'It's frustrating for everyone': Continued delays at the state hospital impacting Boulder County

May 27—Boulder County officials have continued to express their frustrations with ongoing delays at the state hospital, as the courts and jail have seen cases drag on while 50 to 60 inmates await mental health evaluations on any given day.

As of Thursday, officials said the statewide waitlist for people awaiting evaluations at the state's two psychiatric facilities, the Colorado Mental Health Institute of Pueblo and Colorado Mental Health Hospital in Fort Logan, is 460.

Leora Joseph, director of the office for the Office of Behavioral Health for the Colorado Department of Human Services, said the delays can be attributed to staffing issues, as the department is at a 45% vacancy rate for both sites.

"Like the rest of the country, we're struggling with our work force, and where this plays out the most is in our nursing," Joseph said.

Joseph said about half of the current nurses are contract employees and are not full-time state employees. As a result, there are about 100 vacant beds, 84 of them at the Pueblo hospital, because the state does not have enough staffing.

"The reality is, we've had to make the difficult decision to close some units," said Joseph.

The delays have had an enormous impact on the criminal justice system. When attorneys raise a competency issue, a criminal case cannot move forward until a defendant can be evaluated, and then treated, if it is found they are not competent enough to stand trial.

With many inmates not getting transported to Pueblo or Fort Morgan for the evaluation they need, inmates are languishing in the jail as their cases get pushed back time and time again to the dismay of judges and attorneys already dealing with a backed up docket due the COVID pandemic.

"Once an individual is committed to the state hospital in connection with a competency evaluation, the attorneys and the judge have little to no control at that point," Boulder County District Attorney Michael Dougherty said. "I think it's fair to say it's frustrating for everyone in the justice system. There is no set timeline for how long the delay is going to last, and the delay impacts every party in the case."

'It presents a very serious problem'

The issue was bad enough that Dougherty questioned the state hospital's ability to properly evaluate and care for patients in a motion asking for a competency hearing in involving the the case of the mass shooting at the south Boulder King Soopers in March 2021.

Dougherty in the motion noted that, at the time, 59 inmates were in the Boulder County Jail still waiting for a spot at the state hospital.

"When you think about the 59 individuals sitting in the Boulder County Jail, they've been denied an immediate transport to the state hospital, and that means a judge has ordered them to the state hospital for evaluation, care and treatment, and that treatment is delayed and they are sitting in a jail cell instead," Dougherty said.

Dougherty said in addition to the impact on the inmates, crowding at the jail becomes a community safety issue.

"In terms of community safety, it presents a very serious problem," Dougherty said. "That is 59 beds being taken and used."

But Division Chief Jeff Goetz said the impact of those awaiting transportation is actually much larger than just a single bed at the jail. Goetz noted that many inmates awaiting evaluation at the state hospital require special housing needs or must be placed in lockdown for safety.

"The police chiefs are mad because we've got the arrest standards in place still," Goetz said, referring to a policy enacted during the pandemic to reduce inmate population by only taking in defendants accused of certain crimes.

"We've relaxed them a little bit from the initial COVID standard, but where a dilemma comes in... If you and I don't get along, we can't be in the same cell together because bad things are gonna happen. So we go from a jail that could hold 542 people if there was a body in every bed, to now our max number is about 460 before we hit a panic mode where we need to figure out what are we gonna do with these extra people.

"So when we're trying to manage the jail, the impact that the state hospital has on us, not only by not being able to take the inmates that don't belong here, but now how do we manage the rest of the jail?"

Goetz said taking 50 of the inmates who require evaluation at the state hospital would likely open up space for 100 more inmates that don't have mental health concerns.

"So if we took those 50 inmates and move them where they belong, that opens up a lot of other possibilities here within the jail, which impacts the arrest standards, which impacts the issues that the cities are dealing with," Goetz said. "It would open up a lot more opportunity to deal with other issues that are going on."

Boulder County Sheriff's Office Sgt. Chris Reiss, who is in charge of the jail and court transport team, said the delays also mean his team doesn't get much in the way of advance notice when they need to get an inmate all the way to Pueblo or Fort Morgan.

"The problem with the state hospital is they'll let us know that there's a bed available, but based on my staffing, I'm short staffed too, like everywhere else," Reiss said. "I can't jump up and just get these people down there, so we try to do the best we can. I don't want them to lose a bed space so we will get them there. We haven't had that happen as far as I recall, losing a bed space yet, because we try to get it done soon."

Melanie Judson, the health services administrator for the Boulder County Jail, said inmates' conditions tend to get worse in jail without the care they need.

"That's the biggest problem that I have with it," Judson said. "These are people that are sick; mental illness is no different than medical illness. They need treatment, they need medication, they need help. And when they're in custody, in a locked area, they tend to decompensate; they get worse. And to have them linger for months in our jail, waiting for restoration, waiting for court dates; we do an injustice to the people that live in our county and to the families of these people that are suffering. So something has to be done."

And as inmates get worse, Reiss said it can become harder to get them to the state hospital, compounding the delays.

"They deteriorate so much in our facility that it takes time for us sometimes to talk them into going with us," Reiss said. "We do get orders from the courts to get them there by any reasonable means necessary, but my team doesn't wanna use force on these people, so they have to spend an exorbitant amount of time trying to talk them into going. And if they refuse, then it becomes more of an issue if they keep refusing."

Pam Levett, the jail's Mental Health Clinical Supervisor, said they have an inmate who has been waiting almost 300 days for an evaluation. She said other inmates have spent 459 days and 628 days waiting, while one inmate was in custody for more than 1,000 days and had to make four different trips to the state hospital.

"That was very disturbing to all of us," Levett said. "Four different times to the state hospital on one case is unimaginable."

State law prevents any inmate from being kept in custody, whether at the jail or in custody at the state hospital, for a period exceeding the maximum sentence on the most serious charge filed against them.

As the delays at the state hospital have worsened, Dougherty said they have already seen some inmates who had to be released after essentially being forced to serve the maximum sentence on their case without benefit of a trial or even plea negotiations.

"It's not fair to the defendant who may want to litigate his case or believes he may want to go to trial," Dougherty said. "It's also certainly not fair to the victim and the community. It's outrageous we're running up against delays so long that cases can be dismissed or individuals have to be released because of delays at the state hospital."

Added Levett, "Having a mental illness should not be a crime."

'Our solutions are unique'

Goetz said there are some local solutions that may help a bit with the backlog. The jail's pending alternative sentencing facility could open up some space, and other mental health facilities in the county could also provide bed space.

Goetz said the county has also reinstituted a "gaps team," a group of individuals from different parts of the justice system whose goal is to monitor cases that have, for one reason or another, fallen through the "gaps."

But ultimately, officials agreed the change needs to come at the source of the problem, or changes at the county levels will just be stop gaps.

"This isn't just a Boulder County issue, all the jails on the Front Range are experiencing the same thing," Goetz said. "Our little tiny jail that we have here, in the big scheme of things in the state, we've got 50 people waiting to go. What about the other Front Range jails, the other big nine jails in the state? What do you suppose their numbers are? So I mean it's a huge problem and there's not one finger in the dike that's gonna fix this."

Joseph said the state is also trying to examine other options to try and alleviate the backlog.

"These are very complicated problems that need a nuanced response, there is not going to be one quick fix here," Joseph said. "Colorado is not the only state dealing with this problem and this exact issue. People with severe mental illness caught up in the justice system, it's not unique to Colorado. However, many of our solutions are unique."

Those solutions include trying to get judges to allow more inmates to get out-of-custody evaluations, a dedicated competency docket for cases involving mental health concerns, a transition facility for patients, and studies on mental health issues in the homeless community.

"Approximately 50% of the people waiting in jail (for evaluations) are people experiencing homelessness," Joseph said. "We have some funding that the Legislature gave us to analyze other places that are succeeding in handling this population through treatment and community placement."

But ultimately, Joseph said the state hospital needs to address its employee shortage.

"We won't be able to solve the waitlist problem without solving our staffing problem," Joseph said.

As far as staffing at the state hospital, Joseph said the pandemic had a huge impact on its workforce.

"COVID had the effect of burning out a lot of our medical workforce," Joseph said. "The U.S. is facing a nursing shortage, and Colorado is not an exception to nurses leaving the field or becoming contract nurses."

But officials also pointed out that the state hospital's issues date back even before the start of the pandemic in 2020.

in 2019, Colorado and disability advocates reached a new agreement that resolved an eight-year legal battle over long waits that created a system of fines to penalize Colorado when it fails to meet deadlines. Colorado has paid the fine every year since.

"This is not just my opinion based on what I see, a federal judge fines them every year for $10 million," Dougherty said of the continuing delays. "Every year $10 million of taxpayer money is being used to pay a fine because the state hospital is understaffed and overwhelmed."

Joseph said to get more nurses, the state has created a $14,000 hiring incentive. Since implementing the bonus in March, Joseph said they have already hired 11 new nurses, more than double the eight they were able to hire in all of 2022.

"That's significant money that is competitive in the industry right now," Joseph said.

Dougherty said it was good to see the state beginning to look at solutions, but said the delays need to be addressed sooner rather than later.

"In fairness, over the last couple months I believe the governor's office has become focused on this issue, and I'm hopeful we'll see improvements soon," Dougherty said.

"But it's long overdue, because until it does community safety is going to suffer, people are going to suffer and defendants are going to suffer."

___

(c)2023 the Daily Camera (Boulder, Colo.)

Visit the Daily Camera (Boulder, Colo.) at www.dailycamera.com

Distributed by Tribune Content Agency, LLC.