Patient has been trying to prove he’s not mentally ill

Laing

Cooped up at Oregon State Hospital, Richard Laing became a frustrated and fiery critic of patient care and hospital conditions.

Despite evidence that he wasn’t mentally ill, Laing couldn’t get out of the crowded, run-down mental institution.

In late 2005, he took off. Given a solo pass to visit Salem Public Library, Laing hopped a bus and left town.

Nearly two years later, police collared Laing in Portland. His negotiated punishment for the escape: 32 months in prison.

Laing figured he got a good deal. As he saw it, serving prison time was preferable to being stuck at the psychiatric facility, and he would be free upon completing his sentence.

Much to his dismay, Laing now is back inside the hospital he hates. He was hauled back to OSH on March 18, the day he completed his prison sentence for the 2005 escape.

A hearing today before the state Psychiatric Security Review Board will determine whether Laing, 70, remains at the mental hospital or receives a green light to live in the community — subject to post-prison supervision and separate monitoring by the PSRB.

Laing’s bid to get out of the state hospital renews his long-running battle to prove he’s not mentally ill.

“If you’re not crazy, you don’t belong in a mental institution,” he said by telephone this week from Ward 50G in the hospital’s forensic psychiatric program.

Steve Gorham, a Salem attorney representing Laing, said his client should be discharged from OSH.

“It’s clear that he has been in the state hospital for years and not been treated for anything there,” Gorham said. “He’s not under any medication.”

Laing had no mental health problems while on escape status from the hospital and received no psychiatric treatment during his prison stint, Gorham said.

“It seems to me that there’s pretty good evidence that he doesn’t have a psychiatric illness,” he said.

Laing entered OSH in 2002 after getting drunk and hitting his Portland landlord in the head with a coffee cup. He was in the throes of an alcohol-induced psychosis.

Laing said he pleaded guilty except for insanity to avoid a 70-month mandatory prison term for assault.

In Oregon, criminal defendants found guilty of crimes but insane at the time go to the hospital’s forensic program for treatment instead of prison. More than 400 forensic patients are housed at OSH.

Laing was unable to get out of the hospital, even though therapists and staffers said he had no symptoms of mental illness.

The state Psychiatric Security Review Board, which monitors the progress of forensic patients and controls their discharge dates, repeatedly turned down Laing’s release requests amid concerns about his checkered participation in group therapy sessions, whether he would be accepted into a community-based program for drug and alcohol abusers and his prospects for staying sober on the outside.

In December 2004, the Statesman Journal profiled Laing in a story that raised questions about his hospitalization.

It reported that taxpayers had shelled out $300,000 for his stay at OSH and quoted Laing’s assessment of the tab: “You could put somebody in a Hilton Hotel for that kind of price. It’s just insane.”

The following November, the PSRB again refused to release Laing.

Fed up, Laing used his off-grounds pass like a ticket to freedom. Instead of going to the city library, he boarded a Greyhound bus to Portland.

The escapee stayed free for almost two years, sleeping under bridges and roaming Portland. His meager income came from selling newspapers and collecting cans and bottles for refunds.

Laing’s days on the lam ended in October 2006. By happenstance, he was spotted on a Portland street by Mary Claire Buckley, executive director of the Psychiatric Security Review Board.

Buckley called police and she followed Laing until officers arrived and put him in handcuffs.

Laing looks back on Buckley’s role in his capture with a mix of irony and disbelief.

“It was just a fluke. I’m walking around in downtown Portland and I just walked right into her,” he said. “She had her cell phone and called police. Of all the things.”

Laing served part of his prison sentence at the Snake River Correctional Institution in Eastern Oregon. Last year, he was transferred to the Oregon State Correctional Institution in Salem.

Laing got a break when about nine months were lopped off his sentence through a controversial early-release program approved by the 2009 Legislature. To save money on lockup costs, lawmakers approved an expanded “earned time” program for prisoners. The new law increased from 20 percent to 30 percent the amount of time many inmates could have shaved off their sentences.

Laing’s prison time expired March 18, but he didn’t go free. Instead, he was sent back to the mental hospital, pending the outcome of today’s hearing before the PSRB.

Returning to OSH has rekindled Laing’s hatred of the hospital. He describes it as a crowded and violent warehouse.

Laing said he was punched in the face last week by another patient, a sneak attack that came as Laing was watching television on Ward 50C. Two blows to the face broke his prescription glasses and left him shaken.

“I’m no spring chicken anymore,” he said.

By Laing’s account, the assault was committed by a patient assigned one-on-one staff supervision due to recurring acts of violence.

“In 22 months in state prison, this never happened to me,” he said. “I’m back here eight days and some nut hits me in the head.”

Laing faces two years of post-prison supervision once he leaves OSH. In addition, he will continue to be monitored by the PSRB.

As Laing hopes for board approval to leave the hospital, he is taking legal action against the state.

After being assaulted, Laing filed a tort claim notice with the state, alleging the hospital was negligent in failing to properly supervise his attacker. Laing said he intends to sue the state unless he’s offered an out-of-court settlement.

agustafs@StatesmanJournal.com or (503) 399-6709

http://www.statesmanjournal.com/article/20100331/NEWS/3310427/1001/news

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State hospital adviser re-admitted as patient

A conditionally released mental patient who serves on the Oregon State Hospital advisory board is back inside the psychiatric facility after a relapse of mental illness.

Mike Adelman, appointed to the OSH advisory board last year by Gov. Ted Kulongoski, landed back in the state hospital after what he described as “a manic episode.”

The state Psychiatric Security Review Board revoked his conditional release March 18, acting on a county case manager’s concerns about Adelman’s deteriorating mental health.

Now housed in the hospital’s forensic program, Adelman said by telephone that he hopes for a quick recovery and short stint of care at the Salem facility.

“Relapse is a part of life,” he said. “It happens, and you recover from it, and you get back on track as fast as you can.”

Adelman’s hopes for a fast release from the facility hinge on evaluations of his mental health by hospital therapists and a review of his case by the PSRB. A board hearing is scheduled for April 7.

“The board will decide on that date whether he’s ready to go back out, and where that should be,” said Mary Claire Buckley, PSRB executive director. “He had graduated to an independent level. A determination has to be made as to whether he should be at that level or whether for a period of time he should go to a supervised type of housing.”

Adelman’s conditional release was revoked based on the recommendation of his Marion County case manager, according to a March 18 affidavit written by a PSRB staff member.

It says the case manager, Bev Shoopman, reported to the PSRB that he had been hostile, irritable and “unwilling or unable to take direction from her,” and that “in her opinion, Mr. Adleman’s conditional release should be revoked because his mental health has deteriorated such that he can no longer be managed (in) the community.”

Adelman, 42, initially was committed to the state hospital in December 2003 after a Marion County judge found him guilty except for insanity of arson and resisting arrest.

In Oregon, criminal defendants found guilty of crimes but insane at the time go to the forensic program for treatment instead of to prison. More than 400 forensic patients are housed in outdated, crowded facilities along Center Street NE in central Salem.

The PSRB reviews each patient’s progress at the hospital and determines patient discharge dates.

Conditionally released patients can be sent back to the hospital for violating conditions set by the board or because of recurring mental illness.

In 2005, Adelman was conditionally released from OSH after about 16 months of treatment. Back in the community, he made regular visits with his case manager and progressed to independent living. He also became an advocate for better patient care and conditions at the state hospital.

Adelman linked his recent psychiatric problems, in part, to flawed medication management and a rocky relationship with his case manager. As his condition deteriorated, he experienced sleeplessness and mania.

Before his conditional release was revoked, Adelman was hospitalized for about a week at Salem Hospital’s psychiatric center. By March 18, therapists there determined that he was ready to be discharged, according to the PSRB affidavit. However, Shoopman reported to the PSRB that Adelman still required hospitalization.

“In Ms. Shoopman’s opinion, Mr. Adelman cannot be managed in the community,” states the PSRB affidavit. “This opinion is based on her past experience with Mr. Adelman when he has been in a similar manic state.”

On the afternoon of March 18, Adelman was transported from Salem Hospital to the state hospital. That same afternoon, the most recent meeting of the hospital advisory board occurred at OSH.

Adelman said he was disappointed about not being able to attend the board meeting. He also described his return to the forensic program as “rough, really rough.”

Adelman initially was housed on Ward 50G, a medium-security treatment unit packed with 40 patients. He shared a room with four other patients.

“The ward’s overcrowded. Every single bed is full,” he said.

A day or two after Adelman was admitted to the ward, an altercation occurred — one patient assaulted another in the 50G laundry room. The violent patient was moved to a maximum-security unit.

For Adelman, the assault revived bad memories about violence he witnessed and experienced during his previous hospital stay. In an upbeat development Friday afternoon, Adelman said he was looking forward to a planned transfer to a minimum-security unit.

“I’ve heard the milieu is a lot better,” he said. “The patients are good, and I’ve heard they allow you a lot more privileges.”

Hospital superintendent Roy Orr said Friday in an e-mail to members of the advisory board that Adelman’s position on the panel will be placed on hold.

“We all know recovery is non-linear,” Orr wrote. “It is not a step-by-step process. It involves some setbacks, and it involves learning from experience.

“I know we all support Mike in his recovery and look forward to his return to active board membership.”

agustafs@StatesmanJournal.com or (503) 399-6709

http://www.statesmanjournal.com/article/20100329/NEWS/3290330/State-hospital-adviser-re-admitted-as-patient

Patient’s death points to persistent problems at Oregon’s state mental hospital

Patient’s death points to persistent problems at Oregon’s state mental hospital
By Michelle Cole, The Oregonian
March 16, 2010, 9:45PM
The Oregonian

The body of Moises Perez, 42, was discovered in this bed located just to the left of the door of a room he shared with four other men. The Oregon State Hospital patient had been dead several hours before he was discovered during evening medication checks.T he last time anybody can be sure that they saw Moises Perez alive was about 7:15 a.m. Oct. 17.

A nurse at the Oregon State Hospital saw Perez lumbering down the hallway in Ward 50 F, a medium-security unit inside the state’s mental hospital.

He seemed, the nurse told police, “just like he always was.”

Diagnosed with chronic paranoid schizophrenia, Perez had been institutionalized for nearly 15 years. In that time, he’d developed physical problems often linked with powerful psychiatric drugs and years spent behind locked doors.

At 5-foot-8, Perez weighed 300 pounds, had high blood pressure and was at risk for diabetes. He was 42 and in terrible shape.

So nobody was shocked that Perez died later that day. The shock came in knowing he died in a room across the hall from the nurses’ station and nobody discovered his body for several hours.

His death, according to public records gathered by The Oregonian, points to serious problems that persist at the Oregon State Hospital despite multiple outside reviews, the threat of a federal lawsuit and millions spent on hiring and other improvements.

Police concluded that no crime had been committed. The state medical examiner ruled Perez died of coronary artery disease. Still, his case prompted a sharp rebuke from the U.S. Department of Justice, which had threatened federal legal action two years ago if the state did not address the abysmal conditions at the same hospital where “One Flew Over the Cuckoo’s Nest” was filmed.

After reviewing Perez’s hospital records, Shanetta Cutlar, head of the department’s special litigation section, sent Oregon a warning letter that said Perez received care that “consistently fell well below constitutional and statutory standards.” What’s more, Cutlar wrote, the hospital has systemwide deficiencies that could cause “serious harm or death in other situations.”

Perez’s history

Perez’s family has declined to talk to the reporters. But public records and interviews paint a picture of a closely knit family that stood behind a young man, even in the worst of times.

Born in Cuba, Perez immigrated to the United States with his family in 1982, when he was 15. He was the third of four children and the only son. He had a clubfoot that was corrected surgically but that left his right leg shorter, leading to a life of chronic back and foot pain.

His mental illness surfaced during his late teens. Perez was hospitalized multiple times, returning home to a small apartment on his parents’ property in Woodburn. His mother, Dora Perez, cooked his meals and did his laundry.

Just before Christmas 1994, 27-year-old Perez suffered a violent break. He had been unable to sleep since his release from the hospital two days prior. His mother told police she felt sorry for him: “He looked anxious and nervous and scared.”

She was cooking breakfast when he attacked. Perez punched his mother, cut her and bit off four of her fingers. She thought he was hallucinating. “He’d never done something like that before,” she said in a police report.

Later, Perez asked a Woodburn policeman to “shoot him” and “tell the other officers that he tried to get away.”

He was found guilty except for insanity of attempted murder and assault. Instead of prison, the court placed him under the jurisdiction of Oregon’s Psychiatric Security Review Board for a maximum of 40 years.

Dora Perez filed a federal civil rights lawsuit against the doctor, the private hospital and Marion County. The suit, which ended in a settlement, claimed that Moises Perez had been discharged before his medication took hold.

Dora Perez’s lawyer, Les Swanson, said the 1995 case is among the few he won’t ever forget.

Dora Perez forgave Moises, Swanson said. “This was a mother who had an ill son and who loved him very much. She understood that he did not do this voluntarily but it was a result of his illness.”

Hospital routine

Perez’s family routinely visited him at the Oregon State Hospital, where he lived on the third floor of a beige building that from the outside resembles a 1970s college dorm.

On weekdays, Perez spent much of his day watching game shows on the giant-screen TV. “The Price is Right” was among his favorites.

But Oct. 17 was a Saturday, and there were no game shows on. Nurses, staff and patients told investigators they didn’t think it all that unusual when Perez stayed in bed.

He could be a difficult patient. Perez often refused to take a bath unless staff bribed him with a soda. His slovenly eating habits got him barred from the ward’s main dining room. That meant he ate alone from a tray set up elsewhere.

Acknowledging that Perez was difficult, the Department of Justice’s review of his medical records still criticizes the hospital and staff for the care Perez received.

Federal officials note that from April 30 until his death on Oct. 17, Perez’s medical file contained only two recorded blood pressure readings in nurses’ notes.

Doctors had identified his risk for diabetes, but Perez was not regularly monitored for the disease. He also refused his psychiatric medications at times. Federal officials described his contact with his psychiatrist as “infrequent” in the months prior to his death — once in July and once in September.

Federal officials also question whether Perez actively refused medication or simply didn’t show up at the appointed hour to get his pills.

His file contained no nursing notes for the 10 weeks leading up to his death despite the fact that hospital policy requires nursing notes on each patient at least once every four weeks.

On the day he died, Perez didn’t wake up and have lunch. He was scheduled to receive medications at 4 p.m. but did not show up at the medication window near the nursing station. An aide told police that he called out to remind patients to come for their pills. When Perez failed to show, the aide wrote an “R” with a circle around it in his chart to indicate that Perez had refused his meds.

Perez shared room 379 with four other men. His bed was just to the left of the door. Police reports indicate patients and staff were in and out throughout the day.

Staff later noted it was odd that he did not show up for dinner at 4:30. But it wasn’t until 7:35 p.m. that staff tried to wake him up for medications. That’s when they discovered Perez, who lay covered by two thin hospital blankets, had died. They called his family and then the police.

Improvements questioned

Perez’s death has prompted some advocates and state leaders to ask: Has the hospital changed at all?

On Thursday, a newly formed hospital advisory committee is expected to question hospital Superintendent Roy Orr about the death and the Department of Justice letter.

During a recent interview, Orr said he was surprised by suggestions from federal officials that conditions at the hospital have not improved. Those same officials visited in July and “they all said it was clear to them that we’d made progress,” he said.

Since the federal government issued its scathing report in 2008, Oregon has broken ground on a $250 million hospital. Lawmakers have committed more than $60 million to hire more than 500 new employees. Officials are pushing a “continuous improvement” plan that addresses everything from patient aggression to electronic record-keeping.

Still, Orr concedes, “Mr. Perez’s death was a real opportunity for us to zero in on changes.”

The hospital has revisited its policy on what to do when a patient refuses medications.

Because people with severe mental illnesses die, on average, 25 years earlier than those without mental illness, doctors are paying more attention to a mental patient’s physical well-being.

And since Perez’s death, the hospital has changed its rounds policy. From now on, for each hour a patient is in bed, staff is required to “confirm patient viability” through observation, touch — or the sound of breathing.

— Michelle Cole

http://www.oregonlive.com/politics/index.ssf/2010/03/patients_death_points_to_persi.html

Waterford man who stabbed mother committed for up to 15 years

Article published Mar 12, 2010
Waterford man who stabbed mother committed for up to 15 years

By Karen Florin
A New London judge ruled this morning that a Quaker Hill man who stabbed his elderly mother last year and chased her into a neighbor’s home should be confined for up to 15 years at the Whiting Forensic Institute.

James C. Perkins, 37, suffers from chronic paranoid schizophrenia and has a history of not taking his medication, according to court testimony. He has been at the state’s maximum security psychiatric hospital in Middletown since January, when Judge Susan B. Handy found him not guilty by reason of insanity. He sat hunched over in a New London courtroom this morning while a social worker testified about his condition.

Perkins was charged with first-degree assault and first-degree burglary after he stabbed his mother, Edith Perkins, at their James Avenue home with a kitchen knife on Jan. 17, 2009.

According to court testimony, he followed Mrs. Perkins when she ran to a neighbor’s home seeking safety and broke through an interior door to get in. He chased his mother out the back door and back to the street, where he continued to stab her. He struggled with police, who used a Taser and pepper spray on him without success.
Edith Perkins suffered two stab wounds to the neck and three defensive wounds on her left arm.

Attorney Peter E. Scillieri sought the commitment to a mental hospital for Perkins, who has a history of mental illness. Prosecutor Paul J. Narducci did not object to the so-called “NGRI,” or not guilty by reason of insanity defense.
Handy listened to evidence in January and found the state had proved, beyond a reasonable doubt, that Perkins committed the crimes. She found him not guilty, however, because she said the defense had proved, by a preponderance of the evidence, that Perkins “lacked substantial capacity, as a result of mental disease or defect, either to appreciate the wrongfulness of his conduct or to control his conduct within the requirements of the law.”

Perkins returned to court today so that the judge could review his progress and determine how long he should be confined. He faced confinement of up to 40 years based on the crimes he committed. He will be under the care of the state’s Psychiatric Security Review Board, and may eventually be allowed to transfer to a lower level facility or be released to the community with supervision.

Social worker Susan McKinley, part of a team of clinicians that evaluated Perkins at Whiting, testified that Perkins has been cooperative with his treatment and that he is “mortified” by the events of January 2009. She said he appears to have made every effort to hold his life together and not to be a further burden to his parents, who are both ill.

“This court finds the release of James Perkins would cause a danger to himself and others,” Handy wrote in her decision. She said that the Psychiatric Security Review Board would notify Perkins’ mother and the neighbors who were victimized of any hearings concerning his confinement status.

http://www.theday.com/article/20100312/NWS02/100319896/1047