Oregon hospitals fall short in fight over long-term psychiatric care

PORTLAND, Ore. (CN) — A group of community hospitals that say Oregon is forcing them to house civilly committed patients for months at a time saw most of their claims dismissed Tuesday.

The hospitals can’t bring claims on behalf of their patients, U.S. District Judge Adrienne Nelson, a Joe Biden appointee, wrote in a 27-page order.

The hospitals — Legacy Health System, PeaceHealth, Providence Health & Services and St. Charles Health System — accused the Oregon Health Authority of wrongly placing patients at their facilities rather than at the Oregon State Hospital to comply with court-ordered admission timelines for defendants found unable to stand trial.

The case is one of several concerning admission to the Oregon State Hospital. Metropolitan Public Defenders and Disability Rights Oregon, then called the Oregon Advocacy Center, first sued state health officials over two decades ago over accusations of civil rights violations of mentally ill people.

A 2002 federal court determined that jailing a mentally incompetent person for over seven days is unconstitutional and entered a permanent injunction requiring the state to admit to the Oregon State Hospital any detainee who is found unable to stand trial within seven days.

The community hospitals say the state hospital has “effectively outsourced its responsibilities to civilly committed patients by leaving patients indefinitely in hospitals’ emergency rooms, acute behavioral care units, and medical-surgical units." The practice has led to a shortage of acute psychiatric beds, the community hospitals claimed.

The health systems claim they are forced to house civilly committed individuals for up to months on end despite their hospitals being ill-equipped to do so. They also raised a litany of constitutional violation claims against the state health agency, but Nelson found that only two of 12 could proceed.

The bulk of the claims were asserted on behalf of the community hospitals’ civilly committed patients, and Nelson found that they lacked third-party standing.

“A health care provider and their patients do not per se have a close relationship; rather, the party seeking to establish third-party standing ‘must be able to convince the court that it would be as effective a proponent of [the third parties’] rights as they would be,’" Nelson wrote.

The community hospitals told the court they were requesting that civilly committed patients have access to the most appropriate and least restrictive long-term treatment options. They clarified that the relief they were seeking would increase the placement options for civilly committed patients and discourage premature discharge.

Nelson found the community hospitals fell short of addressing whether the remedy likely to be achieved by their lawsuit would benefit rather than harm their patients.

“Indeed, these allegations remain focused on shifting long-term care of civilly committed patients out of plaintiffs’ hands,” Nelson wrote. “In other words, this case does not clearly mirror the cases in which a close relationship was found between healthcare providers and their patients, whom those healthcare providers sought to continue to serve — in contrast to those cases, plaintiffs here seek to have their patients be treated elsewhere, i.e., in simplest terms, for their patients to no longer be their patients.”

Still, Nelson allowed the hospitals’ two due process claims to proceed.

The hospitals accused the state health system of knowingly harming civilly committed patients and essentially forcing the hospitals to house those individuals indefinitely throughout their 180-day commitment.

The Oregon Health Authority requires that hospitals be approved and certified in order to provide treatment services for civilly committed or detained individuals. The community hospitals argued that failure to do so would inevitably still force them to provide treatment.

In a statement, the community hospitals said Nelson’s decision to allow the case to continue validates their position and “underscores the crisis we are seeing with a broken behavioral health care system in Oregon.”

“Now is the time for the state to seize this opportunity to substantially increase its efforts in building a functional behavioral health system that will help all Oregonians — especially those in crisis,” the hospitals said.

Nelson’s ruling comes as the state health authority continued to rack up contempt fines for failing to admit criminal defendants in need of mental health treatment to the hospital within seven days. Also on Tuesday, Nelson ordered the health authorities to pay $1.257 million in contempt fines for such violations from July 15 to Nov. 14. The state is fined a daily $500 fee per person who is not admitted.

The average wait time for criminal detainees pending admission to the state hospital rose to nearly 30 days earlier this year — more than quadruple the court-ordered limit.

The Oregon Health Authority did not provide a comment before press time.