WPAS wins stunning victory in court

Public policy
David Lord
Director of Public Policy

WPAS Wins Stunning Victory in Pierce County v. State of Washington

Last month, the Washington Protection and Advocacy System (WPAS) and Pierce County Regional Support Network (RSN) won a stunning victory for Washington State mental health consumers in Pierce County v. State of Washington. This lawsuit was originally brought by Pierce County RSN and WPAS joined the court case as a plaintiff almost two years ago. Ira Burnim, the legal director of the Bazelon Center for Mental Health Law, was also an attorney on the case.

The case is not yet completed and a trial is scheduled for November. However, the judge has already made two significant rulings and a major part of the case settled.  As a result, people who use State mental health services have won three important victories:

  • The State must provide appropriate treatment for long-term hospital patients.
  • Western State Hospital has a new discharge policy that will be monitored by WPAS.
  • The State can no longer automatically take money away from community service providers when too many patients are admitted to Western State Hospital.

Appropriate Treatment for Long Term Hospital Patients

On September 9, 2005, Thurston County Superior Court Judge Paula Casey ruled that the State is responsible for taking “custody” of patients with 90 or 180 day civil commitments.  This means that the State can no longer refuse to treat these patients when Western State Hospital (WSH) is full.

The State left many patients with 90-day and 180-day commitments at community hospitals, emergency rooms, and sometimes even jails.  As a result, these patients were stuck in “evaluation and treatment” and other facilities.  These facilities are not designed or licensed to provide long-term psychiatric hospital care.  Patients who have longer commitments don’t receive adequate treatment in these short-term facilities.

As a result of the Judge’s ruling, the State must take “custody” and it seems likely that the State will have to open a new ward at WSH.  However, an increase in hospital beds should only be a short term strategy to address the Judge’s ruling. In the long term, more effective community supports should be put into place.

WPAS to Monitor Discharges from State Hospitals

As a result of a partial settlement of the lawsuit, Western State Hospital has a new discharge policy.  The new policy requires that patients be psychiatrically stable at the time they are discharged, and they cannot be discharged to a place that is likely to cause their mental illness to become worse.  The implementation of this policy will be monitored by WPAS. The State agreed to the policy after WPAS and the Pierce County RSN showed that numerous hospital patients had been inappropriately discharged from the State psychiatric hospital.  Patients were sent to the streets, homeless shelters and other unsafe situations.

WPAS began its investigation over two years ago after receiving reports of people being discharged to the streets.  “The investigation was hard work – and you couldn’t do it from the office,” explains Debbie Dorfman, WPAS Legal Director.  “Legal team members interviewed homeless people in shelters, streets, and jails.  We found out how bad the ‘patient dumping’ was at Western by talking to the people who experienced it.  For example, some people had to walk to shelters in downtown Tacoma from WSH.”  There was no discharge policy at Western State Hospital.

The investigation took months to complete.  WPAS staff visited shelters, soup kitchens, boarding homes, clinics, and community providers.  Many people were interviewed and the records of many patients were examined.

WPAS investigator Craig Awmiller was swamped in paper.  “The documents!  There were thousands of them.  We pored over files for months.  We reviewed records at Western, at community agencies, and records from the State,” Awmiller said. “ Then, we had to get examples of discharges to the experts.  They determined whether or not the discharges were up to professional standards.”

The WPAS team found many instances of poor and unsafe discharges.  An examination of Western State Hospital patient discharge records by a national expert, Dr. Ivor Groves, found that 46 percent of those discharges did not meet professional standards.  Another expert, Dr. John R. Elpers, UCLA Professor of Psychiatry, stated that “in regard to discharge planning, [Western State Hospital] treatment teams are indeed doing the same unsuccessful thing over and over again . . . that places their patients at risk of suffering immediate and irreparable harm.”

Community Services Cannot be Punished when Patients are Admitted to Western State Hospital

Judge Casey also ruled that the State can not charge the Pierce County Regional Support Network “liquidated damages” for admissions to Western State Hospital.  These charges reduced the money the RSN has available to provide community services by over $1 million per year.

For several years, the State has set a limit on how many patients can be admitted to the state psychiatric hospitals from each Regional Support Network (RSN).  When there are more admissions than this limit, the State automatically charges a penalty against the community providers.  The theory is that the community providers will do anything to avoid having their clients admitted to the State hospital, because they will have to pay a huge penalty if there are too many admissions.

WPAS supports the goal of serving people with psychiatric disabilities in the community.  However, as Awmiller puts it, “the State’s method for reducing hospitalization makes no sense. They are actually taking away the money from community providers when they don’t succeed in avoiding hospitalizations.  That’s backwards.  Community providers need more resources, not less, to keep their clients out of Western.”

Instead of punishing failure, the State should mandate that community providers use services that have been shown to be effective in preventing hospitalization.  However, these services don’t come free.  Siphoning money out of the community through liquidated damages only makes the problems worse.

The money taken away from the community as liquidated damages should be used to pay for individualized, wrap-around services.  Instead of requiring a client in crisis to go to a community mental health center or other agency, services and supports travel to the client.  WPAS will advocate for the development of these sorts of community services.

Potential Impact of the Settlement and the Orders

The partial settlement and Judge Casey’s orders in this case have major implications.

First, the court’s requirement that the State take responsibility for long-term patients will increase the size of Western State Hospital in the short term – but patients will no longer be kept in community facilities, including jails, that aren’t able to meet their needs.

Second, WPAS will closely monitor the discharges from WSH and will challenge the State when discharges don’t meet the policy’s standards.

Finally, the end of liquidated damages could result in the restoration of millions of dollars to community programs.

The Pierce lawsuit shows that reducing the size of the State hospitals is not a worthy goal if the result is patients dumped onto the streets or denied hospital care when they need it.  Downsizing must be done appropriately and safely.  The lawsuit also affirms that well-funded, quality community services are a solution for many of the serious problems of the State’s mental health system.