‘We don't have prisoners': Eastern State Hospital works to balance patient rights, community safety

The review found the long hospitalization process unusually expensive, restrictive and not necessary for public safety. Jane McCarthy investigates.

MEDICAL LAKE, Wash. -- Over the summer, Washington state lawmakers failed to agree on a capital budget, which would have included expansions at both state mental health centers like Eastern State Hospital.

Months later, scores of state building and maintenance projects are still on hold.

Millions of dollars would have added more beds at Eastern State Hospital for mentally ill patients who may have committed a crime. Eventually that expansion should help get patients well and back to their lives faster.

An independent review found Washington state keeps forensic patients hospitalized far longer than other states. The review found the long hospitalization process unusually expensive, restrictive and not necessary for public safety. Some of the forensic patients agreed and a resulting settlement has been slowly forcing change at Eastern State Hospital.

Eastern State hospital started accepting psychiatric patients not long after Washington became a state. For more than 125 years, staff have quietly worked at the

Medical Lake campus to help patients push through mental illness and often the stigma associated with it.

"The first misconception I think people have about Eastern State Hospital is that it's a prison. And we don't have prisoners. Our patients are not committed to the department of corrections, they're committed to Eastern State Hospital for psychiatric care," said Eastern State CEO Dorthy Sawyer.

That care happens around the clock every day of every year. We do not hear much about what goes on here until suddenly, we do.

One of the cases seared into the public consciousness is the 2009 headline-grabbing escape of the man dubbed as a criminally insane killer, Phillip Paul. He was on a therapeutic field trip at the Spokane County Fair when he wandered away. Paul was found not guilty by reason of insanity in the murder of a woman 22 years prior.

“People were upset and I understand their initial reaction of being afraid because people didn't know what was going on. But the people who did know what was going on were the doctors at the hospital who assess everyone very rigorously, who are very cautious when someone has gotten better, when medication is working," Attorney Andrew Biviano said.

Biviano represented patients in Ross v. Inslee, a suit aimed at the Department of Health and Human Services and ultimately Eastern State and Western State Hospitals. The suit maintains in the wake of the Paul escape, the reaction was punitive to all Eastern state patients and unnecessarily stripped them of their liberties.

"And as a result, we collectively punished everyone at the hospital. Even those who were doing wonderfully. Even those who'd done everything we'd asked of them and had gotten better, recovered ready to return to their lives and support their families," Biviano explained.

The state legislature enacted a series of new laws that restricted freedoms and slowed the release process for NGRI patients.

Chad McAtter is a supervisor in Eastern State's forensic unit. His work includes helping forensic patients reintegrate into society, while ensuring public safety. After the Phillip Paul incident, he said reintegration became monumentally more difficult even when doctors recommended specific steps for treatment.

"Patients that had court orders to allow them to go into the community on authorized leaves either to attend AA or NA meetings, to meet with their corrections officer, to volunteer, go to school all of those were immediately put on hold. The wards were locked down and so there was no patient movement even on the grounds," McAtter said.

David Wilson was committed to Eastern State more than 10 years ago for setting fire to his neighbor’s house. So, can a man like Wilson actually get better?

"That is the main question. People have a hard time believing that someone with mental illness can get better. And that's what I hope this story and other media outlets can educate people on the fact that is not true. People get better all the time and completely better," Biviano said.

"When I came here I wasn't anywhere near like what I am now. I wouldn't have been able to do an interview like this 10 years ago. I would have been so scared. But now I've learned ways to communicate effectively and be able to share my feelings and emotions in a positive way," Wilson said.

If Wilson had been sent to jail for his crime, his time served likely would have been over.

"The irony of this is that people who are found guilty and are in jail or prison. They have a re-offense rate of close to 75 percent because the conditions that cause them to commit crimes are usually the same or worse when they get out. People who are released after not guilty for reason of insanity after treatment have a re-offense rate of less than one percent. That's because the conditions that caused it are gone," Biviano explained.

The hospital appears to be making strides in response to what the Ross settlement demands. The average length of stay for a forensic patient at Eastern dropped from 239 days in 2014 to 113 in 2016. That's not to say people are now being released prematurely. Eastern State officials insist their experts are always evaluating whether the risk of release is too great.

Studies show careful release planning, which includes trips off campus, helps lead to extremely low rates of forensic patients committing another crime. Simply put, it is better for the community and less shocking to patients, like Wilson, whose point of reference to the public dates back ten years. Under the Ross settlement,

Eastern is striving to get patients back to a place where they are reintegrated to society through more trips into the community before a full release.

"We're getting back to what we had done pre-2009. For example, we used to be able to take patients on staff escorted activities and we're just starting to get those privileges back for the patients," said McAtter.

Nobody likes a lawsuit, but the Ross settlement is one the staff at Eastern largely believe pushes everyone to a better place.

"I would say that, yes, it continues to get better. It's better now than it was two years ago and it'll be better in two years than it is today," Sawyer said.

There is a hearing scheduled for January for all parties of the Ross Settlement to check in to see if both Eastern and Western State Hospitals are complying with the agreed upon changes. This is an unfunded mandate so the hospitals have to figure out how to do it without any additional funding.

© 2017 KREM-TV


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