Ross Settlement

 

How did the Ross Settlement Impact the Not Guilty by Reason of Insanity Program?

In 2014, select patients found to be not guilty by reason of insanity and sent to the state hospitals for treatment brought a lawsuit against DSHS. The named plaintiffs were six NGRI patients at Western State Hospital and Eastern State Hospital, as well as Disability Rights Washington. The plaintiffs alleged that patients’ rights were being violated due to inadequate treatment and release planning.

Why was the lawsuit brought?

For decades prior to the lawsuit, patients received treatment that increased stability, allowing gradual reintroduction into the community, for instance through supervised trips to visit family or go to the store. According to hospital data, this careful and deliberate release planning provided the proper balance of patient recovery and public safety and resulted in streamlined releases of patients who no longer needed to stay at the hospital.

In 2010, a series of new state laws added restrictions to the release process for NGRI patients. The new laws generally required the NGRI patients to obtain a court order to leave the hospital, including for family visits or taking a walk off of hospital grounds, even if doctors recommend this for treatment and recovery.

These laws also created the Public Safety Review Panel, an advisory panel composed of a psychiatrist, psychologist, prosecutor, law enforcement representative, consumer and family advocate representative, and a public defender. This panel provides an additional layer of review before NGRI patients are permitted to leave the secure areas of the state psychiatric hospitals.

In the view of the plaintiffs, because the changes in the law delayed the treatment and recovery process, plaintiffs brought the lawsuit in an effort to ensure timely clinical decision-making while respecting the safety of patients and the public.

Dismissal order for the Ross v. Lashway case

On Aug. 7, 2019, a U.S. federal court dismissed the Ross, et al. v. Lashway et al case after the Department of Social and Health Services demonstrated it had greatly improved policies and practices, trained staff, and hired new staff tasked with ensuring the continuation of program improvements allowing patients found not guilty by reason of insanity a better chance of success once they are approved to leave either of Washington state’s two adult psychiatric hospitals.

Our Agreement

The plaintiffs and the defendants agreed that there were several steps the hospitals could take to improve the treatment and release process that could bring significant benefits to patients without having to involve the court.

For example, it was agreed that treating clinicians are in the best position to make individualized treatment decisions. The hospitals also agreed to help patients obtain necessary court orders and begin reintegration as clinically appropriate. They also agreed that when a patient no longer presents a substantial danger to others as a result of mental illness, the petitioning process for release should promptly begin.

DSHS also made the following commitments to improve patient care and release:

1. Individualized Treatment Plans: Patients have individualized treatment plans. Beginning at admission, the treating facility assesses the patient and then offers treatment to assist persons acquitted as NGRI in preparing for the release process to account for the safety and security of the individual and of the public.

2. Grounds Privileges: The grounds privileges review and implementation process has been improved and streamlined. For example, readiness for both grounds privileges and release are assessed within 30 days of admission and at least every three months afterward during quarterly treatment meetings. A court order in not required to obtain grounds privileges in all circumstances.

3. Release: The conditional release and unconditional release processes have been streamlined with deadlines for the facilities’ Risk Review Board and Secretary of DSHS to respond and submit timely recommendations with the courts.

The goal of the agreement is that implementation of a conditional or unconditional release is accomplished as promptly as possible after it is clinically appropriate. The facilities offer assistance to patients to advocate for their own release, even if the facility is not in agreement with the request. Clinical factors, conduct, history, and public safety risk, rather than a simple categorization of offenses, determine an individual’s fitness for release.

4. Restraints used only when clinically indicated: Restraints are not uniformly used on all patients when being transported off grounds of the facility. Instead, a doctor’s order is required, documenting why restraints are needed for that patient.

5. The privilege system: Behavioral Health Administration facilities providing care to NGRI patients have a uniform NGRI Community Access Privilege policy. Community access privileges increase on an individualized basis as patients progress in their treatment and risk is sufficiently mitigated. Conversely, privileges can be restricted if behaviors and/or response to symptoms change to the extent that risk is not sufficiently mitigated for safe exercise of privileges.  

6. Patients’ role in treatment and release planning: Patients have a right to their treatment records and to participate in a review of their treatment plans every 90 days. Patients will be given opportunity for input during the development of post-discharge conditions, such as appropriate housing and inpatient or outpatient addiction or mental health treatment.

7. Personal property: Staff must take the safety of all patients into account when approving access to personal property, but any restrictions must be consistent with clinical judgment and facility accreditation standards. The agreement supports allowing patients’ access to their personal belongings as part of an individualized care and treatment plan.

8. Strip searches prohibited without a doctor’s order: Patients will not be strip searched unless there is clear clinical documentation that the patient has expressed or implied suicidal or homicidal ideation, or there is a reasonable suspicion with specific and articulable facts that the patient has potentially harmful items on their person.

9. Prohibition of staff retaliation: Any privilege restriction or ward/unit holds will be documented in the patient’s chart and must be consistent with clinical judgment. Patients disagreeing with privilege restriction can contact the Patient Rights Ombuds, who will have the power to request an independent review. Inadvertent and minor violations of facility policies, including policies that may be ambiguous or misinterpreted, are not grounds for restricting privileges, placing a patient on ward/unit hold, or revoking a conditional release.

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