A crackdown on patients leaving the grounds of state mental hospitals put in place after the high-profile escape from an outing to the Spokane County Fair in 2009 will be largely reversed, thanks to a settlement reached earlier this month with patients who contended the rules violated their civil rights.
Six patients and Disability Rights Washington, an advocacy group, sued the state in 2014, alleging that restrictions on access to hospital grounds and outside trips, implemented after patient Phillip Paul walked away from his field trip group in 2009, violated patients’ constitutional rights.
Patient advocates say the settlement will put doctors, not politicians or administrators, in charge of treatment decisions for patients.
“We’re not just freeing people willy-nilly. It’s about the doctors making a decision,” said Andrew Biviano, a Spokane attorney who represented the patients in the suit. Biviano is running for Spokane County commissioner as a Democrat against incumbent Shelly O’Quinn, a Republican.
The settlement will allow patients in the hospitals’ forensic wards to have standing court orders allowing them to leave hospital grounds, making therapeutic field trips and family visits easier. It will also require more frequent review of cases to see whether patients are progressing toward release.
“We have confidence that this agreement will balance the treatment needs of our patients and the public safety needs of the community,” said Carla Reyes, a DSHS assistant secretary. “We look forward to continuing to improve our discharge and treatment processes for the patients we serve.”
Prior to Paul’s escape, patients at state psychiatric hospitals regularly went on field trips to shop at stores or attend community events. Those trips were designed to help people reintegrate into the community and anticipate privileges.
“As they got better, they would be allowed to get increasing freedoms,” Biviano said.
A judge committed Paul to Eastern State Hospital after finding he was not guilty by reason of insanity in the killing of a Sunnyside schoolteacher in 1987. He walked away from a field trip to the Spokane County Interstate Fair, prompting a three-day regional manhunt.
News reports, including those in The Spokesman-Review, described Paul as a “paranoid schizophrenic killer.” Biviano said such reports stoked fears from the public and ignored the fact that Paul was doing well in treatment.
People demanded action from legislators.
Biviano said the controversy regarding such visits reflect a common view that “not guilty by reason of insanity” is just another way to say someone is guilty of a crime and deserves to be punished.
“The state has no right or permission to punish them because they were found not guilty,” he said. “They were insane, they had no moral culpability. They didn’t know what they were doing.”
A law passed in 2010 required patients in the hospitals’ forensic wards to get a court order to leave the hospital for nearly any reason other than a dying family member. Many patients who had privileges found them revoked overnight.
“These weren’t just fun trips. They were part of the treatment that was provided,” Biviano said. “Their right to freedom was forfeited in the name of public safety.”
Ketema Ross, a Spokane resident and one of the plaintiffs in the case, spent several years at Eastern State Hospital without being allowed to go outside on hospital grounds. He was stable, complied with staff orders and was described as a model patient, according to the suit. But after the 2010 law change, he was no longer allowed to go out into the community or onto hospital grounds.
“Those were the kinds of things that make life worth living. If you take those away and do the math, there aren’t as many things to look forward to. That made for a much more dangerous hospital,” he said.
The resulting atmosphere made people feel hopeless and depressed and led to more friction between staff and patients, he said.
“It took away people’s ability to heal,” he said, adding that the changes after the Paul escape reflect the belief that people sent to the hospital after committing crimes are beyond repair.
“It’s largely a reflection of the way society looks at people in the hospital as a whole. People don’t look at people locked away in the hospital as citizenry,” he said. “What this settlement agreement will do is remind people and DSHS as a whole that we are still humans. We are still citizens.”
Ross, who has schizoaffective disorder, was committed to the hospital by court order in 2007 after being found not guilty by reason of insanity for assaulting his neighbor in Pullman. At the time, he was experiencing delusions and believed he had to attack his neighbors to stop a terrorist attack on orders from the president.
He stabilized and responded well to treatment almost as soon as he was sent to the hospital but had to fight to show he was stable enough to be released. Finally, Ross won release in 2015 after spending seven years at Eastern State.
“From a legal standpoint, it was not just a waste of public resources. It was a trampling on of my constitutional rights,” he said.
Ross said if the guidelines in the settlement had been in place when he’d been sent to Eastern State, he would have spent far less time there.
“It’s at least nudging in the direction of a cultural shift, a systemic shift in the way business is done at the hospital,” he said.
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