fails to care for patients.
The advocacy group found worsening problems at the hospital, the state’s principal secure mental health facility, after touring it without an escort, using its federal authority through Oregon’s Protection and Advocacy System. Disability Rights Oregon is the state’s federally designated mental health care watchdog. The group, after its tour and staff interviews, sent a letter on Monday to Gov. Kate Brown and Oregon Health Authority Director Patrick Allen.
The letter, obtained by The Lund Report, warns of shortcomings across the board, including exhausted, short-handed and overworked staff, patient transfers that contradict provider recommendations and management with no sense of urgency to address the crisis. The state-run hospital, overseen by the Oregon Health Authority, provides residential psychiatric care for Oregon’s most severely ill mental health patients. Usually, it has about 500 patients.
“During our investigation into the conditions and treatment of people with mental illness during the pandemic, staff and providers paint a picture of a State Hospital in complete disarray and an agency that is unwilling or unable to confront just how bad things have gotten,” wrote Jake Cornett, executive director of Disability Rights Oregon. “OSH staff report a lack of urgency from OSH administration and OHA in developing a hiring/retention strategy.”
In recent weeks, news media have reported dire staff shortages and resignations at the facility -- as there have been at many other health care facilities pressured by the COVID-19 pandemic.
Charles Boyle, a spokesman for the governor, confirmed the office received it but had no further comment.
Oregon State Hospital has struggled to maintain staffing. Oregon National Guard members have been deployed twice this year to the hospital in response to staffing shortages. The state hospital had a $17,800-a-day contract with the Oregon Military Department earlier this year so 30 Guard members could serve meals and do other work that doesn’t require medical certification, Salem Reporter reported.
Disability Rights Oregon warned that the longstanding staff shortage will make matters worse for patients.
“This staffing crisis within the hospital, which the Oregon Health Authority (OHA) has been aware of for the better part of a year, is likely leading to longer stays and worse quality of care for the patients,” the group wrote. “The longer these conditions persist, the less effective the hospital is in performing its duties, and the greater the negative effect is on patients, staff, and the larger behavioral health system that relies on the State Hospital to treat its highest-acuity patients.”
Health care experts for many months have warned that the slow pace at which the hospital accepts new patients has meant that severely mentally ill patients have been left in jails, hospital emergency rooms, or on the streets.
In its letter, Disability Rights Oregon said health authority officials had “expressed confidence” earlier this year that the hospital would increase staffing levels and be able to open two new units this fall.
“Instead, large numbers of staff resignations took place, and OHA did not recruit adequate staff to maintain even its existing level of service without National Guard assistance,” the group wrote.
Patients Not Getting Treatment
Disability Rights Oregon has received complaints from staff who say that patients are not getting the treatment or other services they need.
The group’s letter draws directly from staff statements about conditions.
In one complaint, a staffer said there is a “lack of treatment opportunities for patients, even when clinical needs have been identified” and “many programs are no longer offering substance abuse treatment.” Some units don’t have staff to provide patients with legal skills, even when a patient is sent to the hospital to restore their competency to stand trial.
Another complaint said patient transfers to units are made “without any regard” for individual patient needs or the expertise of staff and providers on the units. Units at the hospital can vary based on the acuity and needs of individual patients.
Chaotic Patient Transfers
The staff complaints also center around protocols -- or the lack thereof -- for patient transfers among units or between the Salem campus and the Junction City branch of the Oregon State Hospital.
For example, one staffer said they “still don’t know what the criteria is” to move a patient to the COVID-19 unit and quarantine patients in a unit that has a suspected COVID-19 outbreak.
In another instance, a staffer said a program director told the Salem unit to find patients to transfer to Junction City by the end of the week.
“We were told not to tell patients until right before it was time to move them,” a staffer said in the complaint. “Everyone was so upset (staff and patients).”
A complaint also reported that patients are transferred to different units around the hospital against the recommendations of their treating providers, sometimes with less than 24 hours notice to prepare the patients “even when they have long-standing relationships with their current teams and are making gains in treatment.”
There’s also no clear plan in place for when families can visit patients, a restriction that has been in place for more than 18 months since the pandemic started, the letter said.
‘Not Our Monkey’
Disability Rights Oregon also cited complaints about the treatment of patients in so-called “aid and assist” cases. Those patients are assigned to Oregon State Hospital so they can recover and aid in their defense as defendants in pending criminal cases. Courts assign defendants to the hospital after judges determine they cannot stand trial due to their poor mental condition.
Complaints reported a “complete absence of any training” for clinicians who don’t have experience in the program.
There also is inadequate discharge planning, including for patients with high-risk medical issues, a staffer reported. That complaint reported that staff were told discharge planning for those individuals is “not our monkey, not our circus.” In discharge planning, staff are supposed to ensure there is support for the patient once they leave the hospital.
Aid-and-assist cases have long dogged the state hospital and led to a federal lawsuit after it was failing to admit patients within the required seven-day time frame. That meant patients languished in county jails instead of receiving prompt treatment at the hospital.
The court-ordered seven-day requirement was loosened during the pandemic, but a federal judge last week gave the state hospital until Dec. 3 to hasten admissions and boost capacity so the system can quickly admit patients who are awaiting trial.
Disability Rights Oregon warned that the hospital’s lack of action could have a ripple impact and harm jails too.
“If OSH continues to lose staff and is not able to increase its capacity to meet the needs of Oregonians with serious mental illness—or worse, if the hospital is forced to reduce capacity—you risk presiding over a system-wide breakdown as jails fill with people unable to aid and assist in their defense but with nowhere to go to receive appropriate treatment,” the group wrote. “Between conditions at OSH and those we have documented at some Oregon jails—it is plainly clear the system is teetering on the edge of this breakdown.”
Disability Rights Oregon asks the state to take several steps, including more transparency about patient transfers and COVID-19 policies.
The group also wants the state to treat the staffing shortage “as the emergency that it is” and immediately put in place a hiring and retention plan to maintain current staffing in the short term and increase it in the long-term so National Guard troops aren’t necessary.
The group also wants “clear criteria” for when National Guard personnel will leave the state hospital, with a plan and timeline.
Disability Rights Oregon also is pushing for emergency housing vouchers for patients who no longer need hospital-level care and are waiting to return to their hometown.
Given the lack of resources for aid-and-assist patients, the group also is asking the state and the hospital to work with judges, prosecutors and law enforcement to seek the dismissal of low-level charges to free up resources for more serious cases.