Hospital, jails juggle hot potato

Lawsuit seeks timely admission to the state hospital for mentally ill

A.J. Madison, a Portland man in his 30s, was jailed March 5 in Multnomah County on charges that he assaulted his mother with a sledgehammer.

He was found unable to proceed to trial because of his mental incapacity and ordered to be committed to Oregon State Hospital in Salem, which houses and treats the state's most seriously mentally ill patients.

But because no beds were available, Madison waited 23 days at the county jail, running up a bill of $3,648, or slightly under $160 a day. Similar delays have plagued dozens of other mentally ill individuals who were ruled 'unfit to proceed' after being charged with crimes.

Advocates for the mentally ill say that besides running up exorbitant costs to the county, the delays in treatment are 'unjust and inhumane.'

'They can't get better if they're waiting in jail,' said Bob Joondeph, executive director of the Oregon Advocacy Center. Because of their exacerbated conditions, he said, some are confined to their cells 22 to 23 hours a day because of unpredictable behavior that's sometimes harmful to themselves or others. They also require more staff attention and resources.

Meanwhile, officials at the state hospital say their hands are tied because of budget cuts and a lack of bed space.

A lawsuit centering on this issue will be heard Wednesday at the 9th U.S. Circuit Court of Appeals in Portland. The complaint was first filed in March in U.S. District Court by Madison, the Oregon Advocacy Center and the Metropolitan Public Defender's Office.

The lawsuit alleges that Oregon State Hospital was not expeditiously providing hospital admission and medical treatment for criminal defendants who are determined by the court to be unfit to proceed to trial because of mental capacities.

'Our position is that the person's committed to the hospital, not to the jail,' Joondeph said. The issue has been a problem for many years, he said, and resulted in a 1999 state law requiring the state hospital to admit patients within seven days. However, the law had a sunset clause that ended in 2001.

A U.S. District Court judge ruled in favor of the plaintiffs in May. The state appealed the ruling; the case was expedited and sent to the appeals court.

Since that ruling, things at the state hospital have been 'a little calmer,' said Barry Kast, assistant director of the state Department of Human Services.

Joondeph said whatever the current conditions may be, the state must be held accountable to the seven-day standard all the time.

Kast said the bed space at the hospital may improve soon. Currently, none of the hospital's 400 beds available for forensic patients (those who are criminally involved) is vacant for very long. But the state hopes to open a new 35-bed ward for forensic patients no later than Jan. 1.

Yet those who work in the county jails say housing and paying for such inmates is still a serious problem.

'I think we're definitely the default mental health hospital in some ways,' said Cathy McCollough, a corrections counselor at Multnomah County Inverness Jail.

According to the lawsuit, holding inmates without hospitalization is dangerous because jail staff cannot force inmates to take their medication, whereas the hospital can. Inmates who go unmedicated can become more psychotic, which often leads to them being placed on suicide watch.

Here are some costs associated with the care of the mentally ill in jails:

• There were 73 people on suicide watch in Multnomah County jails during the first six months of 2002, up dramatically from 29 during the same period a year ago. In July, deputies spent 633 overtime hours, or $30,896, on suicide watch prevention for inmates in Multnomah County jails. There have been no suicides in the jail since March 1998.

• Although jail officials say 17 percent to 20 percent of the jail population has mental health issues, drug costs for the mentally ill take up almost half of the entire pharmaceutical budget of $1.3 million.

A favorable ruling by the appellate court 'would help force the state to take responsibility for some of the most serious mentally ill,' said Multnomah County Sheriff Dan Noelle. 'But I think it is not going to deal with the fact that we have an incredibly high number of very mentally ill people in jail.'

In addition to this case, the Multnomah County sheriff's office filed a lawsuit in Multnomah County Circuit Court in July that asks for reimbursement from the state for Madison's care. Madison remains at the state hospital today.

That case is pending, and the state is expected to respond by mid-September, according to the county attorney's office.

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