February 06, 2005

Sheriff calls for change to state regulations

By Dianna Cahn
Times Herald-Record

Goshen – Nobody knows what to do about Sheila West.

Not Orange County Jail, where, they say, the mentally ill West simply doesn't belong.

Not at the numerous psychiatric hospitals where she's been a patient. Security workers there say West is violent and volatile, but state regulations limit how she can be restrained.

West goes back and forth between jail and institution, punctuating the problem of what to do with mentally ill people accused of crime.

The answer, Orange County Sheriff Carl DuBois and jail corrections administrator Dominick Orsino said for the first time Friday: Change the state regulations.

It's the first time the county's top law enforcement officials are echoing what security workers at the hospitals have been saying for a long time.

"I think the union hit it on the head," said Sheriff DuBois. "(The state's) Office of Mental Health really needs to look at that policy."

West was charged with assault last week after striking a Security Hospital Treatment Assistant at Mid-Hudson Forensic Psychiatric Center. It's part of the pattern of this mentally ill 22-year-old. She lashes out through her insanity and assaults these workers.

She's sent to court.

Occasionally, she's sent to jail.

But within days, said Orsino, she becomes violent and unmanageable in jail and is transferred back to a psychiatric facility. Other times, like last week, a judge sent West back to Mid-Hudson for an evaluation of her competency to stand trial.

This is the end and beginning of the cycle through a pockmarked system that is the life of Sheila West. To many in the health care and corrections systems, West has come to symbolize what is wrong with state regulations.

"OMH should have a logical progression in place," said DuBois. "We are not a hospital. We are not designed for it or staffed for it."

Under state regulations, a patient can only be restrained for a short period – if at all – and must be placed in a room with the door open.

Treatment assistants, who work most closely with the patients on a regular basis, say these policies make them sitting ducks with violent patients like West, and they show their injuries as proof.

In the jail, said Orsino, West is placed in an observation cell, where she can be monitored from a distance. If she is moved somewhere, she is shackled. But, unlike in the psychiatric facilities, jail officials cannot force West to stay on her medications. That's when mentally ill patients begin to destabilize.

"She's been in this loop for quite a while," said Orsino. "We wish we could change this. We are not doing anybody any favors by bringing these people here."

Mid-Hudson and other state facility administrators are barred from talking to the press. They refer questions to the Office of Mental Health in Albany, whose spokesman offers scripted answers on the subject: OMH is concerned for the safety of both staff and patients; the policies are aimed at diffusing a crisis and staff are well trained.

On Friday they said: "Restraint and seclusion are very tightly regulated under federal regulations by the Joint Commission on the Accreditation of Health Care Organizations as well as by state laws."

Orsino just shakes his head.

"It's frustrating on all ends," he said. "I feel sorry for those guys if they are not able to manage these patients. I also think it would be difficult to manage an institution when the safety concerns are that deeply based on policies established at a higher level."