Hospitals and the State of Oregon Battle Over Responsibility for Civilly Committed Patients

The high-stakes federal litigation is all about overcrowding at Oregon State Hospital.

Most of the state’s largest hospitals today fired a broadside in U.S. District Court at the state of Oregon and the advocacy group Disability Rights Oregon in the latest round of a legal skirmish over responsibility for psychiatric patients and the scarce beds at Oregon State Hospital.

The hospitals, including Legacy Health, PeaceHealth, Providence Health & Services, and St. Charles Health System, filed a federal lawsuit in U.S. District Court in Eugene last year, alleging the state was failing in its responsibility to find placements for people who had been civilly committed because they were a danger to themselves or others.

That case then got consolidated with two cases already pending in federal court in Portland, in front of Judge Michael Mosman. Those cases also concerned patients who require in-patient psychiatric treatment: those found guilty of a crime except for insanity, and those who’ve been charged with a crime but found unable to aid and assist in their own defense.

The state hospital’s two campuses (in Salem and Junction City) can serve just over 700 patients. The preexisting lawsuits were aimed at ensuring patients got admitted to the hospital in a timely fashion, rather than languish in county jails, which are ill-equipped to serve them.

Overcrowding at the state hospital reached a crisis point late last year, and Judge Mosman ordered early release of some patients.

Related: Judge Declines to Stop Oregon State Hospital Early Releases.

In part because of the litigation on behalf of guilty except for insanity and “aid and assist” patients, civilly committed patients got squeezed out of access to the state hospital: They went from occupying about 200 beds five years ago to 16 late last year.

In their lawsuit, the private hospital systems allege that they became de facto warehouses for civilly committed patients, who were in fact the state’s responsibility. That, the hospitals argued, did patients a disservice because community hospitals lack the staffing and facilities to provide long-term psychiatric care and patients occupied beds and resources, costing the hospitals money and other patients access to those resources.

(As WW reported, county circuit court judges agreed with the hospitals that civilly committed patients were the state’s responsibility.)

But in December, Oregon Department of Justice attorneys representing the Oregon Health Authority filed a motion asking Mosman to dismiss the hospitals’ federal lawsuit, saying the hospitals had “no standing for the claims they bring on their own behalf because they do not allege any actual injury in fact that is fairly traceable to the challenged state action” and the hospitals “have no standing to bring claims on behalf of civilly committed persons.”

In their response to the state’s motion to dismiss, the hospitals today disputed the state’s objections and urged Mosman to focus instead on the harm caused to patients and to the hospitals and their other patients by OHA’s failure to find beds for civilly committed patients.

That, the hospitals argue, is the crux of the case.

“When OHA abandons civilly committed patients in health systems’ acute care hospitals, health systems remain required under both medical ethics and federal law to continue caring for such patients until either they are safe to discharge or their period of civil commitment expires,” the hospitals’ reply motion states. ”Thus, in context, OHA’s conduct forces health systems to hold civilly committed individuals that OHA abandons care for those individuals to the best of their ability.”

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