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Spokane, Washington  Est. May 19, 1883

Review of Paul escape highlights basic flaws

The state’s review of Eastern State Hospital patient Phillip Paul’s escape during a field trip to the Spokane County Interstate Fair in September shows that the opportunity for an “elopement” had been in place for a long time.

Protocols for authorized leaves, community outings, handling emergencies, the intermingling of patients of varying danger levels “were not uniformly up-to-date, systematically disseminated, or reliably implemented.”

In short, this was a disaster waiting to happen. That it didn’t turn out worse is pure luck and can be attributed to decisions Paul didn’t make.

The State Hospital Psychiatric Hospital Safety panel recommends many changes that should have been in place long ago. And though existing policies were often ignored, the panel did not return any disciplinary findings. That could still occur after the Washington State Patrol finishes a separate review. The chief executive officer of Eastern State Hospital did resign after the incident, but if others put the community at danger through actions or inaction, they should be held accountable.

For those wondering how a man deemed criminally insane could be allowed to attend the fair, the report offers details, though it couches the missteps in classic bureaucratic language that softens the impact.

For instance, “forensic unit practices had evolved such that they no longer aligned with existing policies or procedures in some cases.” Translation: Hospital staff failed to adhere to the rules. They should have been conducting and documenting risk assessments. They should have contacted law enforcement immediately when the emergency arose. Instead, they waited for hours.

Some of the recommendations of the panel are painfully obvious:

Patients whose conditional release is challenged – as was Paul’s – can’t go on field trips.

Any escape from a field trip will immediately trigger a 911 call.

Law enforcement will be notified in advance of such field trips.

Planning for field trips will include a review of patient behavior.

The simplicity of this advice suggests that the bureaucracy never seemed to consider the possibility that patients with significant mental illnesses and proven histories of committing violence might not want to return from a field trip.

Beyond obvious recommendations are suggestions to consolidate patients such as Paul at Western State Hospital and to form a security review board to judge how treatment intersects with public safety.

With this report in hand, the Department of Social and Health Services and the state hospitals must follow through to ensure public safety. That’s the best way to put this episode behind us.