Oregon State Hospital's chief forced out amidst reports of patient abuse, neglect

From The Statesman-Journal in Oregon:

New developments are rapidly unfolding in the wake of the March 26 release of a critical report examining the death of an Oregon State Hospital patient, and the same-day forced resignation of hospital chief Roy Orr.

Among them:

-Three mental-health advocacy groups say that federal court oversight of the state hospital is necessary to stop a pattern of patient abuse and neglect.

Leaders of Disability Rights Oregon, NAMI Oregon and Mental Health America of Oregon are calling for Gov. Ted Kulongoski to cut a deal with the U.S. Department of Justice that would place the psychiatric hospital under federal court control.

"The state claims to support a new culture of care, yet the governor has shied away from real accountability," said Beckie Child, president of Mental Health America of Oregon. "Oregonians should call upon the governor to demonstrate his commitment to Oregonians who live with mental illness by agreeing to a court-enforceable agreement with the U.S. Department of Justice. Until that happens, we have no faith that Oregon will abandon its deplorable neglect of patients in the care of the state hospital."

-Hospital employees described Orr's ouster as surprising and unsettling. Some predicted that it will lead to more confusion and uncertainty for a work force that is reeling from tough scrutiny and sweeping changes.

Mental health therapist Brant Johnson said Saturday that it didn't make sense to replace Orr, certainly not when workers are putting in lots of overtime hours, adjusting to new treatment malls, coping with an ongoing federal investigation of patient care and hospital conditions, and planning for a future move to a new 620-bed, $280-million hospital that is being built to replace the run-down existing facility.

"You cut the head off the management, and that's going to trickle down big-time," he said. "I think this is going to add a lot of confusion that we don't need right now."

-Dr. Bruce Goldberg, director of the state Department of Human Services, said outside experts will be hired to hasten the pace of change at Oregon's main mental hospital.

"We are going to get whatever outside help we need," he said.

-Nena Strickland, deputy superintendent, has taken over as interim superintendent while state officials conduct a national search for Orr's replacement.

Strickland said her top priority will be changing "our overall approach, our attitude and the culture that we have related to paying attention to individual patients."

Report sets deadlines for changes
Friday's release of a 27-page investigation report examining the death of Moises Perez underscored the need for fast and dramatic changes in patient care, state officials said.

Perez, 42, was found dead in his hospital bed Oct. 17. After a five-month inquiry, investigators with the state Office of Investigations and Training concluded that the hospital failed to provide Perez with adequate medical care for chronic health problems. Perez had been described as sedentary, had high blood pressure and often refused his medications because he thought they were killing him.

Investigators said the evidence was inconclusive about whether Perez was neglected the day of his death. But it found that his overall care was deficient and neglectful.

The report also rapped hospital staff for keeping Perez's family in the dark about his condition by failing to return their phone calls during the last weeks of his life.

Dated March 18, the OIT report wasn't made public until Friday. State officials said release of the report was delayed to arrange a meeting with Perez's family, so they could hear about the findings before the critique appeared in the press.

Goldberg met Friday afternoon with Perez's mother, and the report was released shortly thereafter.

Since Perez died, the hospital has taken seven measures to improve patient medical care, monitoring and medication management, the report says. It also spells out seven more "supplemental" and "required actions" for the hospital to take, setting deadlines for all of them.

One requirement calls for the hospital to work with the Oregon National Alliance for the Mentally Ill ( NAMI) to evaluate and improve hospital communications with concerned family members of patients.

The OIT report imposed a 60-day deadline for improved communications to occur.

Chris Bouneff, executive director of NAMI Oregon, said he's unhappy because the hospital hasn't contacted the organization about the issue. "We are already into April and NAMI has not been contacted or informed about this requirement," Bouneff said. "I am deeply disturbed. If OSH cannot implement this simple step, why should anyone have confidence that it can change its treatment culture?"

Orr's ouster counterproductive?
Richard Harris, head of the state's Addictions and Mental Health Division, said he asked for Orr's resignation Thursday afternoon because "it was time for a change." Friday was Orr's last official day on the job.

Goldberg played down the notion that Orr's forced resignation might have a counter-productive backlash at OSH.

"We need to speed up the pace of change," he said. "I don't think that the ability to create the kind of hospital that we want is going to hinge on the back of any one individual."

But Johnson, who serves as a non-voting member on a new citizen-led hospital advisory board, predicted the hospital would be "worse off" following Orr's departure.

"I really thought he was bringing a new way of thinking to the hospital and trying to move it in a new direction, and I thought that was a good thing," he said.

Hiring of Orr's replacement could take months. Meanwhile, workers will grapple with added anxiety and confusion about what's in store, Johnson said.

"Right now, it seems we need him more than ever," he said about Orr. "We need somebody that knows what they're doing more than ever."

Advocates push for federal court oversight
Fed up with festering flaws in patient care, mental health advocacy groups say it's time for Oregon to resolve a nearly 4-year-old federal investigation of the state hospital.

They want the state to enter into an agreement with the U.S. Department of Justice that would spell out binding terms for improvements in patient care and make them subject to federal court oversight and enforcement.

Since the start of the federal investigation of OSH in mid-2006, Kulongoski and his legal advisers have steadfastly opposed entering into any agreement that would lead to federal court oversight of the state-run institution.

They fear that federal court control of the hospital could drag out for many years, perhaps more than a decade, forcing the state to shell out huge sums of money for reforms.

As a worker on the front lines of patient care and supervision at OSH, Johnson said he was disappointed to hear that mental health advocates are demanding federal court monitoring of the hospital.

"I think it's pretty shortsighted for people to be calling for turning it over to the feds," he said. "Would they make some good changes? Probably. But once they have you, you're going to be running (OSH) the way they want, and they're not going to cough up control for a long time."