An advocacy group has asked a federal judge to hold the Oregon Health Authority in contempt over what it calls its lack of urgency to the mounting human toll from the state’s worsening mental health crisis.

Lawyers for Disability Rights Oregon filed the motion on Tuesday asking U.S. Judge Adrienne Nelson to bring sizable financial penalties against the health authority while compelling it to overhaul its management of the state’s mental health resource.

The development represents a major potential escalation of the decades-old litigation over Oregon State Hospital admissions. And it comes as Nelson in recent court hearings has been bringing up the idea of a contempt order against the state.

She also has noted that the Legislature — which meets in two weeks for the 2025 session — has the power to fix the situation.

In Washington state, a judge’s contempt order led to a state agreement to improve services in 2018, followed by hundreds of millions in fines to enforce it — including $100 million in 2023 — helping spark major investments

Portrait of neglect

The motion states that the state’s current crisis, in which mentally ill people languish in jail without treatment, was predictable more than a decade ago, but the state’s leaders have done little to fix the situation.

In 2002 a federal judge issued an order requiring the state hospital to admit within seven days people accused of crimes who are unable to aid and assist in their defense. The intent of the order was to get these defendants treatment to stand trial instead of deteriorating in jail. However, the state hospital has been violating the order routinely.

“Jails are just ill-equipped,” Emily Cooper, an attorney for Disability Rights Oregon told The Lund Report. “They’re designed to punish, not to treat, and so there’s just a huge human cost in keeping these people in jail.”

In recent years, at least two “aid-and-assist” patients died in jail while waiting for a bed at the state hospital, according to the filing. The two people died because of complications from their mental illness and the related inability to eat or drink, it states.

Meanwhile, “Hundreds of other detainees have spent weeks or months languishing in jail, often in isolation and without treatment, while their conditions worsened,” according to the filing.

Cooper previously litigated the case in Washington state in which a contempt finding led to major changes.

She said Disability Rights Oregon decided to move forward with the contempt filing after the health authority’s lawyers said during a November 18 mediation meeting that they had no plan to get back into compliance with the seven-day admission requirement.

Health authority spokesperson Amber Shoebridge told The Lund Report in an email that “Oregon State Hospital does not comment on active litigation.”

Crisis reemerged in last two years

State officials complied with the 2002 court order until 2018. That’s when Disability Rights Oregon again went to court to enforce the order requiring timely state hospital admissions.

To free up space at the state hospital, a court-ordered outside expert named Dr. Debra Pinals recommended discharge deadlines for how long aid and assist patients could stay in the state hospital. In 2022, U.S. District Judge Michael Mosman issued an order setting the deadlines.

The state hospital eventually began complying with the seven-day admission requirement for a total of seven months, Cooper said. But admission wait times again rose.

Meanwhile, critics have said the discharge deadlines are creating a revolving door in the criminal justice system, straining the system and hurting public safety and patients rather than helping.

Problem was years in the making, lawyers say

The contempt filing claims the problem’s roots date back more than a decade as the state failed to provide enough community-based services for people with serious mental illness.

“At least as early as 2012, Oregon was aware of significant problems regarding the aid-and-assist population in Oregon and the operations of the state hospital,” the filing states.

The state and the U.S. Department of Justice in 2012 entered an agreement giving the federal agency oversight of Oregon as it carried out a plan to add resources for this population.

Despite the federal scrutiny, the availability of community mental health settings decreased, the state didn’t meet its goals for building more supportive housing goals and state hospital patients had to wait longer to be discharged despite being deemed ready to leave, according to the filing.

The filing cites the court-ordered expert’s 2020 report that stated it’s not clear how the health authority intended to hold county-based mental health agencies or coordinated care organizations, the state’s Medicaid insurers, accountable for meeting the needs of people with persistent mental illness.

In 2017, state hospital officials testified to a legislative committee that the number of aid and assist patients was growing. However, the health authority “never truly assessed—and indeed still have not really assessed today— how to right-size its services to meet demand,” the filing states.

Lawmakers have approved record amounts of funding in recent years intended to address Oregon’s behavioral health crisis. But the filing dismisses the investments as too little and too late to address a problem officials were aware of in 2012.

“Due to the lack of investments into Oregon Health Authority and the Oregon State Hospital, the inevitable was predictable,” the filing states.

What the contempt motion asks for

The contempt motion asks Nelson, the judge, to compel the health authority to fully implement six recommendations from Pinals, the independent expert. Those include:

• Discharging patients who have been deemed ready to be released in a community setting. The filing states that there were 75 aid and assist patients housed at the Oregon State Hospital as of December 15 who no longer needed a hospital level of care. 
• Directing more patients toward community placements instead of the state hospital. Cooper said this would require community restoration programs to take aid and assist patients even if they are challenging. 
• Enforcing contract requirements with mental health providers, coordinated care organizations and county mental health programs. Cooper said this would require the health authority to ensure that treatment is available to people who have been in and out of the state hospital on aid and assist orders. She said this would mean providers “can’t just offer this to the people (they) want to serve.”
• Expand substance use disorder treatment.
• Limit the amount of time someone can remain in community restoration programs, which people remain in for years, Cooper said. 
• Reforming how spots in community restoration programs are given to patients being released from the state hospital.

Cooper said “true system reform” will take a long time. But she said that ordering the state to implement these recommendations could bring the state hospital into compliance within months.

“If those urgent, aggressive, resource-laden steps are taken, the state could be in compliance,” she said.

If Nelson approves the contempt motion, it could mean the state faces escalating financial fines for each day it is not in compliance. That money , Cooper said, could help pay for services the state has been failing to fund.

This story was originally published by The Lund Report, an independent nonprofit health news organization based in Oregon. You can reach Jake Thomas at [email protected] or @jakethomas2009 on X.

This republished story is part of OPB’s broader effort to ensure that everyone in our region has access to quality journalism that informs, entertains and enriches their lives. To learn more, visit opb.org/partnerships.

News Source : https://www.opb.org/article/2025/01/08/oregon-should-be-held-in-federal-contempt-for-mental-health-failures-advocates-say/