Minn. moves mentally ill patients to avoid legal action

A state-run program for mentally ill patients, faced with overwhelming demand, moved several inmates into a medical treatment area last week in a last-ditch effort to avoid legal action, according to internal emails obtained by MPR News.

The decision by Minnesota Security Hospital officials to turn a medical treatment area into temporary sleeping quarters for program residents was prompted by concern from judges and attorneys over a chronic shortage of beds at the St. Peter-based Competency Restoration Program, forensic administrator Carol Olson wrote in a Dec. 6 email to employees.

"Please recognize that this is not ideal," wrote Olson, the hospital's top administrator. "The pressure to move these individuals has become now a statement that if needed, court action will be taken against us."

The competency restoration program, run by the Department of Human Services, provides evaluation and treatment of mentally ill adults who have been charged with crimes but have been deemed not competent to stand trial. Participants receive legal education, psychiatric medication and other services so they can become competent and return to the courtroom.

"It's like going to school where they teach you, 'This is what a judge does, this is what your defense lawyer does,' " said Mary Moriarty, who manages the adult division of Hennepin County Public Defender's Office. "This is a plea negotiation."

The bed shortage has left inmates stuck waiting in county jails and state hospitals and delayed the legal process. As of Dec. 1, 23 people were waiting for a spot in the 25-bed program, according to Olson's email. The average length of stay is six months.

Hennepin County Judge Jay Quam, who handles the county's mental health cases, called the wait times unacceptable.

"The longer someone sits in an adverse environment like [jail], the more their mental illness becomes serious," Quam said Thursday. "And sometimes it's irreversible."

Quam said no one at the Department of Human Services notified him about the plan to turn a convert a medical treatment area into sleeping quarters for competency restoration patients.

Three people with direct knowledge of the facility said the plan is completely inappropriate because it's unsafe, provides little privacy, and is an affront to residents' dignity. They asked MPR News not to publish their names because they fear retribution from the Department of Human Services.

They said that before this change happened, the medical area was used for exam rooms and by nurses to temporarily monitor someone with a medical problem, like a contagious disease or an allergic reaction. It is not an area that's designed to be secure for long-term residents, they said, in part because the area also includes nearby rooms for electro-convulsive therapy, dental care, and minor surgical procedures.

"I know if I were a patient I wouldn't want to live in what is essentially a doctor's office," one of the people with direct knowledge of the facility said. The three people familiar with the facility said they're worried that competency restoration patients might be able to slip into one of the nearby treatment rooms and take medical supplies, like scalpels, which could be used to commit suicide or hurt someone else.

DHS deputy commissioner Anne Barry, who oversees the Minnesota Security Hospital and other programs, said the temporary fix, although not ideal, is safe. Patients living in the area will be closely monitored, she said, and the area meets licensing standards.

"We've made a commitment to the court to move people out of jails as quickly as we can so that they can start to get treatment in our programs, and this right now is the best way for us to do that," she said.

According to Olson's email, the decision to move competency restoration residents to the area came after top DHS administrators Alan Radke and Pat Carlson asked Olson and medical director Steven Pratt to expand the program by four to six beds as soon as possible.

The email said the facility planned to put four beds in the medical treatment area, starting Dec. 7, while it looked for a permanent spot elsewhere at the facility to add four to six beds.

Those who are "the best to be able to sleep off the unit" will be moved to the medical area, the email said.

The rest of the program will remain the same. Participants who sleep in the medical area will spend their days in the regular competency restoration program at the facility, Barry said.

The lack of bed space is not a new problem. Olson's email notes that concerns about the shortage have "been 'cooking' for some time, but came to a full boil" last week.

The program "has been recognized for a long time as needing to be approximately 40 to 50 beds on this campus," but only has room for 25 beds, the email said.

"This has not been very well accepted by jails, courts, judges, attorney, etc... who are not happy with [State Operated Services] when individuals are committed to this program, but have to wait in jail for an available bed," Olson wrote. "More importantly, it is not the right thing to be doing to these individuals."

There are also delays in moving participants out of the program. Nearly half of the participants are ready to leave, but are stuck waiting for judges and attorneys to decide how to proceed with the criminal charges against them, according to the Department of Human Services.

Another reason for the delay is that legal rules allow prosecutors to wait up to three years for a defendant charged with a felony to become competent. It's rare for defendants to spend the full three years in the program, but with so few beds, having just a few long-term defendants is a problem.

Barry, the DHS deputy commissioner, said the department is working more closely with the courts to move patients back to the courtroom when they're deemed competent, which will free up beds for new patients. The department also plans to ask the state for more money, she said.

Olson's Dec. 6 email suggests that other patients at the Minnesota Security Hospital will need to be moved around to find space to create more permanent beds for the competency restoration program.

The Minnesota Security Hospital's primary role is to provide treatment to nearly 400 adults committed as mentally ill and dangerous. Patients are spread out in several buildings on the St. Peter site, which sits next to the Minnesota Sex Offender Program.

During the last 12 months, the facility has been under scrutiny for licensing violations, staff injuries and the controversial tenure of administrator David Proffitt, who was forced to resign in March because of his abrasive management style. Olson was hired to head the facility after Proffitt left.

"[T]here will be some hard decisions to make around patients and where they will best be served," Olson wrote in the email to employees. She asked employees to provide suggestions to their supervisors about how to deal with the issue.

"There will not be any program on this campus that will not be affected by this and hopefully we can move forward positively," she wrote.

Hospital at Risk:
Danger and Dysfunction at the Minnesota Security Hospital
► State facility for the mentally ill risks losing license over turmoil
―Published: Feb. 28, 2012
► Data: Violence, restraints common at Minnesota Security Hospital
―Published: Feb. 28, 2012
► David Proffitt, head of Minnesota Security Hospital, resigns at state's request
―Published: March 27, 2012
► Former Minn. Security Hospital leader's 'extremely assertive' style rankled some
―Published: March 28, 2012
► State failed to review troubled past of ousted Minn. Security Hospital administrator
―Published: March 30, 2012
► Auditor to look at agency's hiring practices in wake of Proffitt dismissal
―Published: April 2, 2012
► Former Security Hospital head still getting paid
―Published: April 12, 2012
► After complaints, MN Security Hospital inspected
―Published: April 13, 2012
► Plan gives DHS more oversight in state mental health services
―Published: April 20, 2012
► Funding for St. Peter hospital renovations in doubt
―Published: April 27, 2012
► Security hospital worker 'emotionally abused' patient
―Published: May 1, 2012
► Security Hospital in line for fraction of funding request
―Published: May 4, 2012
► State investigating Security Hospital's handling of missing patient, stabbing
―Published: May 9, 2012
► Investigation shows complexity of caring for the state's most violent and mentally ill adults
―Published: June 8, 2012
► DHS confirms resignation of executive
―Published: Aug. 23, 2012
► More injured employees, fewer doctors at Minnesota Security Hospital
―Published: Aug. 29, 2012
► Minn. moves mentally ill patients to avoid legal action
―Published: Dec. 14, 2012

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