Health systems act to ensure state provides treatment for the civilly committed

October 17, 2022 Providence Oregon News Team

Oregon state capitol building at sunrise

In a move to protect the civil rights of vulnerable Oregonians, three leading Oregon hospital systems are coming together to ensure the Oregon Health Authority fulfills its legal obligation to provide adequate mental health treatment capacity for civilly committed individuals.

Legacy Health, Providence Health & Services and PeaceHealth filed a lawsuit in the Oregon U.S. District Court in Eugene alleging OHA has forced acute care hospitals to provide long-term care for those who are civilly committed. These community hospitals are neither designed nor equipped to provide long-term treatment for mental illness. As a result, the health systems believe OHA has violated the civil rights of Oregonians with severe mental illness.

“Because their rights are not being protected by the state, some patients who have severe mental illness and may be violent have been forced to stay for as long as a year at community hospitals. This is unsafe for patients, those charged with their care and our communities,” said Alicia Beymer, Chief Administrative Officer, PeaceHealth, Sacred Heart University District and Cottage Grove Community Medical Center.

Under Oregon law, individuals who are a danger to themselves or others may be civilly committed by the state for involuntary treatment for up to 180 days. Acute care hospitals are often the first stop for many patients who require urgent medical care and short-term stabilization. Once that is achieved, the state is legally required to place these individuals in a facility that specializes in long-term treatment, such as the Oregon State Hospital, and that can give them the appropriate and necessary care to enable them to regain their liberty.

Rather than transfer these individuals to an appropriate facility, the state is warehousing them in community hospitals for months. Community hospitals are not equipped, staffed or designed to provide long-term mental health treatment for civilly committed individuals. The behavioral health units in these hospitals are intended to serve the community as acute care facilities where patients in mental health crisis can be evaluated, stabilized and discharged to the next appropriate level of care. Units at acute care hospitals are highly restrictive, locked environments. Patients can only leave the units for short periods of time, if at all, because of environmental and staffing limitations.

The necessary components for safe and effective treatment provided at long-term care facilities — such as security, private rooms, kitchens and physical exercise — are not feasible at hospitals that are also responsible for meeting the short-term acute care needs of their communities. As a result, patients left in these environments by OHA do not receive needed care and, in many cases, decompensate back to unstable conditions.

The Oregon Health Authority has not only failed in its responsibility to its most vulnerable population, but by relying on acute care hospitals, OHA has negatively affected the hospitals’ capacity to care for other patients experiencing acute mental health crises in their communities. Oregon is in the middle of an unprecedented mental health crisis, and community hospitals are desperately needed to treat and stabilize other vulnerable patients in crisis, many of whom are also struggling with substance abuse disorders and houselessness.

“We are deeply committed to a compassionate approach to behavioral and mental health treatment. We work hard to provide the best care possible, but acute care hospitals are simply not designed to provide long-term care,” said Melissa Eckstein, President of Unity Center for Behavioral Health at Legacy Health.

More than 500 individuals with severe mental illnesses are civilly committed to OHA for treatment each year. The community hospitals estimate that annually, hundreds of patients who are being kept in acute care hospitals should actually be in specialized long-term care facilities such as the Oregon State Hospital.

“It leads to a situation in which vulnerable Oregonians are denied the care that justifies their commitment in the first place and that they are constitutionally entitled to,” said Dr. Robin Henderson, Chief Executive of Behavioral Health for Providence in Oregon.

Under Oregon law, the state is required to serve three populations of mentally ill persons:

  • Civilly committed individuals.
  • Those found guilty except for insanity in a criminal case (sometimes called GEI).
  • Individuals who are arrested but not able to participate in their defense because of a mental illness (sometimes called aid-and-assist).

Starting in late 2019, the Oregon State Hospital shifted admission priorities to focus almost entirely on the aid-and-assist and GEI populations. In 2022, the Oregon State Hospital census averaged fewer than 20 civil commitment patients per month, leaving hundreds stuck in community hospitals.

OHA has neglected its responsibilities by failing to provide adequate treatment capacity for civilly committed individuals. OHA is also unlawfully prioritizing care for other populations of mentally ill individuals. Through the lawsuit, the hospital systems hope to ensure that OHA accepts its legally required responsibility to provide mental health services to civilly committed individuals. Rather than seek compensatory damages, the suit seeks declaratory and injunctive relief, nominal damages and attorneys’ fees for having to pursue the litigation. 

The hospital systems strongly support the rights of aid-and-assist and GEI patients to be removed from jail and to receive meaningful treatment. But OHA must do this without abandoning civilly committed patients. These actions have had detrimental consequences for all Oregonians, most importantly its most vulnerable populations.

This coalition of health systems is also filing to intervene in the Oregon Advocacy Center v. Mink case, asking the court to withdraw its recent ruling that civilly committed patients cannot be admitted to the Oregon State Hospital except in rare circumstances. This lawsuit will also protect the constitutional rights of many aid-and-assist patients who will be released in response to the Mink order, because many of those patients are likely to be civilly committed and end up in acute care hospitals either on release or if they decompensate in the community after release. 

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