Eastern State Hospital sanctioned over delayed mental health evaluations

It’s been three months since prosecutors charged Christopher Ramirez with killing his uncles, Arturo Gallegos and Juan Gallegos-Rodriguez, at their apartment in Spokane Valley.

But his trial is on hold until Eastern State Hospital can complete a court-ordered mental health evaluation determining whether Ramirez is competent to stand trial.

Relatives told police he was paranoid, “prone to regular mental breakdowns” and would “freak out for no reason,” court documents show. A judge ordered an evaluation, and Eastern State received the order and supporting documents on Feb. 14. Despite a state law setting a one-week target for competency evaluations once the hospital receives an order and report, Ramirez is still waiting. And he’s not the only one.

Since last December, Spokane County Superior Court Judge Sam Cozza has found the hospital in contempt of court in 11 cases for failing to evaluate inmates promptly. As of March 6, 39 people jailed on felony charges were waiting for an evaluation at Eastern State. Thirty-one of them had been waiting for more than a week.

Eastern State is one of two state-run psychiatric hospitals for adults in Washington. The hospital is tasked with evaluating people accused of crimes who are suspected of being incompetent to stand trial – meaning they’re incapable of understanding the charges against them or assisting in their own defense. Evaluations can be requested by any party in a case, and are required if a defendant intends to plead not guilty by reason of insanity. If a defendant is found competent, a trial can proceed. If not, the defendant is committed to Eastern State to receive treatment with a goal of restoring his or her competency.

In one case, a man accused of breaking into his ex-girlfriend’s house waited 122 days for a completed evaluation after Eastern State received an order, court records show. The average wait time for a completed competency evaluation at Eastern State for defendants referred from jail was 50 days in the third quarter of 2014, according to a report submitted to the Legislature by a branch of the Department of Social and Health Services, which oversees the hospitals.

Delays like that keep defendants who may have severe mental health issues in jail. Spokane County Jail has four full-time mental health professionals on staff, but their focus is on stabilizing inmates in crisis, not on longer-term treatment.

“When people with mental illness hit our door, they’re in pretty bad shape. Our goal is to get them stable,” Spokane County Jail Sgt. Tom Hill said.

The jail has a cell block reserved for people with mental health issues. It usually houses about 30 inmates, Hill said. Those inmates have cellmates and common time outside cells where they can watch TV or do other activities.

But inmates who pose safety risks to themselves or others, whether mentally ill or not, may end up in more restrictive housing. In a worst-case scenario, that means segregation housing, where inmates are kept in cells by themselves for 23 hours per day. At least three of the Spokane County inmates whose delays have led to sanctions against Eastern State were housed in the jail’s segregation unit for some portion of their stay in jail, according to court records.

Several public defenders and disability rights groups filed suit against DSHS last August, alleging delays in competency evaluations violate due process by keeping mentally ill people waiting in limbo until state hospitals have the capacity to evaluate them. A federal judge in the Western District of Washington agreed with them in a December ruling finding that wait times at both hospitals are a due process violation. A trial in that case to determine a limit for acceptable wait times is scheduled to begin Monday.

The state’s “failure to provide timely services to these detainees has caused them to be incarcerated, sometimes for months, in conditions that erode their mental health, causing harm and making it even less likely that they will eventually be able to stand trial,” Judge Marsha Pechman wrote in her ruling.

In each of the 11 cases in which Cozza has found Eastern State in contempt, he’s ordered the hospital to pay $200 for each day each inmate’s evaluation is delayed. That money is supposed to be deposited in a Superior Court fund, to be allocated later. Ramirez’s evaluation is now set for March 24, which would be 31 days longer than the seven-day maximum set by state law.

Assuming his evaluation continues as scheduled, Eastern will end up paying $6,200 for the delay. The total bill for all 11 cases tops $86,000, assuming the hospital meets the scheduled evaluation dates for Ramirez and three other inmates who still are waiting to be evaluated.

Eastern State is responsible for evaluating defendants in all 20 Washington counties east of the Cascades and has a staff of six evaluators. DSHS says understaffing, lack of funds and an increase in evaluation requests have all contributed to longer wait times.

DSHS pays the psychologists who perform evaluations between $61,632 and $82,896 per year – less than competing organizations like Veterans Affairs or private mental health facilities can offer. That makes it difficult to recruit and retain qualified evaluators, said John Wiley, a DSHS spokesman.

“The department does not deny that these wait times are unreasonable. The wait times are clearly unreasonable and the department is doing everything in its power” to reduce wait times, said Andrea Utigard, an assistant attorney general for the state, defending Eastern State at a March 6 contempt hearing.

But she objected to the court fining the hospital.

“Any monetary sanctions are coming directly out of Eastern State Hospital’s operating budget. Every time the department is sanctioned … it impacts the department’s ability to provide resources,” she said.

Requests for evaluations have increased over the past decade, with a 30 percent increase from the beginning of 2011 to 2014. Cozza noted this trend in a Dec. 15 hearing in which he found the hospital in contempt for evaluation wait times for five defendants. He attributed the rise to “a greater recognition of mental health issues among criminal defendants and perhaps a little bit more aggressive posture on the part of the defense to seek competency evaluations for people where there’s a suspected problem.”

Kari Reardon, a Spokane County public defender, represents 10 of the 11 defendants in cases in which Cozza has held Eastern State in contempt. She said she’s seen more defendants with mental health problems in recent years, as cutbacks in state funding have led to more mentally ill people being released earlier from state hospitals.

“When you’re pushing to get people out of the hospital, they’re going someplace,” she said. Often, she said, people end up on the streets, then in jail.

Legislative action may help ease some of these problems. The supplemental 2015 budget, signed by Gov. Jay Inslee on Feb. 19, provides $8.6 million in funding for increasing capacity at both state hospitals, including funds for hiring and retaining staff to provide competency evaluations. A DSHS news release said that funding would allow Eastern State to hire two new evaluators.

A law signed by Inslee on March 12 sets a target of seven days and a maximum time limit of 14 days for competency evaluations for defendants in jail. That clock begins at the time the state hospital receives an order for the evaluation, plus discovery documents, criminal history and other information from the court.

Reardon said she’s concerned about the 14-day timeline in the new law, especially because it allows a seven-day extension on competency evaluations for “clinical reasons” but doesn’t require notifying a defendant’s attorney when that occurs.

She’s hopeful the pending federal court case will force DSHS to get their wait times down so they don’t violate due process rights.

“They have to find a way to do it,” she said. “They have to do more.”