Stricter rules adopted for patient outings from mental hospitals

The escape of a mentally ill patient in September has prompted the state Department of Social and Health Services to adopt stringent new rules on which patients can go on outings from the state's mental hospitals.

Forensic patients — those judged criminally insane — will not be allowed to go on field trips unless a conditional release has been granted by the courts and local law enforcement, and the patients' victims have been notified in advance, according to the changes announced today.

Additionally, field trips will be limited to no more than four patients at a time, according to Susan Dreyfus, secretary of the Department of Social and Health Services (DSHS), which oversees the state's mental hospitals.

The adopted changes were among those recommended by a state safety review panel that examined the escape of Phillip Arnold Paul, a mentally ill man who slipped away during an outing to a Spokane County fair on Sept. 17.

The review found that a number of errors committed by hospital staff and policy problems contributed to the escape.

Had staff been less friendly with patients, searched their backpacks and been clearly instructed in what to in the event of a breach of security, Paul may not have escaped, the panel found.

Many of the policy changes recommended by the State Psychiatric Hospital Safety Review Panel have already been implemented, according DSHS.

The review panel also recommended the state consider relocating all patients who have been found not guilty of a crime by reason of insanity to Western State Hospital in Lakewood, Pierce County. Unlike Eastern State Hospital, the forensic unit at Western is in a secure, separate structure.

That recommendation is under review.

Paul was committed to Eastern State Hospital after being found not guilty by reason of insanity in the 1987 slaying of an elderly neighbor. He had been on a hospital-sanctioned field trip with 30 other patients and 11 staff members to the Spokane County Interstate Fair on Sept. 17.

Paul, 47, slipped away from the group and was gone for about two hours before his disappearance was reported to law-enforcement authorities.

The review determined the reporting delay resulted from a lack of a designated staff leader. It also found that the staff had not planned for the possibility of an escape and that the response was, therefore, highly disorganized and chaotic.

The review found the staff should have immediately called 911, which it did not.

A massive manhunt ended three days later when Paul surrendered to police near Goldendale, Klickitat County, about 180 miles from the fair.

His escape — and the hospital's practice of allowing criminally mentally ill patients to go on field trips and outings — drew sharp criticism from Gov. Chris Gregoire and Spokane County Sheriff Ozzie Knezovich.

The state's three mental hospitals also temporarily ceased all field trips.

Many said that Paul should have never been outside the state hospital's walls.

Knezovich threatened to bill the state for the manhunt and said he planned to ask the state Legislature to ban field trips for the criminally insane.

Dreyfus ordered an immediate halt to all outings involving forensic patients — people who have been committed as a result of criminal proceedings — and asked the review panel to make policy change recommendations.

The panel concurred with an internal critical incident assessment conducted by Eastern State Hospital, which found discrepancies in policies on safety, security, emergency response notification and the manner in which policies were implemented.

Christine Clarridge: 206-464-8983 or cclarridge@seattletimes.com