October 10, 2008

Hospital is Working to Reduce Wait

By Linda Thomson Deseret News

In courtrooms throughout the state, it's not uncommon for someone to be declared "incompetent" to stand trial and, according to the law, they must be sent to the Utah State Hospital for treatment.

What actually happens, however, is that some of those defendants often end up on a hospital waiting list for a period of time and usually are jailed until a bed opens up at the hospital.

The good news is that since a 2007 state audit, the hospital has been tracking those on court-ordered waiting lists and has made sizable inroads in reducing the number of people on the waiting list as well as the wait time.

"Competency" in legal terms is a relatively low standard. A person is competent if he or she can understand the charges against him or her, comprehend the court process and help attorneys in his or her defense. It is quite different from an insanity defense, which has much more stringent standards and is rarely raised in Utah.

As the state's population has grown, so has the number of people who are mentally ill, which is one of many factors affecting the hospital.

"Even though the population has grown, the state has been proactive in trying to find ways to not criminalize the mentally ill, but there still is a shortage of beds," said Utah State Hospital administrator Dallas Earnshaw.

The hospital has 359 beds. Of those, 100 are "forsensic" beds, or those devoted to individuals who have been involved in a criminal court proceeding. Those could include people who have been committed under law, those found to be mentally incompetent to stand trial, people who have been found to be guilty of a crime and mentally ill, and those whose status is not guilty by reason of insanity.

The other beds include: 182 for other adults, 72 for pediatric services and five beds for acute recovery treatment.

In the past, there often was an average of about 20 criminal defendants on the waiting list to get "competency restoration" treatment at the hospital. Depending on how full the hospital was, wait times could be as long as 10 weeks.

The legislative audit recommended that the hospital speed up procedures for admitting and discharging such patients and also suggested the counties be charged a fee if they did not arrive promptly to take defendants whose competency had been restored back to their local jails.

The audit also urged better communication among the hospital, county attorney offices and local jails.

"Implementing those strategies was actually very effective," Earnshaw said.

As of January and February of this year, the waiting list contained an average of 18 people on it during those two months. The numbers on average began declining: March (13 on the list), April (15), May (12), June (11), July (9), August (7) and September (15).

The waiting time in general was about five weeks.

However, there is no easy way to predict crime or who might enter the criminal justice system, so the numbers can fluctuate -- as the September figures show.

"In September, we were doing quite well, but all of a sudden, we were hit with up to 10 referrals in a two-week period," Earnshaw said. "We had 10 (court) orders to restore competency, so the list jumped from eight to 18."

With discharges and new admissions, the average came out to 15 people on the waiting list, according to Earnshaw.

He suspects this was simply a fluke.

Hospital staffers also must factor in what type of mental illnesses or disorders they are dealing with regarding each patient who needs to have mental competency restored, which also can affect bed space.

"You would think there would be a direct correlation between the waiting list and wait time, but it depends on the type of patient we would receive," he said.

The increased communication involving courts, jails and the hospital has improved the situation overall, but there is an occasional slip-up.

Phillip Joseph Simmons, 36, recently was brought before 2nd District Judge Rodney Page for a review hearing. Simmons, who is charged with first-degree felony murder in a Bountiful slaying, was found to be mentally incompetent and was ordered into the hospital in May, but there was no space for him at the time.

Simmons remained in the Davis County Jail until his Sept. 23 hearing, at which time Page directed that Simmons be put at the top of the waiting list for a bed. Simmons' case will be reviewed by the judge on March 24, 2009.

Davis County assistant prosecutor Rick Westmoreland said "some miscommunication" involving the hospital resulted in Simmons staying at the jail so long.

"My experience was this was just a glitch, and not a systemic problem," Westmoreland said. "I have not run into this with other cases. Sometimes there's a waiting period, but my experience is more the four- to five-week kind of thing.

"I think they do a pretty good job," Westmoreland said. "Obviously they're an agency governed by the Legislature as far as money, and with the money they're allotted and the business we send them, they do a remarkably good job."

Salt Lake County assistant district attorney Alicia Cook said she has had a positive working relationship with individuals at the hospital.

"I've probably worked with them more than the average prosecutor because of the Brian David Mitchell and Wanda Barzee cases (the individuals charged with several crimes involving the alleged kidnapping of Elizabeth Smart)," Cook said.

"I have been very impressed with the doctors we have out there. I don't know much about the state hospital as an institution, but I have been impressed with the doctors -- their backgrounds, experience, professionalism."

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