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Errors preceded fair escape

Fri., Dec. 18, 2009

Panel faults hospital procedures, urges new rules for insane patients

Eastern State Hospital failed to train its staff adequately, ignored staff concerns about patients going on outings in the community and didn’t anticipate the possibility of an escape, a state review found.

The review was ordered after a criminally committed Eastern State Hospital patient escaped while on a field trip to the Spokane County Interstate Fair in September.

In its report issued Thursday, the review panel also recommended consolidating all patients ruled not guilty by reason of insanity in Tacoma’s Western State Hospital and establishing a psychiatric security review board similar to Oregon’s to manage dangerously insane patients.

The Department of Social and Health Services said Thursday that it has adopted many recommendations of the review panel, which was convened by Secretary Susan Dreyfus after Phillip Paul, who had been found not guilty of murder by reason of insanity, escaped Sept. 17.

Paul, who has been diagnosed with paranoid schizophrenia, had been in and out of Eastern State Hospital on court-approved conditional release several times since killing a 78-year-old Sunnyside, Wash., woman in 1987 during a psychotic episode.

However, a Yakima County Superior Court had ordered Paul returned to the Medical Lake facility a few weeks before he was taken on the field trip with 30 other patients.

After he escaped, hospital administrators waited hours before notifying law enforcement.

Paul, 47, was recaptured in rural Klickitat County three days after his escape.

Dreyfus immediately ordered a halt to all field trips by patients at Eastern and Western state mental hospitals while the task force reviewed the facilities’ policies and procedures.

Among the other recommendations in the panel’s report:

•Only forensic patients who have been cleared for conditional release or partial conditional release by the courts will be allowed to go on therapeutic field trips.

Patients whose conditional release has been challenged, as Paul’s was, will not be permitted to go on such trips.

•Law enforcement agencies will be notified in advance of field trips, as will victims and victims’ families if they request it.

•Field trips will be limited to no more than four forensic patients – those committed to the hospital through the criminal justice system – at a time. In addition, there will be a predetermined level of supervision and trip planning will include a review of patients’ behavior.

•Hospitals will maintain up-to-date photos of all forensic patients and descriptions of clothing worn on the day of the field trip.

•Any escape from a forensic field trip will be immediately reported to 911.

“Public safety should always be our top priority,” Dreyfus said. “These recommendations will help us ensure that.”

The panel did not recommend disciplinary measures at Eastern State Hospital, but Richard Kellogg, DSHS director of mental health systems, said Thursday that the Washington State Patrol was assigned to review staff roles during Paul’s escape.

Within days of Paul’s escape, Dreyfus accepted the resignation of Eastern State Hospital CEO Harold “Hal” Wilson.

Kellogg said DSHS will have to review the panel’s recommendation that a security review board be formed to evaluate treatment of forensic patients in terms of public safety.

“We are very interested in the recommendation and view it positively,” Kellogg said.

As for the panel’s recommendation to consolidate patients found not guilty by reason of insanity at Western State Hospital, Kellogg said it has merit, “but it’s not our top priority.”

Such a move, he said, has challenges related to patients’ family involvement and community access.

Kellogg said hospital staffs are being trained in the newly adopted policies and procedures and a decision will be made next week about resuming field trips.

The panel declined to endorse an alternative to the not guilty by reason of insanity verdict known as “guilty but mentally ill,” which has been discussed by state officials.



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