In recent months, court commissioners on both sides of the Cascades have found the state of Washington in contempt, and even imposed fines, over access to state psychiatric care for people with severe developmental disabilities.
The cases involve people who’ve been found to pose an imminent risk to themselves or others, but are languishing in local hospitals.
Their plight has become the latest legal front in a years-old battle over the availability of beds at Western and Eastern State Hospitals, the state’s two psychiatric facilities.
For families, the delays in access to care and the ensuing legal battles have been anguishing.
Last October, Dawn Akerman moved her 51-year-old brother Fred to Washington from Texas in hopes he’d get better care for his severe intellectual disabilities.
But in November, Fred violently lashed out at Akerman and her husband. The police were called. With no crisis intervention beds available, Fred was taken to the emergency room at Providence St. Peter’s hospital in Olympia.
There, Fred was found to meet the criteria for involuntary commitment at a state psychiatric hospital. But because of the long waitlist to get into Western State Hospital, Fred remained at St. Peter’s. First he was boarded in the emergency room. Eventually he was admitted to the hospital.
As the days passed, Fred’s behaviors intensified and the hospital had to take steps to protect its staff.
“It was scary, I think, for the staff and they put a 24-7 security guard on him and they also had a CNA [certified nursing assistant] in the room, so they had two fully staffed, 24-7 people in his room,” said Akerman, who is also her brother's legal guardian.
At times, her brother had to be physically restrained.
“He was like, ‘I’m stuck Dawn, I’m stuck’ and that’s all he could say and I’m like ‘I’m sorry,’” Akerman said.
Fred didn’t like being stuck in the hospital. His family wasn’t happy he was there. And, it turns out, the hospital wasn’t pleased either. Eventually, Providence St. Peter's did something drastic. It went to court to force the state of Washington to take Fred off its hands.
“It’s not the ideal situation, it’s not what we want to have to do,” said Michelle James, the hospital’s chief nursing officer.
James said hospitals play an important safety net role, but are not the appropriate place to care for a developmentally disabled person with severe behavior issues.
“We don’t have the resources and the environment that that particular person needs to really thrive,” James said. She spoke generally about the issue because she was not authorized to discuss any specific cases.
In December of last year, a judge ordered Fred moved to Western State Hospital. When that didn’t happen immediately, the court found the state in contempt and imposed sanctions. The transfer finally happened in mid-February, after the state racked up $62,000 in fines.
By then, Fred had been at St. Peter’s for three months. Akerman is still angry it took so long.
“What they are doing is so very wrong and immoral and I can’t believe they get away with it legally,” Akerman said.
But what happened to Fred is not an isolated case. Over the past 18 months, Providence Health and Services has sought court orders in Thurston County and in Spokane County to require the state's psychiatric hospitals to take over care of developmentally disabled patients who've been involuntarily committed.
In at least three cases, when the state has been slow to act, court commissioners in both counties have found the state in contempt.
Most recently, that happened last month in Spokane County in the case of Mirriam, a 19-year-old woman who is at Providence Sacred Heart Medical Center awaiting a bed at Eastern State Hospital. According to her parents, Scott and Charlene Hamilton, their daughter has a genetic condition that presents like severe autism and is at times accompanied by violent outbursts.
Mirriam was taken to Sacred Heart's emergency room in June after reporting that she had swallowed glass. After a mental health evaluation, she was found to meet the criteria for involuntary committment. Since then, Mirriam has remained at Sacred Heart, during which time her parents said her behaviors have often been disruptive.
“It’s not physically good for her, it’s not emotionally good for her … it’s hurting her,” said Charlene Hamilton, who is also her daughter's legal guardian.
The delays in admitting patients to the state’s psychiatric hospitals come as both Western and Eastern State Hospitals continue to grapple with long wait lists. As of last week, 63 people were awaiting a civil admission bed at Western State.
“We do follow the court’s orders when we have the appropriate spaces to get them in,” said Sean Murphy, the assistant secretary for behavioral health at Washington’s Department of Social and Health Services.
Murphy said that while his agency takes court orders seriously, he doesn’t think whether someone sues should have a bearing on where a patient is on the waitlist.
“I do believe it is important to recognize that they’re lots of competing interests and we want to serve the folks who need the resources the most,” Murphy said.
Murphy noted that state lawmakers prioritized mental health funding in the current two-year state budget. The budget includes pre-design money for two new, state-run psychiatric facilities in the community with a total of 64 new beds.
However, it's not clear those new beds will add capacity because, at the same time, the number of civil beds in the state hospitals is slated to decline. Instead, those beds for non-criminal patients are being converted to forensic beds to better serve patients who require competency restoration services before standing trial for alleged crimes.
In Fred’s case, his eventual move to Western State Hospital was not the end of the story. In fact, the cycle repeated itself this summer when Fred was released back into his sister’s care. There was another incident where he bit her. He ended up back at St. Peter’s.
Once again, the hospital went to court and obtained an order for Fred’s immediate placement at Western State Hospital. After another delay, he was moved back to the state hospital in mid-August.
The fact people with developmental disabilities are ending up involuntarily committed and hospitalized concerns advocates.
"The systems are failing the people," said Donna Patrick, the public policy director for the Washington State Developmental Disabilities Council.
Patrick said the situation highlights the need for more robust community-based services and emergency supports for clients of the state's Developmental Disabilities Administration and their families.
"If our residential providers were staffed and supported to take care of people, and if our families were being supported, then we wouldn't have as much crisis," Patrick said.
This October will mark the one year anniversary since Dawn Akerman moved Fred to Washington, a decision she has since come to regret.
“In hindsight, we probably would have left him down there,” Akerman said.
The question now is what happens next. Akerman's hope is the state can find her brother a stable placement in the community with the support he needs to end the cycle of going in and out of the hospital.