Jail-based programs considered for State hospital forensic needs

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SALT LAKE CITY — As demand for forensic services exceeds available beds, the Utah State Hospital is considering jail-based options to restore the competency of criminal defendants.

Forensic patients are adults whom courts have found not competent to stand trial. Traditionally, they have been treated at the state hospital until their competency is restored or other placement is arranged.

While Utah's waiting list for beds is far smaller than other states, hospital officials have begun to work with sheriffs and jail captains along the Wasatch Front to serve patients in jail until beds open at the state hospital.

"How do county sheriffs feel about that? Does this require more time that these individuals stay in jail?," asked Utah House Speaker Rebecca Lockhart, R-Provo, during a meeting of the Audit Subcommittee of the Utah Legislature's Management Committee on Tuesday.

The hope is that launching competency restoration services in the jail will reduce the lengths of stays at the state hospital, said superintendent Dallas Earnshaw.

Presently, 45 people are on the waiting list for a forensic bed at the state hospital, which Earnshaw said was atypical. Usually, around 10 people are waiting for beds, significantly fewer than the 300 to 500 awaiting services in other states.

Legislative auditors, in a review of the Department of Human Services budget, found that some forensic patients' lengths of stay have exceeded what is allowed by law.

Over the past five years, 64 patients have been held longer than 365 days, the audit states.

A legislative audit says some forensic patients at the Utah State Hospital have stays that exceed limits in state law, resulting in waiting lists. State officials say patient cases are complex and the actual number of overstays is rare.

"Twenty-seven patients were held beyond the maximum length of stay; had they been released before the legal deadline, the state could have saved up to $3 million; had they been civilly committed, the state could have saved up to $289,000. In addition, beds would have been made available for patients on the waitlist," the audit states.

Earnshaw told lawmakers that each case has its own complexities.

“It’s actually very complicated, he said.

“It always is,” said Lockhart.

One issue is Utah's competency laws, which have a higher threshold for restoration than other states, Earnshaw said.

Lockhart said the audit suggests that hospital stays that exceed statutory limits may be the judicial decisions.

"I just have a hard time understanding how courts can just violate the law. The attorneys for the people being evaluated, are they not concerned about this taking so long?” she asked.

"They are. We're in discussion with them all the time. In actuality, these are very rare cases,” Earnshaw said.

Some patients also require services overseen by the Division of Services for People with Disabilities, which can extend the time they are hospitalized.

Many patients have significant physical illnesses on top of their psychiatric conditions, Earnshaw said.

"One of the issues the state hospital has, we need to provide that medical care for them as well," he said.

The audit noted that the cost of treating patients' medical issues "are unpredictable and vary greatly year to year."

The hospital's off-site medical costs were $597,107 in 2012 but exceeded $900,000 in 2013.

Auditors recommended that hospital administrators institute a fee schedule for off-site medical procedures, as well as establish contracts with regularly used providers.

Earnshaw said hospital officials agree with the auditors' recommendations but noted that the state hospital has unique challenges.

"It is a challenge to take patients off campus into the community and find providers willing to provide those services to us," he said.

Earnshaw said the growing demand for forensic services will be the topic of ongoing discussion with lawmakers.

The hospital has proposed four options to address the growing forensic population:

• Provide pre-admission, jail-based competency restoration services ($300,000).

• Privately contracting to provide jail-based competency programming ($2 million).

• The Utah State Hospital staff a step-down unit at the hospital for forensic overflow ($4 million).

• Build additional beds at the Utah State Hospital ($20 million) plus staff ($4 million per unit of 26 beds).

The most cost-effective option is restoration services offered in jails, though Earnshaw said he does not view it as a long-term solution.

"However, there are companies in other states who are looking at providing these services, and there are studies now that have proven that some of those programs have been effective," he said.