Outside investigation reveals ‘utter disarray’ at Oregon State Hospital
Disability Rights Oregon staff found Oregon State Hospital in critical condition and heard repeated warnings from hospital staff and providers about a facility stretched to breaking point that does not support patients .
The advocacy group saw worsening problems at the hospital, the state’s main secure mental health facility, after visiting it unescorted, using its federal authority through the protection and defense system of the ‘Oregon. Disability Rights Oregon is the federally designated mental health care watchdog. The group, after their tour and interviews with staff, sent a letter Monday to Governor Kate Brown and Oregon Health Authority director Patrick Allen.
The letter, obtained by the Lund Report, warns of shortcomings in all areas, including exhausted, understaffed and overworked staff, patient transfers that contradict provider recommendations and management without any sense of d emergency to face the crisis. The public hospital, overseen by the Oregon Health Authority, provides residential psychiatric care for Oregon’s most critically ill mental health patients. Usually there are around 500 patients.
“In our investigation of the conditions and treatment of people with mental illness during the pandemic, staff and providers paint a picture of a state hospital in disarray and an agency unwilling or unwilling. can’t face how bad things have turned out, ”wrote Jake Cornett, executive director of Disability Rights Oregon. “OSH staff report a lack of urgency on the part of the OSH administration and the OHA in developing a hiring / retention strategy. “
In recent weeks, media have reported serious staff shortages and resignations at the facility, as at many other healthcare facilities under pressure from the COVID-19 pandemic.
Charles Boyle, a spokesperson for the governor, confirmed the office had received it but made no further comment. Oregon State Hospital spokeswoman Rebeka Gipson-King did not respond to a request for comment.
Oregon State Hospital has struggled to maintain its workforce. Members of the Oregon National Guard have twice deployed to the hospital this year in response to staff shortages. The State Hospital had a $ 17,800 per day contract with the Oregon Military Department earlier this year so that 30 members of the Guard could serve meals and do other work that does not require a certificate. medical, reported Salem Reporter.
Disability Rights Oregon has warned that the long-standing staff shortage will worsen the situation for patients.
“This staffing crisis within the hospital, of which the Oregon Health Authority (OHA) has been aware for nearly a year, is likely leading to longer stays and poorer quality of care for patients,” he said. writes the group. “The longer these conditions persist, the less efficient the hospital is in carrying out its functions and the greater the negative effect on patients, staff and the broader behavioral health system that relies on the hospital.” ‘State to treat its most urgent patients. “
Health care experts have warned for many months that the hospital’s slowness to accept new patients has meant critically mentally ill patients have been left in prisons, hospital emergency rooms or on the streets. .
In its letter, Disability Rights Oregon said health officials “expressed confidence” earlier this year that the hospital would increase its staff and be able to open two new units this fall.
“Instead, a large number of staff resignations have taken place and the OHA has not recruited adequate staff to maintain even its existing level of service without the help of the National Guard,” the group wrote. .
Patients not receiving treatment
Disability Rights Oregon has received complaints from staff who say patients are not getting the treatment or other services they need.
The group’s letter is directly inspired by staff statements on the conditions.
In a complaint, a staff member said there was “a lack of treatment opportunities for patients, even when clinical needs were identified” and that “many programs no longer offer treatment for the disease. substance addiction”. Some units are not staffed to provide patients with legal skills, even when a patient is sent to the hospital to restore competence to stand trial.
Another complaint stated that transfers of patients to the units are made “without regard” to the individual needs of the patients or the expertise of the staff and providers on the units. Hospital units may vary depending on the acuity and needs of each patient.
Chaotic patient transfers
Staff complaints also relate to the protocols – or lack thereof – for patient transfers between units or between the Salem campus and the Junction City branch of Oregon State Hospital.
For example, a staff member said they “still don’t know what the criteria are” for moving a patient to the COVID-19 unit and quarantining patients in a unit where there is a suspected outbreak of COVID-19. COVID-19.
In another case, a staff member said a program director asked the Salem unit to find patients to transfer to Junction City by the end of the week.
“We were told not to let patients know just before it was time to move them,” a staff member said in the complaint. “Everyone was so upset (staff and patients). “
A complaint also reported that patients are transferred to different units in the hospital against the recommendations of their care providers, sometimes with less than 24 hours’ notice to prepare patients “even when they have long-standing relationships. with their current teams and are making gains. Processing.”
There is 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 start of the pandemic, the letter said.
“Not our monkey”
Disability Rights Oregon also cited complaints about the treatment of patients in so-called “help and assistance” cases. These patients are assigned to Oregon State Hospital so they can recover and help defend themselves as defendants in pending criminal cases. Courts assign defendants to hospital after judges determine they cannot be tried due to their poor mental condition.
Complaints reported a “complete lack of training” for clinicians who do not have experience in the program.
Discharge planning is also inadequate, including for patients with high-risk medical conditions, a staff member reported. This complaint indicated that staff had learned that leave planning for these people was “not our monkey, not our circus.” In discharge planning, staff are expected to ensure that there is support for the patient once they leave the hospital.
Aid and assistance cases have long plagued the state hospital and led to a federal lawsuit after failing to admit patients within the required seven-day time frame. This meant patients languished in county jails instead of receiving prompt treatment in hospital.
The court-ordered seven-day requirement has been relaxed during the pandemic, but a federal judge last week gave the state hospital until Dec. 3 to speed up admissions and increase capacity so that the system can quickly admit patients awaiting trial.
Disability Rights Oregon has warned that the hospital’s lack of action could have a ripple impact and hurt prisons as well.
“If OSH continues to lose staff and is unable to increase its capacity to meet the needs of Oregonians with severe mental illness – or worse, if the hospital is forced to reduce its capacity – you risk presiding. to a system-wide outage as prisons fill with people unable to help and assist in their defense but with nowhere to go to receive appropriate treatment, ”the group wrote. “Between the conditions at OSH and those we have documented in some Oregon prisons, it is clear that the system is on the verge of this breakdown.”
Disability Rights Oregon is calling on the state to take several steps, including more transparency on patient referrals and COVID-19 policies.
The group also wants the state to treat the staff shortage “as the emergency it is” and immediately put in place a hiring and retention plan to keep the current staff short-term and increase it long-term. term so that National Guard troops are not needed.
The group also wants “clear criteria” for when National Guard personnel will leave the public hospital, with a plan and timetable.
Disability Rights Oregon is also pushing for emergency housing vouchers for patients who no longer require hospital care and are waiting to return to their hometowns.
Given the lack of resources for patient aid and assistance, the group is also calling on the state and the hospital to work with judges, prosecutors and law enforcement to demand the dismissal of the cases. low-level loads to free up resources for more severe cases.
You can reach Ben Botkin at [email protected] or via Twitter @ BenBotkin1.