The hospital that won't let people go

Six years ago, Richard Laing got drunk and hit his roommate in the head with a coffee cup.

He's been trying to get out of the Oregon State Hospital ever since.

Laing, 67, entered the Salem psychiatric facility in 2002. Though he had no symptoms of mental illness, he pleaded guilty except for insanity to avoid a 70-month mandatory prison term for assault.

Since then, Oregon taxpayers have shelled out an estimated $360,000 for Laing's care, even though records show he takes no medications and receives little or no psychiatric help.

After years of arguing for his release, Laing found freedom by escaping in November 2005. Three months ago he was hauled back, not because he was sick, but to face punishment for absconding.

"Can you imagine what it's like," Laing said, "to be locked inside an insane asylum when you're not insane?"

Laing's story illustrates what some say is a core problem at the 125-year-old hospital, now under threat of a federal lawsuit based on a lengthy list of civil rights violations that includes the failure to discharge patients who no longer need to be there.

Unlike other state-run mental facilities, the hospital's medical staff does not decide when forensics patients -- those who have committed crimes -- are discharged. Instead, Oregon leaves that choice to a five-person board that by law must consider public safety before patient needs.

The Psychiatric Security Review Board, headed by Portland lawyer Mary Claire Buckley, was created three decades ago to protect the public by monitoring the "ongoing progress" of those under its watch. It has broad authority to commit people to the state hospital, release them to a community program or free them.

But because there are so few community options for forensics patients, who make up nearly 500 of the hospital's 670 patients, Buckley and her fellow board members have been reluctant to release even those who are no longer acutely mentally ill -- even though others are in need of services at the hospital.

"The board's role is not to empty the state hospital," said Buckley, who spoke to The Oregonian about Laing's case after he signed a privacy waiver. "The board's responsibility is to protect the public. We're not in the business of letting people go just because the hospital is a snake pit or overcrowded."

Oregon is years away from building replacement facilities for the hospital, but in the meantime the state continues to grapple with crumbling buildings, inadequate staffing and severe crowding. Last month, a U.S. Justice Department report detailed pervasive problems with medical care, supervision and discharge planning.

The state's system shocked federal investigators, who'd never seen another hospital where a state board and not clinicians have such power, officials testified at a legislative hearing following the report's release. Now, lawmakers have begun to question the review board's role as they look to solve the hospital's problems.

"Make no mistake about it," Senate President Peter Courtney, D-Salem, said at the hearing. "We treat this hospital as though it's a prison."

Insanity defense

Laing, a former construction worker from California, was admitted to the forensics ward in early 2002 on a second-degree assault charge. An alcoholic, he said he was "bombed out of my gourd" when he hit his roommate.

"I had been drinking that whole weekend," Laing said, "and I whacked him with a coffee cup."

Under Measure 11, the state's mandatory sentencing law, he faced nearly six years in prison. So Laing said his lawyer recommended an insanity defense and told him he'd be out of the hospital "in three months."

Laing maintains he wasn't mentally ill. According to Buckley, a court evaluation said Laing was an alcoholic with a "self-reported" history of schizophrenia.

Once in the hospital, the months turned into years.

In August 2003, the review board refused to release Laing. Although he had no symptoms of psychosis, the board said he still hadn't come up with a "plan" to prevent a relapse into alcoholism.

Laing didn't give up. Desperate to escape what he called "barbaric conditions" inside the hospital, he appealed his case to the courts and decided to bide his time working from inside to help fellow patients.

Straight-talking and clear-headed, Laing reported the abuse and neglect of patients who couldn't speak for themselves. From pay phones in the forensic ward, he called reporters and state investigators, filling their ears with stories about overmedicated patients, bullying staff, bloody patient fights and ceilings that leaked sewage.

As news reports focused public attention on dire conditions at the hospital, lawmakers asked Laing to come to the Capitol and testify. Eventually, the state moved to replace the hospital with new facilities that are expected to open within the next four to five years.

But Laing remained behind the locked walls of Ward 50.

Release denied

Laing's hope for release was renewed in March 2005 when the Oregon Supreme Court ruled that people can't be held at the hospital if they have personality disorders or commit crimes on drugs but aren't mentally ill.

"I thought there was no way they could keep me after that," said Laing.

Still, the review board turned him down three months later.

Records today show that his only condition is antisocial personality disorder. But Buckley argues that hospital doctors have wavered on Laing's diagnosis, mainly because of his self-reported history. That, she says, is why the board has been reluctant to release him despite the absence of overt symptoms of mental illness.

In September 2005, the board did give Laing a shot by recommending that he be considered for release into a community program for drug and alcohol abusers. Because of the shortage of such programs, Laing said he got just one chance to interview for a spot. The program turned him down, and the board refused to release him.

Justice Department investigators focused on the problem in their January report criticizing hospital conditions, finding that the system allows community providers to "cherry pick" patients they want.

As a result, "some patients remain at OSH for months, or even years, after having met the criteria for discharge," the report said, citing 31 forensic patients who had waited more than three months for a transfer.

One patient was stuck in the hospital for four years unnecessarily, and investigators said the long waits for discharge violate patients' civil rights and make them sicker. "Patients' despair, anger, and agitation about having been turned down by community providers has become a part of their illness," the report says.

At a hearing in November 2005, Buckley and her colleagues turned Laing down for release once more.

The next day, he asked for an off-grounds pass to the Salem library. Instead, Laing hopped a Greyhound to Portland, vowing never to return.

"Once they get you here, they don't want to let you go," he said. "And this is a horrible place to live."

On the streets, on the run

For the next two years, Laing hid in plain sight.

He lived on the streets of Portland, collecting discarded soda cans and selling the Street Roots newspaper. And though he often slept under freeway bridges, Laing said he felt safer than inside the hospital.

In September 2006, Laing was on a bus in downtown Portland when he looked up and found himself face-to-face with Buckley, the hard-nosed administrator who had repeatedly denied his release.

She instantly recognized him.

Laing panicked and fled from the bus. Buckley chased after him.

"He jumped off, I jumped off," Buckley recalled. "I called police on my cell phone, trying to keep up with him. We ran around town."

Said Laing: "She was in heels, but I can't walk that fast because I'm old. She chased me through Pioneer Square, yelling at me, 'You're going to go back.' "

Laing eventually hopped on another bus and, once again, escaped.

Last October, Buckley again spotted Laing in downtown Portland, and he quickly boarded a bus. But a month later, he wasn't so lucky. Buckley saw Laing again, this time walking along Alder Street. She ducked behind a building, called police and followed him until they arrived and handcuffed him.

"I'm sorry it came to this," Buckley recalls telling Laing, "but you need to go back and try to get yourself out of the state hospital in a legal way."

Still fighting

Later this month, Laing will face Buckley's board to again argue that spending two years on the lam shows he can make it on his own without getting into trouble.

"I'm sure the fact that he was able to maintain himself in the community helps his argument that he is no longer mentally ill or poses a substantial danger to others," Buckley conceded.

The hearing will not involve the criminal charge pending from Laing's escape.

To address that issue, Laing and his attorney plan to rely heavily on the Justice Department's report, portraying the hospital as a dangerous place beset with rampant patient-on-patient assaults, multiple suicide attempts by patients, improper use of seclusion and restraint and poor medical practices.

Investigators also cited insufficient infection controls, noting that of 28 patient deaths between January 2005 and August 2006, "15 were from pneumonia, an infection-related condition."

"The hospital is so bad that I was justified in escaping," Laing said. "Running was the lesser of two evils."

Until his case is resolved, Laing is back where he started -- pumping quarters into the same ward pay phones he used more than four years ago to draw attention to his situation.

Hospital clinicians seem to be on his side.

His most recent treatment plan lists only one item: Laing is to receive "unfettered access" to his lawyer and the hospital's legal library, it says -- so he can continue to fight for his release.

Michelle Roberts: 503-294-5041; michelleroberts@ news.oregonian.com