Mental-Patient Lawsuit Settled

After months of mediated talks, the state of Washington has tentatively settled a landmark lawsuit brought by Pierce County over the discharge of still-ill mental patients by Western State Hospital. The two-year-old suit alleged that from 2001 to 2004, certain patients' constitutional rights to mental-health care were violated and that Pierce County was forced to pay for patient services that were the state's responsibility.

In some cases, psychotic and suicidal patients were discharged from the psychiatric hospital to the streets of Tacoma or into facilities that could not meet their needs. Many of the patients soon cycled back to the hospital, according to court documents. Some ended up in jail. In one case, Western released a homeless man who was so psychotic that he was communicating by grunting, according to the court record. In another case, a skinhead known to be menacing to others, with schizoaffective disorder, was released to a boarding home in Pierce County, despite medical evidence indicating that he should still be in the hospital.

The Feb. 11 settlement requires the state to provide $2.5 million a year to Pierce County's mental-health system so the county can provide intensive services to about 100 patients such as these. The patients cited in the lawsuit, whose identities are protected by a court order, regularly cycled between the streets, Pierce County–funded mental-health agencies, and Western State, which is in the Pierce County town of Steilacoom.

In addition, the state Department of Social and Health Services, which operates Western State Hospital, agreed to provide adequate discharge planning for patients.

Outside experts working for Pierce County and the Washington Protection and Advocacy System found that about half of the patients discharged into Pierce County were handled in ways that were troubling.

Despite the settlement, it is unclear whether Gov. Christine Gregoire or the Legislature will include money for the lawsuit in the 2005–07 budget. Gregoire's proposed budget will be made public on Monday, March 21. Without funding from the state, the case could end up back in court. Says Fran Lewis, director of human services for Pierce County: "We are confident both the governor and Legislature will act upon this agreement."

Western State Hospital officials declined to comment on the settlement and the patient discharges. In the settlement, neither the state nor Western State admit wrongdoing. But it's clear from court documents that something very wrong was going on at the once-notorious mental hospital.

In one of the more disturbing cases described in court filings, a 54-year-old man, who had suffered from schizophrenia for 30 years and had committed violent crimes, was admitted to Western on April 10, 2003, on a 90-day involuntary commitment order. At the time of his admission, the man had been homeless for several months, had been assaulted on the streets, had been admitted to psychiatric hospitals multiple times, and was known to abuse cocaine and alcohol, according to court documents.

A psychological assessment of the man on April 23, 2003, notes that he "is not capable of caring for himself independently" but that he will be "discharged to a homeless shelter in Tacoma," according to the record. The patient sometimes spoke in gibberish, claiming it to be German, during his short stay at Western.

He was released from Western on April 25, 2003. That's two weeks after he was admitted to the hospital for a 90-day stay. The patient, in the opinion of a plaintiff's expert who reviewed medical records, was delusional and responding to internal stimuli—imagined voices, according to court documents.

The expert, John Elpers, a psychiatrist in California who reviewed 82 admissions to Western from Pierce County between 2001 and 2004, found that discharging patients in such a state placed them "at risk of suffering [irreparable] harm," according to court documents.

In another case, a 51-year-old woman was admitted to Western on Jan. 10, 2001, on a 90-day commitment. Western documents indicate that the woman had a long history of mental illness and commonly ended up in a psychiatric hospital after being abused by her husband. She was discharged from Western on Feb. 20, 2001, and was returned to the home where her abusive husband still lived.

A review of hospital records by Ivor Groves, a Florida-based psychologist, found that a 20-year-old man who was actively hallucinating was discharged to a boarding home in Pierce County. According to Groves, the man was a 6-foot-1 skinhead weight lifter who intimidated others. Groves asserted in court filings that the boarding house was inappropriate for the man and predicted that the patient would soon cycle back to Western State.

In other cases, Groves found, Western personnel had cut-and-pasted treatment plans from one patient's records into the records of another. "The implication of these findings is that a significant number of persons cycle in and out of WSH and other inpatient facilities," Groves states in a court filing. "This cycling results from inadequate discharge planning, a lack of community services to keep these persons stable, premature discharges, or a combination thereof." He adds that Western's discharge planning is not professionally acceptable.

Elpers found that 53 percent of the patients who were discharged should not have been discharged under any circumstances, according to court documents. In more than half of the cases he reviewed, patients discharged from Western were rehospitalized within six months to one year.