Evaluators’ missed deadlines are forcing release of mental patients
Each year, a little-known provision in state law forces King County to cut loose nearly 200 patients in need of treatment for severe and dangerous mental disorders.
Seattle Times staff reporter
When police bring someone to a hospital for psychiatric assessment and possible commitment, a county evaluator must decide within 12 hours whether commitment is necessary. It’s six hours if the person is brought in by a family member.
Why law is needed
To prevent vulnerable citizens from being held indefinitely against their will.
What happens sometimes
Evaluators miss deadlines, leaving officials little choice but to release patients without treatment.
How to fix the problem
Solutions range from changing mental-health laws to putting more money into the system.
• Steve Anderson, emergency-room physician at Auburn Medical Center: Allow county mental-health evaluators to conduct assessments by video, a version of the medical trend called “telemedicine.”
• Anne Mizuta, chief King County involuntary-commitment prosecutor: extend the 12-hour and six-hour deadlines to account for the rising numbers of people needing to be evaluated.
• Eileen Cody, chair of the state House health-care committee: Allow private companies to bid competitively to provide mental-health services, which may force county operations to improve.
• Jean Robertson, director of King County mental-health services: Increase state funding to hire more county evaluators.
• Laurie Jinkins, chair of the state House Judiciary Committee: Put more money into early intervention and outpatient programs to bring down the number of people needing detention, lowering caseloads.
• State Rep. Tami Green: “Start treating mental illness like the medical condition that it is. We wouldn’t have a stroke patient waiting 12 hours before getting treatment.”
— Brian M. Rosenthal
County conceals, then releases emails
Late last fall, reporter Brian M. Rosenthal made public-records requests to the King County Department of Community and Human Services, seeking information about involuntary-commitment cases dismissed on technicalities.
Specifically, he asked for emails of three supervisors of the involuntary-commitment section, from 2011 to 2013, that contained such terms as “time limits” or “12-hour rule,” which refers to a deadline for how long county evaluators have to make certain commitment decisions.
When the public-records officer for the department replied, she had surprising news:
Sharon Logue said the employees searched but had no responsive records.
The Seattle Times knew this representation to be false, based on other reporting. In March, a Times lawyer, Eric Stahl, threatened to sue the agency unless it explained the failure, conducted a thorough search and paid for legal costs and penalties.
The King County prosecutor’s office replied in April that the department had violated the law and was conducting a new, thorough search. It eventually resulted in the release of more than 1,900 pages of emails and other documents, the fruits of which inform this investigation.
Logue and JoEllen Watson, coordinator of the mental-health evaluators, recently were given reprimand letters. The county settled Friday with The Times, paying $41,560 in legal fees and public-records-act penalties.
Three months ago at his family’s Redmond home, Gregory Benson charged across the living room and slapped his younger brother, shouting nonsense.
“There is a name!” he howled. “The name is Jesus Christ! Please leave, accordingly!”
The lanky 23-year-old was suffering a major psychotic episode, his first in five years. Back in 2009, he punched his dad, got arrested, refused treatment and ended up homeless for 18 months.
This time, his family hoped to avoid that, or worse, by quickly getting him into mental-health treatment. They called 911, and soon police and paramedics forced Benson into an ambulance that sped him to Bellevue’s Overlake Medical Center.
Once there, he tried to escape and had to be tied down on a bed. Doctors diagnosed him with schizophrenia. “Continued bizarre ideation,” one noted in his chart. “Nonsensical response to questions.”
The next step was for a King County mental-health evaluator to determine whether Benson legally could be detained and treated against his will. To meet the criteria, he had to be in imminent danger of harming himself or others, or in imminent danger due to being “gravely disabled.”
Although few people even among the hospital staff knew it, an unusual provision in Washington state law said the evaluation was supposed to be conducted within 12 hours.
The county evaluator missed the deadline, arriving eight hours late, but found that Benson was a danger to himself and urgently needed treatment. The patient was transferred to Fairfax Hospital, a private psychiatric facility in Kirkland, and his mother brought him a shopping-cart-sized bag of clothes for what she expected would be a long stay.
A few days later, the mother, Maria Benson, went to King County Superior Court for a hearing to formalize and extend the involuntary commitment. Instead she was told that Benson was getting released because of a “technicality” related to a missed deadline. Confused, she headed to Fairfax. But the hospital had no answers.
Her son had already been let go — and now was nowhere to be found.
Every couple of days
While officials have not reported the problem or even counted how often it happens, a Seattle Times investigation has found that people like Gregory Benson are now released on technicalities from King County hospitals — without treatment or monitoring — on average every other day. During a recent 10-week period, at least 35 people deemed by the county to be imminent threats to themselves or others were released after an evaluator did not show up in time — more than 5 percent of the caseload in that period, according to data collected by prosecutors at the request of The Times.
At that rate, 182 severely mentally ill people will be dumped out of the system this year.
“There are people who are psychotic, in need of help, and they get off on a stupid technicality, which essentially means that this poor person walks out barefoot and is in the middle of the street,” said Arpan Waghray, mental-health director at Seattle’s Swedish Medical Center, adding that, “You’re just waiting for someone to fail.”
“There should be no reason that a patient or family member should suffer due to someone’s incompetence or lack of time management,” he said.
County mental-health officials said their evaluators work hard but are hamstrung by an “overwhelming” rise in mental-health calls, an unfair state funding formula and the obscure law itself. “I wouldn’t blame anybody,” said Jean Robertson, director of county mental-health services.
The issue is unique to Washington, the only state in which involuntary detentions must be ordered by a county evaluator, according to the nonprofit Treatment Advocacy Center.
Enacted in 1973, the Involuntary Treatment Act was designed to protect patients from being detained for days while waiting for an evaluation. Very few mentally ill people are violent, and only about half of those evaluated get detained.
The law gives evaluators 12 hours to decide whether someone brought by police to a hospital for possible commitment should actually be detained. When the patient is brought by friends or family, the limit is six hours from when the hospital calls the evaluator.
Neither limit has ever before posed a serious problem. Even today, officials in populous counties such as Pierce and Snohomish said on average they respond to mental-health calls within one to three hours and hardly ever get ordered to release a patient because of time-limit issues.
But in King County, evaluators are increasingly struggling to meet deadlines. Their average response time was 11.8 hours last year, a 40 percent increase over 2010, according to a Times analysis. Their annual assessments grew 12 percent during that time, to 7,016, according to the state.
Supervisors in King County’s mental-health division have known about the surge in time-limit violations since at least 2011, mentioning it in staff memos and responding to complaints from frustrated hospital workers. But they have never seriously attempted even to determine how often patients get released, according to a review of thousands of pages of internal emails obtained by the newspaper.
Instead, some top officials have seemed to try to conceal the extent of the problem. In response to three Times public-records requests about the issue, King County’s mental-health division provided zero documents and then, in an unexpected follow-up, seven emails. Only after the newspaper threatened to sue did officials turn over a larger collection — 1,976 pages.
Nor has the county shared the problem with state officials. “I have not been contacted by anybody with concerns about the timelines,” said Chris Imhoff, the state Department of Social and Health Services manager who oversees involuntary commitment in the state.
One top state lawmaker gasped after learning from The Times about the number of detained patients released due to missed deadlines.
“Oh my God,” said state Rep. Eileen Cody, D-West Seattle, chairwoman of the House health-care committee. “That’s appalling.”
It is nearly impossible to learn what happened to the people in distress who have been released on time-limit violations already this year. All names and details were redacted from emails released to The Times. Court files of people facing involuntary commitment, which contain psychiatric evaluations, are not public. Officials said they were not allowed to track patients freed from court.
Robertson, the county director, said she believed many of the patients released were detained again soon thereafter, with deadlines presumably being met the second time around. This was speculation, she admitted, because no one has studied the issue.
Some may have recovered their mental health on their own. And some may have hurt themselves or others.
“The system is absolutely taking the chance of that happening,” said Stephen Marshall, an Overlake doctor and past president of the American College of Emergency Physicians’ state chapter. “It’s not hard to see that at some point, this is going to be harmful for a patient or a family or whoever is involved in that patient’s life.”
Anne Longin, a social worker at West Seattle’s Navos psychiatric hospital, put it another way:
“Sending somebody out of the hospital when you know they need help is hard,” she said. “We get used to it. It’s what happens. But they go, and a lot of times we just wait until we see them again and hope nothing bad happens in the meantime.”
7 miles in the cold
At 10:40 p.m. the night Benson was released from Fairfax, his parents heard a single knock on the door, a long pause, then another knock.
Their son stood on the porch, disheveled and shivering in 30-degree darkness. He had walked from the Kirkland hospital to their Redmond home, some seven miles.
The parents were relieved, confused and angry.
“We had been waiting almost two years to get him into a facility so he could get help. We kind of thought, ‘This is our chance,’ ” Maria Benson said. “I couldn’t understand what happened.”
Hospital records show it clearly: Benson was admitted to Overlake at 7:47 p.m. on Jan. 28 but not formally ordered to be detained by an evaluator until 20 hours and 41 minutes later, far more than the 12-hour limit for patients brought in by police.
The commitment case was voluntarily dropped by prosecutors, even though doctors “would have recommended further hospitalization,” according to records from Benson’s brief Fairfax stay.
Under “discharge plan” and “discharge medications,” the records list “none.”
Back at home, Gregory Benson wouldn’t eat or talk. In bed at night, he occasionally burst into raucous laughter, amused by one of several voices in his head, he would later say.
The family was frightened, for his safety and their own. It was especially hard on his 12-year-old sister.
King County officials say patients released on a time-limit technicality can quickly get re-detained if family members call for another evaluation. But Maria Benson found that process complicated and difficult.
She said she tried unsuccessfully to get another evaluation two days after her son was let go, and then tried again, day after day.
Out of desperation, she also called a Times reporter who had recently written an article about mental-health care. After she described what had happened, her voice faltered.
“What am I supposed to do?” she asked, anguished. “Do it all over again? And then what happens?”
Washington state’s mental-health-care system has more than its share of well-documented problems: It has among the fewest psychiatric-treatment beds per capita in the nation and a narrow commitment criteria — the “imminent danger” standard — that ensures only people on the brink of crisis can be forcibly treated.
What is notable about the time-limit issue, frustrated hospital staffers say, is that it involves the system willfully releasing people it knows are dangerous or in danger.
It’s a quandary that has also surfaced in other states. Until recently, Virginia had a law requiring that mental patients being held against their will had to be released if officials could not find them a bed in a psychiatric facility within six hours.
But lawmakers removed that requirement this year after Gus Deeds, a state senator’s mentally ill son, was released because no bed was available in time. He stabbed his father, then committed suicide.
In Washington state, the time-limit issue has gotten almost no attention. Dozens of people, from top lawmakers to front-line hospital psychiatric staffers and mental-health advocates, said they had never heard of it.
Robertson, the county director, said that’s because the deadlines hadn’t been a problem until the past few months. She said she has “not had a hospital contact me and said they were frustrated about this.”
But internal emails provide a different account. Hospital staffers have complained about evaluators moving too slowly since at least 2011, records show.
In July of that year, a nurse on her first night at Seattle’s Harborview Medical Center called the county mental-health division because it was taking so long for an evaluator to arrive that she thought she was being “hazed,” according to one email.
Last summer, as time-limit issues grew, Harborview social worker Molly McNamara wrote to JoEllen Watson, supervisor of the evaluators, to express “heartfelt pain” at the releases.
“When you have detained someone with REAL, ACUTE PSYCHIATRIC needs, we should be able to keep them and treat them,” McNamara wrote.
Six weeks later, in early October, Watson received an email from Susan Kennelly of the Veteran’s Administration hospital in Seattle, asking how to address the “time technicality” issue.
Watson replied that she would forward the message to Robertson and Robertson’s boss “so they are aware of how many cases we are losing at court because of our understaffing.”
“It is very upsetting, and we are working these (evaluators) to death,” Watson wrote.
While King County’s mental-health division has not acted, prosecutors have tried to address the time-limit issue in the past.
In 1999, when deadlines were a much smaller problem, top involuntary-commitment prosecutor Gerald Smith became frustrated after a handful of dismissals. He decided to appeal them. He was opposed by the court’s chief public defender, Richard Lichtenstadter, who argued the deadlines were an important protection of civil liberties.
The case, “In Re: the Detention of C.W.,” made it to the state Supreme Court. The justices agreed the prosecutors deserved flexibility, ruling patients shouldn’t be released unless a deadline was “totally disregarded.”
Fifteen years later, it appears that phrase is being interpreted in a way that favors the position of King County public defenders. Several patients have been released after mental-health evaluators barely missed the time limits, according to emails obtained by The Times.
In one example, a judge in March 2011 released a 26-year-old Kent man who had been brought to a hospital by his family because the county evaluation was completed in 6.5 hours — 30 minutes too late.
The man’s mother said recently she had no idea why he was released until she was contacted by The Times. Under state law, if the patient is an adult, the courts have no duty to notify parents about a dismissal.
For the Kent man, being told he was free to go had the perverse effect of convincing him he was fine, his mother said, and thereafter he became even less willing to take medication.
For months afterward, she said, she watched her son suffer from severe depression and worried that he might kill himself.
King County officials said judges have hewed tightly to the law in the past year, and public defenders have become increasingly assertive. Robertson acknowledged she has not raised the issue with either entity, or state officials or lawmakers.
She said she has repeatedly asked for more money from Olympia but never specifically mentioned that people were getting released on technicalities. Instead, she said the county has been hoping the rash of releases will subside when a new crisis-outreach team starts this summer, taking on some of the responsibilities of mental-health evaluators.
Robertson’s supervisor, division director Jim Vollendroff, pledged in a recent interview to find a longer-term solution, calling it a top priority. He said he did not yet have a plan or timetable.
Loved ones at risk
In the Redmond home now beset by anxiety, Gregory Benson worsened as his parents struggled to get help.
One afternoon, in the car on the way to a family dinner, Gregory turned to his sister and asked, “Who are you? What are you doing here?” Another night, he shoved his father down a staircase.
He would later tell a psychiatric nurse that he was having “homicidal thoughts.”
Finally, seven days after a missed deadline cut Gregory loose, his mother convinced the county to conduct another evaluation. Two women talked with Gregory for a half-hour in the same living room where he had threatened his brother. Then they went to the kitchen to tell his parents their assessment:
“You have no idea how severe he is.”
Gregory was taken back to Fairfax Hospital. But this time, with the time limit met, he stayed for 29 days. Doctors had to inject him with drugs at first, then got him into group therapy and slowly coaxed him back into his own mind.
He left the hospital March 12 in better shape than he’d been in years, his parents said.
But even as Gregory improved, his mother agonized. Recently, Maria Benson requested copies of the court and medical records from both detentions. She still wanted answers about how the state could declare her son sick and then refuse to help him.
“The hardest part is just feeling ...” she said, trailing off. “We were totally abandoned. What will happen if something happens again?”
Brian M. Rosenthal: 206-464-3195 or firstname.lastname@example.org. On Twitter @brianmrosenthal