Abuse Investigations within Oregon Mental Health Hospitals
Bart Brewer – NAMI CC Newsletter Editor
Earlier this year, it came to light that a state mental health hospital in Montana was having an influx of abuse cases, to a degree that six people’s deaths could be linked to the hospital. The issue was that no one in the public, not even their loved ones, knew what had happened, as the details of the investigations were kept internal and were not accessible upon request. After reading about this case, we began to wonder if something similar could happen here in Oregon, and how abuse investigations are conducted here.
So how does Oregon investigate allegations of abuse within mental health hospitals? If there is an allegation of abuse, investigations are either done by a Community Mental Health Program (CMHP) that doesn’t have an employee named in the allegation, or by the Office of Training, Investigations and Safety (OTIS), though OTIS is the primary which all investigations must go through. All these programs are under the umbrella of the Department of Human Services (DHS).
After interviews are done, documents are reviewed and the investigation is concluded, OTIS is required to put out a report on the investigation within 60 days. This report however can be extremely redacted, and in some cases not accessible. Further, some details of the investigation process will never be available for public viewing.
If the investigation finds that there wasn’t any abuse, then a redacted report is available to the public. These redactions are made to protect the identity of patients and their medical records, following rules made by HIPAA, though under Oregon law names of abuse reporters, witnesses, and the adult, as well as photographs of the adult are also confidential.
In the case that an investigation does find a case of abuse, the report of that investigation is not so readily available. If a person wants a copy, they must make a public records request, and then must wait until a final order is issued. This “final order” is up to the department, meaning that they can deny the request, though such a decision can be appealed. This means that investigations that have found abuse are harder to acquire then investigations that don’t find abuse.
There is then also how oversight is handled within the departments doing investigations. Internally, oversight within Oregon seems relatively sound and robust. CMHP’s aren’t allowed to investigate themselves, with OTIS handling those kinds of investigations and being the lead in most of instances. Further, OTIS faces oversight and scrutiny from the DHS, and there are laws in place to act against bias within investigations.
Though there might be a problem regarding federal oversight. Looking back over at Montana, part of the reason that families couldn’t find out any information is that the facility had lost its federal funding, certification, and oversight. There have been times when similar events have almost transpired in Oregon. In May 2022, federal regulators threatened to cut funding to a satellite state hospital for, amongst other things, shortcomings in patient safety; improper record keeping; inadequate supervision; inadequate grievance procedures; and, a failure to maintain the physical plant.
This is among other black marks in Oregon’s state hospital system, making it not outside the realm of possibility that federal funding could be lost. If that happens, and federal oversight goes away, a similar situation to that in Montana could arise.
The question of transparency into abuse investigations requires us to look at the larger system that it is apart of. While not as serious as the situation in Montana, Oregon has the potential to slide backward, especially with the current state of record acquisition. Oregon must continue to move forward in improving the state hospital system generally in order to address the potential gaps there are in investigation reporting there currently are.
What is abuse?
“Abuse” can be one or more of the following:
· Abandonment, including desertion or willful forsaking of an adult or the withdrawal or neglect of duties and obligations owed an adult by a caregiver or other person.
· Any physical injury to an adult caused by other than accidental means, or that appears to be at variance with the explanation given of the injury.
· Willful infliction of physical pain or injury upon an adult.
· Sexual abuse.
· Verbal abuse of an adult.
· Financial exploitation of an adult.
· Involuntary seclusion of an adult for the convenience of the caregiver or to discipline the adult.
· A wrongful use of a physical or chemical restraint upon an adult, excluding an act of restraint prescribed by a physician licensed under ORS chapter 677, physician assistant licensed under ORS 677.505 (Application of provisions governing physician assistants to other health professions) to 677.525 (Fees), naturopathic physician licensed under ORS chapter 685 or nurse practitioner licensed under ORS 678.375 (Nurse practitioners) to 678.390 (Authority of nurse practitioner and clinical nurse specialist to write prescriptions or dispense drugs) and any treatment activities that are consistent with an approved treatment plan or in connection with a court order.
· An act that constitutes a crime under ORS 163.375 (Rape in the first degree), 163.405 (Sodomy in the first degree), 163.411 (Unlawful sexual penetration in the first degree), 163.415 (Sexual abuse in the third degree), 163.425 (Sexual abuse in the second degree), 163.427 (Sexual abuse in the first degree), 163.465 (Public indecency) or 163.467 (Private indecency).
· Any death of an adult caused by other than accidental or natural means.
https://oregon.public.law/rules/oar_407-045-0475 Info on Reports
https://oregon.public.law/rules/oar_chapter_407_division_45 All laws that pertain to this subject.