Todd Van Dorn is clear on his motive for stabbing an Oregon State Hospital psychiatrist in the neck with a pen. He was betting that the assault would get him out of the hospital's...

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SALEM, Ore. — Todd Van Dorn is clear on his motive for stabbing an Oregon State Hospital psychiatrist in the neck with a pen.

He was betting that the assault would get him out of the hospital’s forensic program and into the state penitentiary, an attempt that ultimately failed.

“I just got sick of everything that was going on in the hospital,” Van Dorn told The Statesman Journal newspaper of Salem. “I wanted to go to prison, where I thought the conditions would be better.”

Van Dorn’s story is just one example of the problems plaguing the crowded state hospital, where forensic wards house more than 480 patients, about 65 percent of the hospital’s total population. Most have been charged with crimes and found guilty but legally insane.

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An investigation by The Statesman Journal found six core problems with the state hospital’s forensic program:

• Overcrowding is serious in two complexes housing forensic patients that remain outdated despite expensive patchwork renovations. In some units, more than 40 patients occupy space designed for 30.

• Court judgments send alcoholics, drug addicts and criminals to the state hospital even though they are not mentally ill.

• A reportedly outdated system of monitoring criminally insane patients is used by a state board that controls patient discharges.

• No community-based system has been developed for patients ready to leave. More than 70 patients cleared for discharge are still at the hospital because they have nowhere to go.

• Severe understaffing means overtime expenses are expected to total $11 million during the two-year budget period that ends June 30. Nearly 75 percent of the tab stems from overtime in the forensic program.

• Patients and caregivers face a high risk of violence. Hundreds of patient assaults on staff members have occurred in recent years; only a few resulted in criminal investigations.

The taxpayer tab for each criminally insane patient totals almost $9,000 a month, or about $108,000 a year. It costs less than $25,000 per year for each prison inmate.

In the past, state-hospital problems rarely received outside scrutiny. But new hospital Superintendent Marvin Fickle said he wants to be upfront about the hospital’s problems.

Lew Cronenberg, a veteran forensic-unit worker, is a staunch defender of the hospital’s work force. He said the employees do their best to help troubled patients.

“If you want to improve this place, put some money into the system,” he said. “Either this place is going to get turned around or it’s going to be closed down.”

Workers at the hospital were upset about recent reports that focused attention on decade-old sexual-abuse cases in the hospital’s treatment program for mentally ill children.

In a report issued last Tuesday, a governor-appointed panel did not find any pattern of continuing sexual abuse at the hospital.

Six staff members were fired in 2003 because they abused patients, records show.

Staff members say the forensic wards also have a split personality — part prison, part hospital.

But because security measures are not as stringent as in prison, it’s easier for contraband to slip through.

“Drugs are very easily passed in this place,” said Joanne Hill, one of at least nine patients who tested positive for methamphetamine use in April.

Fixing the ailing hospital, which has a two-year budget of $180 million, would mean spending millions to increase staffing and upgrade old facilities.

Closing the hospital would require the state to develop suitable alternative housing and treatment facilities for hundreds of patients.

And simply ignoring the hospital’s flaws raises the specter of a federal lawsuit and possible takeover by the courts.

State Senate President Peter Courtney, D-Salem, said the forensic center has been shortchanged.

“We haven’t done anything to the Oregon State Hospital in terms of the old forensic buildings since 1950,” Courtney said. “I think it’s just one of those things we’ve all but ignored.”

Mental-health professionals and prison officials are considering a new forensic center that would jointly house hospital forensic patients and mentally ill prison inmates, but it’s still in the planning stages.

And more forensic patients are streaming in. Oregon’s Psychiatric Security Review Board, which has jurisdiction over defendants found guilty but insane, logged a record 110 new cases in 2003.

“Last year was a record, and this year is probably going to beat it by a good 15 or 20,” said Mary Claire Buckley, executive director of the board.

Mental-health professionals cited deep cuts in mental-health services and Oregon’s methamphetamine epidemic as prime factors for the increases. They also pointed to growing use of insanity pleas by defense lawyers seeking to protect criminal defendants from mandatory prison sentences.

But members of the review board are strict about discharging only patients deemed mentally fit, leaving some staff members and patients to claim that the board holds people too long.

Buckley said the board has a long record of public safety to back up its actions.

By many accounts, a shortage of community homes keeps many patients locked up beyond possible release dates.

Forensic patient Steven Murphy said he hopes to leave the state hospital in April, but the lack of community homes worries him.

“It’s frustrating, but there’s pretty much nothing I can do about it,” he said.

In November, the Legislative Emergency Board approved spending $467,000 to draft a state-hospital master plan and create 75 more beds in communities for discharged patients.

But patient Van Dorn, diagnosed as bipolar, will not be going anywhere for years.

“It’s not really a recovery center, it’s just a flophouse,” he said. “I just lay in bed, listen to OPB [Oregon Public Broadcasting] radio and steal coffee from staff for fun.”