More criminal defendants with untreated psychosis languishing in Colorado jails will maim and kill themselves if the state doesn't reduce a growing backlog of nearly 350 people waiting for treatment at the state’s primary mental hospital, court-ordered monitoring reports predict.

And court documents and budget requests show that problems at the Colorado Mental Health Institute in Pueblo are likely to get worse before they improve.

“We see wait lists and wait times increasing exponentially throughout 2021, even if pandemic-related restrictions ended immediately,” concluded a report issued on May 24 by two experts monitoring the state’s mental hospital system for U.S. District Court Judge Nina Wang.

Furthermore, without significant increases in admissions to the Colorado Mental Health Institute in Pueblo, “we foresee serious injury and/or death occurring within this population of severely, acutely ill who have been court-ordered to treatment,” the experts wrote.

As court orders for psychiatric treatment for defendants nearly tripled in four years, new infection-control protocols to protect from COVID-19 restricted the state’s ability to admit patients to the hospital for those services, according to documents.

A crippling workforce shortage, with more than 300 open positions, is a major contributing factor, forcing the Pueblo mental hospital to close three of 24 units in recent months, according to Robert Werthwein, director of the state’s Office of Behavioral Health, part of the Colorado Department of Human Services, which oversees the state’s two psychiatric hospitals.

'People are fed up:' Staff shortages, waiting list grows at Colorado mental hospital

At the same time, state and federal regulators are demanding new construction to mitigate suicide risks at the hospital. The improvements required to fix life-threatening problems identified by regulators at the facility will further delay admissions for treatment, court documents state.

As a result, more criminal defendants suffering acute psychosis are stacking up in jails, unable to proceed to trial until they receive court-ordered mental competency evaluations or return-to-competency services from the state hospital, according to a court filing last month by the expert monitors.

The Colorado Department of Human Services has allowed conditions to regress back to the era before it signed a consent decree in April 2019, to resolve a federal lawsuit accusing the department of violating the due process of inmates, the report from experts Neil Gowensmith and Daniel Murrie states.

“One man — described as catatonic, psychotic, delusional and with bleeding genitals due to his bizarre behaviors — has been on the department’s ‘priority admission list’ for more than one month, and his total wait is now beyond six months,” their report said. “Another detainee has been on the same priority-admission list for weeks, even though he is described as ‘high acuity … aggressive … disoriented’ and threatening to staff.”

Between April and June, two inmates in county jails awaiting hospital admission killed themselves, the experts found.

Michael Pyle

Michael Pyle (Courtesy photo)

One was 42-year-old Michael Pyle, who was arrested and incarcerated on Jan. 22 at the Adams County Jail after he rammed a Thornton Police Department car and threatened an officer with a gun. His actions prompted a high-speed chase through the Denver suburbs, court documents show.

Pyle had terrorized his family, telling his mother that he believed his uncle had the "devil's altar" in his basement, his uncle, David Knipstein, said in a restraining order he filed in court after the arrest. Knipstein described in the document his nephew displaying "violent, erratic behavior."

Anne Pyle believes her son would be alive if he had been transferred to an inpatient bed at Pueblo hospital sooner and treated for his mental illness. But he spent about five months in the Adams County Jail, waiting for a bed at the hospital to open, before hanging himself on May 27.

"If he had only been able to get treatment, everything could have turned out differently," she said. "He had so much to offer and was such an incredible person."

Michael Pyle had been in the Pueblo mental hospital before, his mother said. He was diagnosed with several disorders and placed on medication. He received counseling, was released, got a good job and "seemed to be functioning well," she said.

When street riots started last year during the pandemic near his downtown Denver apartment, he "started spiraling downhill," Anne Pyle said.

"He told me he thought he needed to be in a hospital again, and he started trying to check himself in somewhere," she said, crying.

It was near Christmas last December, and Michael couldn't find anywhere that would take his Medicaid insurance or doctors to give him a referral, Anne Pyle said.

"I think he gave up," she said. "His only option was to get in trouble with the police."

While Pyle was at the Adams County Jail, a judge ordered Pyle to undergo mental health treatment at the Pueblo facility, so he could be restored to competency to stand trial.

"He was told he would be transferred to the Pueblo hospital," his mother said, but the wait stretched on.

"It's appalling," Anne Pyle said. "We should be ashamed of ourselves for the lack of mental health treatment, the shortage of beds and cuts in funding. I'm angry with the system and the legislators."

Colorado Mental Health Institute in Pueblo

The main entrance to the Colorado Mental Health Institute in Pueblo.

'Public health crisis'

Suicides and self-harm are among several consequences of admittance delays, and more such incidents are likely to occur, given the current conditions, the experts said in their memo to state health officials.

Twice as many mentally ill inmates are waiting twice as long now than in the past, a circumstance that Gowensmith and Murrie labeled “a public health crisis.”

“Some individuals have such severe psychiatric illness that they have covered themselves with urine and/or feces, eaten feces, cut or mutilated themselves, refused to shower for weeks, refused to eat for days, attempted suicide and at times been victimized or injured by staff or other inmates,” their May report found. “Some have also attacked staff or other inmates, when acting on paranoid delusions or hallucinations that are symptoms of their untreated psychotic illness.”

Untreated psychosis is a “life-threatening illness” with mortality rates around 7%, they noted.

Patients are entering the hospital from jails in more pressing mental distress, said Sallette Thompson, a psychologist who has worked at the Colorado Mental Health Institute in Pueblo for two years.

“I think the acuity has increased for a lot of reasons, not the least of which is COVID, which has increased stress on everyone,” she said. “Certainly, it’s going to hit more vulnerable populations in a larger way.”

Exacerbating the problem are demands from federal and state regulators for new construction at the hospital to mitigate suicide risks, which the two experts predicted in their August court report will further slow admissions to the state hospital.

The Joint Budget Committee, the legislative body that crafts the state budget, agreed last week to allocate the Office of Behavioral Health emergency funding of $4.1 million for mandated suicide mitigation efforts at the Pueblo hospital.

The agency asked for the money after federal and state regulators warned that the state’s license needed to keep the Pueblo facility open was in jeopardy, following a July suicide attempt, as first reported in The Gazette.

The survey by state regulators after that suicide attempt — which left a 20-year-old criminal defendant from Kersey with loss of brain function from trying to hang himself from the door to his room — found pervasive, life-threatening conditions in seven buildings housing patients at the hospital. The regulators demanded a plan to correct issues severe enough to “have caused, or are likely to cause, serious injury, harm, impairment, or death to a patient.”

Chase Falk

Chase Falk in the intensive care unit at a Denver hospital after he attempted suicide at the Colorado Mental Health Institute in Pueblo in July.

The directive hit as the number of people waiting in jails around the state for court-ordered mental competency evaluations or restoration services continued to mount.

The backlog has grown to nearly 350, Werthwein, of the Office of Behavioral Health, told the state’s Behavioral Health Transformational Task Force on Sept. 23. That’s up from what Werthwein said to The Gazette on Sept. 9 was a waiting list of around 300. Among those being delayed in a jail is “an actively psychotic pregnant female,” Werthwein said.

“Behavioral health right now in this state is the worst I’ve ever remembered,” he said. “It’s bad, people are really struggling.”

Staff shortages continue to be a stumbling block for resuming full operations at the Pueblo hospital, Werthwein said.

Pueblo hospital staff who have joined the labor union, Colorado Workers for Innovative and News Solutions, or WINS, which represents 31,000 state employees, participated in negotiations to raise the minimum wage to $15 for all state jobs and for an annual 3% cost of living raise for the next three years, said Thompson, the hospital psychologist and a union member.

State officials and the union reached the agreement last week.

“Lower wages have caused an exodus of staff to leave the hospital,” Thompson said. “I hope if we can fill some of these positions, we’ll be able to address the (jail) backlog better.

“We do this work because we love our clients — they’re funny and interesting and they want all of the same things we do,” she said. “For a lot of us it’s a calling, not just a job.”

Upgrades necessary to maintain federal funds

Details about the survey by state regulators that found life-threatening conditions at the hospital in Pueblo were referenced in the Office of Behavioral Health’s emergency budget request. The Colorado Department of Human Services declined to make the results public, as did the Colorado Department of Public Health and Environment, which conducted the survey of the facility.

In rejecting The Gazette’s request to release the findings, officials said the state health department was still investigating the July suicide attempt of Chase Falk. However, a provision in the state’s open-records laws allows the release of state agency investigative records if doing so “is in the interest of public health, welfare or safety.”

Some details of the survey could be gleaned from an analysis of the budget request submitted to the Joint Budget Committee. About $800,000 is needed to install new cameras, or the hospital will have to add 154 additional staff to keep patients safe, that analysis found. It further determined that more than $3 million is needed to address suicide hazards in patient rooms.

Crisis at mental hospital

The Joint Budget Committee granted the Colorado Department of Human Services’ request for $4.1 million in funding for suicide mitigation work at the Colorado Mental Health Institute in Pueblo.

Several hospital employees told The Gazette that mitigation devices on doors to rooms were supposed to prevent patients from self-harm but apparently weren't functioning properly. Falk's was at least the third suicide attempt this year inside the hospital, an employee said. An adolescent girl used shards from a broken mirror and a man used a razor to harm themselves.

The Joint Budget Committee staff also said the survey found that the psychiatric hospital’s “current incident management systems are outdated and inadequate in regards to data collection and regulatory compliance.”

The Joint Budget Committee expected a parallel request for more money for additional employees, said Colorado Sen. Bob Rankin, a Republican from Carbondale and member of the Joint Budget Committee, given that the mandatory improvements will change how the facility operates.

The hospital — which has seen state staffing plunge from 1,388 in 2020 to 1,158 as of Friday, with 304 positions vacant —  should beef up hiring, even if the new cameras are installed, the survey determined. Since the hospital will no longer be allowed to lock patients in their room due to suicide risks, an additional 27 safety specialists need to be hired, even as records show the hospital struggles to keep past staffing adequate, according to the analysis by the Joint Budget Committee staff.

“They were locking the doors of the patients for safety, but they have to have the doors unlocked, which means more cameras and surveillance by human beings,” Rankin said. “I’m sure another request will be coming along later.”

The upgrades are required for the hospital to continue to receive federal funding, Rankin said.

“We did not have an option, but it’s the right thing to do,” he said, noting that adding more mental health beds has been a longstanding need in Colorado.

Colorado Department of Human Services officials pointed out to the legislative budget-writing committee that past suicide mitigation requests for the hospital in Pueblo had been rejected in the past two previous fiscal years.

Greater health risk than COVID

The mandate to reduce suicide risk comes at a time when the state’s mental health system is already in distress.

Colorado remains under a two-year-old federal court consent decree that found the state violated due process by not providing mental health competency evaluations to criminal defendants on a timely basis. Not complying has cost the state $17 million in federal fines since March 2019, according to the Department of Human Services.

Gowensmith and Murrie, the two experts monitoring Colorado’s compliance with the consent decree for the federal judge, urged state health officials in their May memo to reconsider infection-control protocols at the state hospital, which they said had slowed admissions.

Months after that memo, in August, the experts reported to the federal judge in a court filing that despite their urging, state health department quarantine mandates that had left 90 beds at the state hospital empty, had not been relaxed. At that time, the waitlist for admission to the Pueblo hospital topped 300 criminal defendants.

“In our view, the untreated, severe psychiatric illness harming certain detainees waiting in jails is now a greater public health risk than the risk of spreading COVID-19 to or from these same individuals,” they stated in one court filing.

While judges order severely mentally ill inmates to be admitted to the psychiatric hospital within 35 days, some are now waiting more than six months for a psychiatric bed and not receiving treatment for their conditions in the meantime, the May report found.

Department leaders had made “substantial progress” until June 2020 in meeting the goals of reducing the number, length of wait and the suffering of the criminal defendants, the report stated.

However, the pandemic has twice halted admissions, from November to mid-December of 2020 and from early April into May, increasing the waiting list from 124 at the end of October 2020 to nearly 350 now.

“Many of these individuals need urgent inpatient mental health care,” the report said, yet “safe and reasonable options are virtually non-existent.”

Forced medications are not allowed in most county jails, private hospital beds contracted by the Department of Human Services at extra expense are full, and other private hospitals refuse to admit such patients, citing safety concerns, the report said.

The Department of Human Services may consider applying for emergency staffing assistance from a program that was reactivated last week, said agency spokeswoman Madlynn Ruble. 

The Staffing Shortage Fusion Center, led by the Colorado Division of Homeland Security and Emergency Management through the Colorado Unified Coordination Center, again is making short-term workers available to long-term care centers, hospitals, correctional facilities, homeless shelters and other licensed care facilities where shortages due to COVID-19 are impacting patient care.

Healthcare contractors, National Guard members, volunteers from the Colorado Volunteer Mobilizer program, nonprofit organization representatives and a Colorado Hospital Association program fill the slots.

“Colorado Mental Health Institute in Pueblo has not used Fusion in the past but will explore it as an option to address current staff shortages,” Ruble said in an email. 

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