State tightens rules for mental-hospital outings

The escape of a mentally ill patient during a field trip to a county fair in September has prompted the state Department of Social and Health Services (DSHS) to adopt stringent new rules on which patients can go on outings from the state's mental hospitals.

Forensic patients — those judged criminally insane — will not be allowed on field trips unless the patient has been granted a conditional release by the courts that is supported by the hospital and the patient's treatment team.

In addition, law enforcement and the patient's victims must be notified in advance of the field trip, according to the changes announced Thursday by DSHS.

Field trips also will be limited to no more than four patients at a time and hospitals will be required to keep up-to-date photographs and clothing descriptions of the patients.

"Public safety should always be our top priority," said DSHS Secretary Susan Dreyfus. "These recommendations will help ensure that."

The panel that recommended the changes is also suggesting the state transfer all criminally insane patients from Eastern State Hospital to Western State Hospital in Pierce County, where a secure, separate, locked-down facility is available.

The recommendation will be investigated, according to Richard Kellogg, director of the state's Mental Health Systems and supervisor of the state hospitals.

The panel was created to review security at the state's three mental hospitals after the escape of Phillip Arnold Paul, a mentally ill patient at Eastern State Hospital who slipped away during an outing to the Spokane County Interstate Fair on Sept. 17.

Paul is one of approximately 194 mentally ill people who have been charged with a crime but found not guilty by reason of insanity and sent to the forensic units at one of the state hospitals.

The hospitals also treat people who have been civilly committed for treatment and people who have been charged with a crime and sent to the mental hospital to have their competency restored. The hospitals are overseen by DSHS.

Paul was committed to Eastern State Hospital after being found not guilty by reason of insanity in the 1987 slaying of an elderly neighbor in Yakima County.

He was on a hospital-sanctioned field trip with 30 other patients and 11 staff members when he slipped away. His disappearance was not reported to law-enforcement authorities for nearly two hours.

A massive manhunt ended three days later when Paul surrendered to police near Goldendale, Klickitat County, about 180 miles from the fair.

His escape — and the hospital's practice of allowing criminal mentally ill patients to go on field trips and outings — drew sharp criticism from Gov. Chris Gregoire and Spokane County Sheriff Ozzie Knezovich.

The sheriff has asked the state to reimburse the county more than $37,000 for the cost of the search.

After the incident, the CEO of Eastern State Hospital, Hal Wilson, resigned one month before he was scheduled to retire.

All field trips were temporarily canceled and Dreyfus convened the State Psychiatric Hospital Safety Review Panel to look at security and safety policies and practices.

According to the panel's review, a number of policy discrepancies and staff errors contributed to Paul's escape.

The review found that many hospital policies were outdated or had not been followed. The panel also found there existed a culture of friendliness between patients and staff members that may have led to poor supervision.

In addition, the review found, there was no designated leader on the field trip, the staff had not planned for a possible escape and it had not been clearly told to call 911 in the event of a security incident.

Despite the negative attention focused on the state hospitals, the "disturbing incident provided an opportunity to recommend positive, and doable, changes," said Kellogg.

In addition to the already implemented changes, the state will look at the possible creation of permanent independent Psychiatric Security Review Board that could provide more oversight and counsel on matters relating to forensic patients.

Among those who served on the panel that reviewed the Paul incident were mental-health advocates, a state Department of Corrections official, King County Prosecutor Dan Satterberg and Knezovich.

Christine Clarridge: 206-464-8983 or cclarridge@seattletimes.com