Amber Boyer spent early mornings last spring crawling out of her bedroom window and into her garage to make breakfast and gather medications for her then 14-year-old son Davin. 

She’d strap on a rugby-style helmet to protect her head and hair when she went back inside her Kay County home to give Davin his meals. Davin has autism and a speech delay. For the last year, he’s had increasingly aggressive behaviors, Boyer said. 

Davin started complaining about headaches in 2022. He’d need to be sedated for any medical testing to figure out why the headaches were happening. But few doctors in the state do sedation before a procedure like an MRI, Boyer said. Finding care was nearly impossible. 

Davin’s behaviors grew increasingly aggressive as his headaches continued. He was biting, pulling hair and breaking doors. By early 2023, Davin was suspended for several days from his public school. He eventually refused to attend school in person. Boyer took off almost four weeks from work to stay home with him as she looked for treatment. When Davin became a serious risk to himself or others, she took him to the emergency room. He visited hospital emergency rooms seven times in six months.  

As Davin’s behaviors escalated, Boyer moved her teenage daughter to her parents’ home, and she moved into the garage, eventually taking medical leave from work. She spent her days making calls to mental health providers, doctors, her attorney, the local school district and the Oklahoma Autism Network, trying to find someone who could help. 

Boyer could only stay inside her house at night while they both slept — her behind a steel-plated door. From the garage, she watched Davin through cameras inside the house to make sure he was safe. 

Davin has been on Oklahoma’s waiting list for developmental disability services for around a decade. Boyer has relied on private insurance and Oklahoma’s Medicaid program to help pay for his care in the meantime.

Struggling to find care is common for parents with children who have dual needs, or an intellectual or developmental disability and a mental or behavioral health challenge. 

Demand for mental and behavioral health care has spiked in recent years amid a staffing shortage, leaving some kids with complex needs behind as providers pick and choose which clients they can take on. The state has ramped up some spending on mental health care and developmental disability services but the investments haven’t been enough to allow providers to expand or feel ready to accept more youth with dual needs, officials say. 

Without better access to care, advocates say children with dual needs are more likely to end up involved with the child welfare or criminal justice system, or be sent to costly out-of-state facilities away from their families. In the 2023 fiscal year, Oklahoma spent over $5 million to send 49 kids out of state for treatment, according to data from the Oklahoma Health Care Authority. Five years ago, the state only paid for two kids to leave for treatment. Some children are likely left out of those numbers.

“It’s kind of this perfect storm, with those with a dual diagnosis in the middle of it,” said Wanda Felty, an advocate who has worked for years to get individuals with disabilities connected to state services. 

Parents turn to schools that lack resources

Oklahoma has had limited mental and behavioral health services available for youth for decades. 

Only nine counties in Oklahoma have any child and adolescent psychiatrists, according to 2022 maps from the American Academy of Child and Adolescent Psychiatry. When a child has a complex need in addition to mental or behavioral health challenges, the pool of outpatient and inpatient providers shrinks even more. 

To fill these gaps, communities rely on public schools to provide significant on-site services to kids. But special education programs are often short-staffed and under-funded. This means less of the consistent, community-based care that can play a role in keeping children from needing inpatient services or residential treatment for issues later on.

Davin’s public school was able to provide him some speech therapy throughout the years but struggled to hire the right professionals in the rural area, Boyer said. 

The school district struggled to keep up as Davin’s care needs escalated, she said. One special education teacher threatened to file assault charges against him. 

By May 2023, Davin hadn’t been to school in about two months. Two special education teachers from the school — who Davin hadn’t met before — tried to come to Boyer’s home to provide lessons. Occasionally these classes went well, but most of the time, Boyer said, Davin was too aggressive. 

Sara Coffey, a child psychiatry consultant to the state’s child welfare department and director of child and adolescent psychiatry for Oklahoma State University, frequently sees families with children who didn’t receive adequate day-to-day services like speech therapy and have started to have other mental or behavioral health issues. 

“That’s whenever they come to see me — when it gets to a point where the child, quite frankly, is older and might be larger, and there’s increased safety concerns,” Coffey said. “But it’s often something that’s been going on for years that we didn’t have the appropriate interventions and supports in place for.”

Kids with dual needs often need more than just crisis care

Getting services early can be critical to improving a child’s stability and future independence, according to the American Psychiatric Association. Problems can become more serious when families can’t find adequate levels of care in schools or the community.

Parents may take kids who are in crisis to emergency rooms, where they may be funneled to a short-stay, inpatient treatment provider if a bed is available. Longer-term, residential treatment for kids with complex needs is almost nonexistent in the state, officials said.

When Davin was home full-time, Boyer reached out to Oklahoma Human Services’ developmental disability services office but never heard back, she said. She called an autism research and advocacy organization.

The organization wanted to help, Boyer said, but the resources her son needed either didn’t exist or weren’t accessible. 

“They actually told me, once I figured something out, to call back and report to them what I was able to get accomplished so that they could help other parents,” Boyer said. 

Last June, Boyer took Davin to another emergency room in Oklahoma City to get help. Even though Davin was admitted for several days and a doctor adjusted the psychiatric medications meant to manage his behaviors, Davin was discharged without any new diagnosis or medical testing, Boyer said. The hospital said to follow up with a psychiatrist and wrote a letter saying Davin needed long-term placement. 

Many crisis interventions are short term, said RoseAnn Duplan, a policy specialist with the Oklahoma Disability Law Center. Kids are kept until they are stabilized and then they are sent home. There are few supports for families, Duplan said, so children can deteriorate quickly. 

“I think in all of these cases, had there been appropriate community-based mental health treatment for these kids to begin with, there’s a really good chance we would never have got to the level of needing inpatient care,” Duplan said.

A lack of providers equipped for complex needs

People with intellectual or developmental disabilities have co-occurring psychiatric conditions at rates that can exceed the general population, including ADHD, depression and anxiety, according to the National Association for the Dually Diagnosed.

But the state’s system has been set up to treat psychiatric needs separately from developmental disabilities, said Traylor Rains, the state’s Medicaid director. It takes highly trained clinicians to figure out where behaviors are coming from when those conditions are intertwined, he said. 

There aren’t enough of these specialists in the state to treat kids with co-occurring developmental disabilities and mental or behavioral health needs, providers said. 

Providers have to seek outside resources to access specific training on working with children with developmental disabilities, which can be expensive and time consuming, said Whitney Downie, chief program officer for Family and Children’s Services in Tulsa.

Health care facilities have to consider physical space for new clients and whether a new client will mix well with other patients, providers told The Frontier. Providers also must often adhere to strict staff-to-patient ratios. 

But a staffing shortage has plagued mental health providers in the state for years. 

If providers feel like their staff aren’t trained to handle a client’s behavior, especially if those behaviors are deemed aggressive, and still provide effective treatment, they’ll decline the patient, said Matthew Spencer, a chief clinical officer with Grand Mental Health in northeast Oklahoma. 

Grand Mental Health provides outpatient therapy and can serve kids with developmental disabilities, but only if patients have the cognitive ability to participate in therapy and benefit from it, Spencer said. If not, Grand Mental Health will refer them to a different provider, he said. 

Oklahoma has a mix of providers that do inpatient and outpatient services, but they don’t always accept kids with dual needs. Integris and SSM Health hospital systems in Oklahoma City have specialized psychiatric units for youth with developmental disabilities. The state has its own hospital in Norman that can accept kids with dual needs if they have capacity to benefit from treatment. The state also contracts with a few other providers that have longer-term programs, though not all accept kids with developmental disabilities. Another facility in Tulsa serves these youth in a residential setting, but only if they are in state custody. 

Leaders from multiple state agencies say they have asked providers across the country to come to Oklahoma or for existing providers to expand their services, but most decline, citing concerns with staffing, training and funding. 

Kids with dual needs can be more expensive to care for because of increased staffing and additional therapies. Low reimbursement rates from the state’s Medicaid program make it difficult for Oklahoma providers to expand services, especially longer-term, residential-style services. 

“Everybody knows that it’s an underserved population, and I think everybody wants to do all they can or more than they’re doing now,” said Eric Sachau, director of administrative services for Parkside Psychiatric Hospital in Tulsa. “The things that will open the doors to that are going to be a long list of things, and reimbursement is one of them.” 

In 2022, lawmakers approved $2 million in incentives to persuade providers to accept more high-needs kids, including those with developmental disabilities. Providers would get a minimum $20,000 for accepting children with complex needs and another $10,000 if a child showed progress. 

But by October of last year, only about 10% of funds had been used by five providers for eight kids, according to the Oklahoma Department of Mental Health and Substance Abuse Services. One of the providers doesn’t accept kids with developmental disabilities and another has since closed down. 

Effective in-patient treatment is increasingly only accessible out of state for some kids with complex needs. 

Boyer found an out-of-state facility that could accept Davin in August with the help of a therapist from Grand Mental Health. It’s a psychiatric residential treatment facility with onsite nurses, behavioral therapy technicians and a daily special education program with multiple teachers. His old school district is paying about $40,000 a month for the facility, Boyer said. 

The staff are highly trained and Davin’s behaviors have decreased significantly, Boyer said. 

He’s answering questions in school and doing homework, things Boyer said she’d never seen him do before. Someone from the state’s developmental disability services office got in touch with Boyer and is keeping an eye on Davin’s case to make sure there are services for him when he comes home. 

Coming Home 

To address the state’s mental health needs, the Oklahoma Legislature has invested hundreds of millions of dollars in the last few years in state funds and federal pandemic relief dollars to expand and build new mental health facilities for adults and children, increase payment rates to developmental disability providers and build the education pipeline for health care workers. 

One of the new facilities is a behavioral health hospital for youth, which should open in Oklahoma City under the OU Health umbrella in late 2026. The $140-million facility will have 72 beds for short- and long-term inpatient stays, an outpatient program and a partial hospitalization program, said Randy Dowell, chief executive officer of the University Hospitals Authority and Trust. 

The facility will be connected to the Oklahoma Children’s Hospital, so patients will have access to medical doctors. Oklahoma Human Services also has a foster care program available, and the facility will have a connection with the Child Study Center, a program on the campus that serves kids with developmental disabilities and trains health care providers, Dowell said. 

The success of the program will depend on staffing and whether Oklahoma kids with high needs are accepted over out-of-state patients for higher reimbursement rates. 

 “I think it’s a great start,” Dowell said. “I don’t know that it solves all the needs for the state of Oklahoma, but it definitely goes a long way in allowing us to have kids treated in the state.” 

Boyer is back at work but living with her parents and daughter while she repairs her home using a loan and help from her church to cover costs. She’s working on writing a resource book to help other parents before they get to the point she did. 

Boyer and her daughter visit Davin every week. His treatment care team has started talking about integrating Davin back home. He’ll be able to start home visits soon. 

“It’s just been really difficult. He’s pulled my hair. He’s cracked my ribs and bit me. I was afraid to get close. Now I don't feel like that at all,” Boyer said. “He’s excited to see us and we’re so excited to see him. And we have a great visit every weekend.” 

The post Oklahoma sends a growing number of kids with complex needs out of state for treatment appeared first on The Frontier.

The Oklahoma Department of Human Services continued to refer clients to a troubled center for people with developmental disabilities in Enid for months after reports of abuse first surfaced. 

The Frontier’s reporting found that a former staff member at the Robert M.Greer Center said coworkers retaliated against her after she reported the allegations. In November, police arrested six individuals on charges of conspiracy and caretaker abuse at the center. The center’s administrator has also resigned. 

Read the full story here. 

Below are five key takeaways from The Frontier’s reporting: 

1. After reporting abuse at the Greer Center, a former staffer found flyers of herself around Enid suggesting she was available for sexual encounters. The flyers had her photo and phone number. She filed protective orders against four coworkers at the Greer Center, and told the court they had retaliated against her for reporting the abuse. 

2. The Enid Police Department started its own investigation into the Greer Center in June, when a detective learned that the Department of Human Services had already tried to investigate reports of abuse, but had not been able to verify the allegations. 

3. The Department of Human Services said it didn’t know various incidents of abuse were connected until late October. The agency didn’t halt new admissions to the facility until Nov. 16, two days after the first arrests were made and five months after systemic abuse was first reported to police.  

4. Investigating and prosecuting allegations of abuse can be difficult because some victims might be nonverbal. Courts may not view people with developmental disabilities as reliable sources, meaning abuse may not be prosecuted unless there are witnesses or cameras to back up allegations.

5. The Department of Human Services said it isn’t planning to shut down the Greer Center or end a contract with the private company that manages the facility. The Greer Center is the only facility of its kind in the state. 

The post Five things to know about allegations of abuse at the Greer Center appeared first on The Frontier.

After a former staff member reported allegations of abuse at an Enid center for people with developmental disabilities, her photo and phone number appeared on flyers suggesting she was available for sexual encounters, she wrote in court documents. 

The flyers were posted around Enid, including on trees near another local facility for people with developmental disabilities one morning in early June, according to a police report. 

A few weeks later, the woman filed four protective orders in Garfield County District Court against coworkers at the Robert M. Greer Center in Enid. The 52-bed, state-owned facility has been at the center of an unfolding scandal involving allegations of widespread abuse of its vulnerable residents. The Oklahoma Department of Human Services continued to refer clients to the troubled center for months after reports of systemic abuse first surfaced.

The woman wrote in applications for protective orders that her coworkers had admitted to hanging the flyers around Enid to retaliate against her for reporting abuse. A judge granted all four emergency orders of protection, and all but one of the orders are still active. The woman no longer works at the Greer Center. 

The Frontier is not naming the former Greer Center employee who reported abuse because of safety concerns. Because none of the people she filed protective orders against have been criminally charged, The Frontier is not naming them either. 

Liberty of Oklahoma Corporation, the private, for-profit company that contracts with the Oklahoma Department of Human Services to manage the Greer Center, did not answer questions about whether employees accused of hanging the flyers faced any disciplinary action or if they still work at the center.

Over the past month, police have arrested six people, including a shift supervisor, on charges of conspiracy and caretaker abuse for allegedly abusing multiple residents over the last year at the Greer Center. Police began investigating the center after the former Greer employee reported systemic abuse at the facility in June, court documents say. 

“We are deeply disturbed by the reports of abuse and consider such behavior to be wholly inappropriate and unacceptable,” said Sue Nayda, chief operating officer of Liberty. The company said it couldn’t comment on specifics because of pending investigations.

The abuse included “choking clients until they were unconscious and then beating them until they regained consciousness, forms of waterboarding in the facility’s showers and enticing other clients to participate in the abuse of specific clients,” according to police. Court documents say that at least one employee tried to tell a Greer Center administrator about abuse but “he had refused to listen.” 

The Department of Human Services still didn’t halt new admissions to the facility until Nov. 16, two days after the first arrests were made and five months after systemic abuse was first reported to police. 

The agency said it wasn’t able to begin connecting all the incidents of abuse until someone made a report to Enid police on Oct. 30, which led the agency to halt admissions and raise safety protocols for remaining residents. The Enid Police Department couldn’t confirm to The Frontier that it received an abuse report on Oct. 30. 

“I think we have an opinion that if they’re getting serious allegations like this — multiple ones — that perhaps they shouldn’t continue to admit people until they figure it out,” said Joy Turner, director of investigations and monitoring for the Oklahoma Disability Law Center. 

Repetitive reports, even if they aren’t substantiated, should be a red flag, she said. Photos of the survivors turned in to police show serious bruising, which Turner said should have been seen by staff when helping individuals with bathing or dressing.  

“Some kind of light bulb has got to go off,” Turner said. The Law Center has opened its own investigation into the Greer Center and how state agencies handled reports of abuse. 

The Oklahoma Department of Human Services investigators didn’t see an imminent safety threat to residents when the incidents were initially reported, said agency spokeswoman Casey White. When the agency first investigated, the incidents “did not appear to be connected,” White said.

The Department of Human Services says it notified Enid police at the beginning of every investigation into allegations of abuse at Greer, but didn’t provide a date to The Frontier of when those investigations began. The agency isn’t legally obligated to update law enforcement about investigations into abuse of vulnerable adults beyond the initial notification unless investigators see immediate, serious safety concerns, according to state rules. 

The Enid Police Department didn’t launch its own investigation until it received a report about the alleged abuse in June. Enid Detective Frank Bruno said it was then that he learned the Department of Human Services had already been investigating the Greer Center.

Bruno wrote in an affidavit that “several of the alleged incidents of caretaker abuse at the Greer Center had also been investigated by DHS’s Office of Client Advocacy,” but “several of the investigations could not be substantiated due to the staff at the Greer Center not cooperating” and victims being nonverbal. 

The Department of Human Services denied in a statement to The Frontier that it had any difficulty conducting interviews with victims and staff or getting documents related to the cases. 

Reports of abuse or neglect at residential facilities nationwide are not unheard-of. 

It can be difficult to investigate and prosecute allegations of abuse because some vulnerable adults may be nonverbal, Bruno said. Enid police have focused their investigation on instances of abuse with witnesses and victims that could be interviewed directly.

A 2018 audit of group homes for people with developmental disabilities by the U.S. Department of Health and Human Services Office of Inspector General in a handful of states found that residents “often experienced serious injuries and medical conditions that resulted in emergency room visits.” 

Between 2017 to 2019, people with cognitive disabilities were almost seven times more likely to be the victim of a violent crime than those that didn’t have a disability, according to the federal U.S. Bureau of Justice Statistics. 

Following a major lawsuit alleging abuse and neglect in the 1980s, Oklahoma shut down Hissom Memorial Center in Sand Springs — one of the state’s residential facilities for individuals with developmental disabilities. Over the next several decades, other residential facilities were closed in favor of community-based services. The Disability Law Center has investigated other reports of abuse at the Greer Center over the past few decades.

Greer Center staff are required to report abuse under the state’s mandatory reporting laws. State investigators will make face-to-face contact with victims, interview staff and review records. Department of Human Services’ investigative reports into allegations of abuse are kept private. 

The Department of Human Services’ investigation of Greer is still ongoing. The results of the investigation will be given to the State Department of Health and the Garfield County district attorney, the agency said. 

Liberty of Oklahoma Corporation is affiliated with Liberty Healthcare Corporation, a private, for-profit company based in Pennsylvania. Liberty also has contracts with the state to manage two facilities for youth with developmental disabilities and to end the state’s years-long waitlist for developmental disability services. Millions in taxpayer funds have gone to the company, according to a state fiscal transparency website. Last year, the company faced a data breach of personal information from over 5,000 families on the waiting list for services. 

Liberty didn’t answer specific questions about what remedial steps the company would take or how staff or administrators could have been unaware of the abuse. 

The Department of Human Services can end contracts with providers, but the agency said Greer is the only facility of its kind in the state that can meet the needs of individuals with developmental disabilities and mental or behavioral health challenges. 

A spokesperson for the Department of Human Services said Greer center staff already received additional training on how to report abuse and neglect, and the agency has placed staff on-site 24/7 for safety monitoring. Liberty is sending daily reports to the agency, a Department of Human Services spokesperson said, and has brought in two out-of-state investigators to “overhaul their internal investigation process.” 

The post After reporting alleged abuse, a former Greer Center staffer found flyers saying she was available for sex acts appeared first on The Frontier.

I was able to collaborate with The Curbside Chronicle to report on what happens to people who are too sick to stay in homeless shelters in Oklahoma City, and I talked with state officials about the 42% staff vacancy rate at Oklahoma’s only secure-care facility for youth. 

The people we write about get to share their stories and struggles with their neighbors. People in power are held accountable for the shortcomings of the systems they build and fund. And readers learn more about what is happening in their community. 

This type of in-depth reporting requires weeks and sometimes months of asking for records, tracking down sources and triple-checking every fact in the story. Many newsrooms are unable to spend this kind of time with a story, even one that is important. 

That’s where our community can help. 

Donations to The Frontier fuel our investigative, independent reporting. Every dollar makes a difference for our small-but-mighty team of reporters. When you donate, you are supporting a newsroom that cares about the future of our state and is committed to getting you the facts. 

If you’ve thought about donating, now is the time — through Dec. 31, donations to The Frontier will be matched by a collaborative fundraising movement called NewsMatch that supports independent, public-service journalism. We can earn up to $50,000 in matched donations. 

Thank you for supporting our reporting. 

The post Your donations help us hold the powerful accountable in Oklahoma appeared first on The Frontier.

The report, published last week, found barriers like transportation, a lack of providers in rural areas and long waitlists make it difficult for biological parents to meet court requirements in a timely way. Child welfare case workers and foster families are underpaid and overworked, the report also found. These factors contribute to children being bounced from one caseworker or foster family to another. 

Oklahoma has spent most of the past decade attempting to reforming its troubled foster care system as part of the settlement of a class-action lawsuit. The state has made sustained progress in nearly every area, including increased oversight of providers and discontinued use of shelters to house the youngest kids in the state, according to recent reports from outside child welfare monitors.

But the state is still struggling to help kids get out of state custody quickly. Additional funding and more staff could help, but those needs will compete against a heavy push from some Republican lawmakers for tax cuts, education funding and economic development during the next legislative session. 

“This won’t be cheap,” said Joe Dorman, director of the Oklahoma Institute for Child Advocacy. “But the return on the investment will be tremendous.” 

Gov. Kevin Stitt formed the Child Welfare Task Force in January to study how to reduce the time kids spend in state custody and what supports families need to avoid state-sanctioned removal from parents. 

Programs that provide transportation, put social workers in schools and train parent mentors need to be expanded, the report found. Lawmakers partially funded a Family Representation and Advocacy Program this year, but roughly another $15 million is needed to take the program statewide.

Many foster families said the state doesn’t give them sufficient resources. Stress from case delays leads many to consider quitting, the report found. The report recommended the state help foster parents take respite breaks, boost funding for childcare and mental health professionals, increase stipends for case workers and foster families and expand Medicaid eligibility to families involved in the child welfare system.

Access to services that disrupt poverty and treat substance use are also key to keeping families out of the child welfare system, the report found. Statewide, nearly 70% of child welfare removals included substance abuse as a contributing factor.

The state hasn’t had a wait list for residential substance use treatment for five years, said Bonnie Campo, director of communications for the Oklahoma Department of Mental Health and Substance Use Services. But mothers may be hesitant to reach out for services if they fear they’ll lose custody of their kids, face criminal charges or judgment from health care providers. 

Some women have been charged with felony child neglect in recent years even if their child was born healthy or child welfare workers didn’t find evidence of abuse or neglect, The Frontier previously reported.  

“We cannot adequately care for patients who are afraid to seek care or be truthful with their physicians,” Angela Hawkins, a local doctor and chair of the Oklahoma Section of American College of Obstetricians and Gynecologists, told lawmakers during an interim study last month.

State lawmakers will consider the task force recommendations during the 2024 legislative session. Efforts to expand social services have been mixed in recent years. The Department of Human Services has received millions to help end the state’s waiting list for disability services,  and several capital projects are in the works to expand access to mental health care. But many state officials say that money is just helping Oklahoma catch up after years of budget cuts.

Rep. Mark Lawson, R-Sapulpa, served on the task force and said that although Stitt created the task force, the governor has also recently called for tax cuts and smaller government. But the recommendations are needed, Lawson said, even if it means increasing appropriations. 

“Being in the fiscal position that we’re in with the surplus that we have … This is the best investment we can make,” Lawson said. 

Senate Pro Tem Greg Treat, R-Oklahoma City, is still reviewing the report, his office said, but is “committed and willing to do what is necessary to improve essential services to children in Oklahoma.” 

The Department of Human Services has requested a $30 million budget increase for next year to pay for higher child care reimbursement rates. Lawmakers get the final say on what funding the department will receive for worker raises or program expenses.

“Our children and families are our future, and it is the responsibility of every Oklahoman to do what is necessary to see our community thrive and flourish,” the report said.

The post Oklahoma lacks accessible services for families in the child welfare system, task force finds appeared first on The Frontier.

More than a year later, Thurman lives in a nursing home and still can’t walk.

After emergency responders took him by ambulance to a third hospital in July 2022, Thurman needed emergency surgery for an infection that had spread to his neck and blood, he said. 

“You don’t know how much pain I’m in every day,” Thurman, 42, told The Frontier recently while sitting in a wheelchair. “I feel like it’ll never go away.” 

Acting on a complaint, federal authorities launched an investigation into whether Oklahoma State University Medical Center and Hillcrest Medical Center violated a federal anti-patient dumping law for failing to treat Thurman, who was experiencing homelessness when he sought care at their emergency departments.

The Centers for Medicare and Medicaid Services sent both hospitals letters in May stating that inspectors had found the facilities were in compliance with federal rules after a review of records and interviews with staff.

The Emergency Medical Treatment and Labor Act requires hospital emergency rooms that participate in Medicare to screen and treat everyone with an emergency medical condition, regardless of ability to pay.  

Hospitals that violate the law can be fined and excluded from participating in Medicare.

But it’s rare for hospitals to face financial penalties, said Barbara DiPietro, the senior policy director with the National Health Care for the Homeless Council. When hospitals are fined, about one in five cases are for people with a mental health condition. 

“It’s a high threshold,” DiPietro said. “…Hospitals have a lot of political relationships, as well, and to sanction a hospital is not a small thing to do.” 

Hillcrest and OSU medical centers said they could not answer questions about Thurman’s case because of patient privacy laws.

“While we are pleased state and federal regulators found our hospital to be in compliance with all regulations relating to this incident, we take our responsibility to care for all individuals — including those experiencing homelessness — very seriously,” Hillcrest said in a statement. 

OSU Medical Center said in a statement that it has “a long history of providing fair and equitable care regardless of the ability to pay.”  

Dumped during summer heat wave 

Julie Bennett started bumping into Thurman after moving into her downtown Tulsa apartment in 2021. 

Thurman slept in the nearby parking lot, and spent his time picking up trash and guarding tenants’ cars at night against break-ins. Sometimes Bennett and Thurman would say hello. Occasionally she’d bring him food. Last summer, Bennett and her husband saw Thurman with what they thought was a broken wrist. He’d had his belongings stolen and got into a fight, he said. 

They brought him a sling, and a few weeks later decided they should call an ambulance as his hand swelled. Thurman went to nearby OSU Medical Center, but said the hospital wouldn’t treat him because of a previous incident at the emergency room where he was escorted out by security, he said. The hospital said it couldn’t respond to questions about the incident. 

He limped back to the parking lot where he slept.

For the next few days, Bennett and other neighbors brought ice and Gatorade to Thurman. It was the hottest week of the year in Tulsa, with temperatures that soared up to 107 degrees. Bennett batted away flies swarming around Thurman’s body. 

“He was all balled up and crying and just couldn’t move,” Bennett recalled. Neighbors called another ambulance that took Thurman a mile and a half away to Hillcrest Medical Center. 

Thurman can’t remember all the details of his time at the hospital, but said a nurse told him to get into a wheelchair. When Thurman said he couldn’t walk, the nurse pulled on his arm to get him into the chair as a security guard waited nearby. 

“I think they thought I was on drugs,” Thurman said of the incident. “But I wasn’t.” 

Security guards ultimately wheeled him across the street from the hospital and dumped him out onto the sidewalk in the middle of the night, Thurman said. A surveillance video first reported by The Tulsa World shows a person being dumped out of a wheelchair onto the sidewalk the same night. He laid there until a friend came the next morning, loaded him onto an orange flatbed dolly and pushed him back to his parking lot.

Bennett was shocked to see Thurman again when she walked to her car in the morning. He was lying next to the dolly in the parking lot and couldn’t use his hands or talk. 

A maintenance man from Bennett’s building called another ambulance a few hours later to take Thurman to a third hospital, Saint Francis. Bennett met Thurman at the hospital and waited with him for several hours in the emergency room. When nurses began to examine Thurman, they tried to get him to get out of a wheelchair and have him stand, Bennett said. Thurman said he couldn’t, but nurses insisted he could. Bennett eventually intervened. 

“I was having to explain to them what my observations were of Brent the last several days and weeks because he just couldn’t explain it,” Bennett said. 

Hospital staff determined it was a severe infection and pulled Thurman into emergency surgery. He spent the next few months in and out of intensive care, at times relying on a ventilator and feeding tubes.

The infection left his arms and legs paralyzed, and another infection flare up this year sent him to the hospital for several weeks in August.

Anti-patient dumping law often applied broadly

Inspectors from the Oklahoma State Department of Health visited OSU and Hillcrest in July and August 2022, records show. 

The federal government relies on local investigators to conduct unannounced walkthroughs, review records and interview hospital staff to investigate complaints.

The goal of inspectors is to investigate complaints and whether a facility is in overall compliance with state and federal regulations, said LaTrina Frazier, a deputy commissioner who oversees hospital inspections for the Oklahoma State Department of Health. 

Federal guidelines say investigators can interview patients and witnesses, but Thurman and Bennett said no one ever contacted them. 

State investigators send their findings to the federal Centers for Medicare and Medicaid Services for a final ruling on whether a hospital violated anti-patient dumping rules.  

The Frontier filed a Freedom of Information Act request for all of the records from the investigation, but the Centers for Medicare and Medicaid Services only released four pages of documents, including two short inspection reports that found no deficiencies at either hospital. The agency did not respond to questions about whether it reviewed the video that allegedly shows Thurman dumped on the sidewalk. 

Rade Vukmir, a doctor with the American College of Emergency Physicians, said the law is often applied too broadly by those who file complaints against hospitals. If a hospital examines someone and provides medical care for an emergency condition, then they’ve met the intent of the law. Federal guidelines say hospitals can’t be held liable for misdiagnosing a condition if they used all of their resources during a medical screening, which can range from a brief physical exam to laboratory tests and other diagnostic tools. Concerns about medical negligence or discharge procedures should be separate issues, he said. 

Patients can sue for medical negligence, but that requires finding a private attorney, which can be a challenge for people experiencing homelessness. 

Thurman was raised by his grandmother until she died when he was 12, he said. Then he was in and out of foster care and living on the streets in Tulsa. He had stints in prison and jails. Thurman can’t read well and didn’t go to school as a teenager, he said. 

An attorney dropped Thurman’s case after several months and never filed a lawsuit on his behalf. 

Tulsa hospitals discharge a growing number of patients to the streets

The number of people discharged to homelessness from emergency departments in Oklahoma is growing, according to data from the State Health Department. Hospitals sent some people back to the streets or to shelters that aren’t equipped to handle their medical needs. 

In 2022 alone, emergency departments made more than 2,000 discharges to homelessness in Tulsa County — nearly four times as many as in 2020 when the state began collecting data, according to provisional figures from the State Health Department. Tulsa County residents had the most discharges to homelessness in the state in 2022.

During the height of the pandemic, the City of Tulsa used federal coronavirus relief funds for a medical respite facility for people experiencing homelessness. The facility served hundreds, but once the federal funding ran out, the program was closed.

Hospital administrators say they provide care to everyone who needs it, but that hospitals aren’t the right place for someone to stay if they don’t need acute medical treatment. This can create tension between shelters, hospitals and patients. Most hospitals employ social workers who try to coordinate discharge plans, but many individuals say they have been turned away from care or discharged early to homelessness. 

As visits to emergency departments are increasing nationally, staffing shortages have led to longer wait times and violence in emergency departments has increased, according to the American College of Emergency Physicians. 

The federal Health and Human Services Office of Inspector General settled a case similar to Thurman’s with a hospital in Alabama in 2018 for discharging a man who was “reportedly aggressive and non-compliant with staff directions.” A hospital security guard placed the man in a wheelchair and left him on the ground off hospital property. The man was found unresponsive and later died. 

Hospitals are required to screen for emergency medical conditions, which the federal government defines as being so severe that delayed medical care could be “reasonably expected” to put a person’s health in serious jeopardy. Hospitals are required to stabilize those that need treatment. 

That requirement stands even if someone is disruptive, said Rich Rasmussen, president of the Oklahoma Hospital Association. But hospitals sometimes call police or have security guards remove patients for being disruptive or violent.

But what’s considered disruptive can be subjective, said Lisa Dailey, executive director for the Treatment Advocacy Center, which supports better access to care for people with severe mental illness. Some hospital staff might see people experiencing homelessness or those in a mental health crisis as just looking for a place to sleep or trying to get drugs. 

Hospital staff should be trained in de-escalation strategies and have the resources to handle upset patients in emergency rooms, Dailey said. A 2014 report from the U.S. Commission on Civil Rights recommended more oversight from federal regulators and increased data collection and training for hospitals.

“If you don’t have appropriate training, it’s almost inevitable that you’re going to be influenced by the fact that a person who’s in a crisis can be very difficult,” Dailey said. 

Hillcrest said in a written response to The Frontier that it created a committee in 2022 to better address disruptive patients or threats of workplace violence. The hospital also offers bus passes or rides to shelters and has a social worker and patient advocate in the emergency department. 

Focusing on healing

For the last year, Thurman has lived in a nursing home tucked in the trees a few blocks from the Arkansas state line. 

It’s a bright facility with deck games on the front porch and a cafeteria with greenery painted on the walls. A large living room area broadcasts black-and-white movies for residents. Thurman doesn’t pay attention to them though, he said. 

When he first got to the nursing home, he was mean and angry. But he’s made friends with the nursing staff now and feels more comfortable.

Sometimes he sits on the porch in his wheelchair. Bennett and other friends visit when they can, bringing Dr. Peppers as a treat. Thurman recently had his 42nd birthday party at the nursing home. He does physical therapy. He says he often thinks about his time at the hospitals last summer. 

He was scared when he woke up from surgery with tubes and monitors hooked up to him. He’ll likely have to take antibiotics for the rest of his life. Sometimes he gets so sick, he has to go back to the hospital. Doctors want to perform another surgery, but Thurman worries about complications. 

“Some of the stuff makes me mad, and some of the stuff I get used to,” he said. “It’s pretty bad that it happened.” 

Bennett is arranging for a volunteer to help Thurman improve his reading ability. She also helped Thurman connect with family members. By next year, Thurman hopes he’ll have regained enough mobility to walk. 

“My hope would be that he could eventually get out of the nursing home and have enough mobility that he can move around in a wheelchair and just participate in life,” Bennett said. “Build relationships. Have healing, fulfillment.”

The post A patient-dumping probe clears two Tulsa hospitals after man left paralyzed on the streets appeared first on The Frontier.

The Frontier is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in select states across the country.

After her arrest for a small amount of methamphetamine in 2017, U.S. Army veteran Krysten Gonzalez signed an Oklahoma County Mental Health Court contract agreeing to behavioral health treatment in exchange for the chance to stay out of prison.

The requirements were extensive: She promised to make every court hearing, treatment appointment, support group and probation check-in. She couldn’t use drugs or alcohol and would undergo regular drug testing. She could be searched at any time. She was required to pay $960 in probation fees. And she couldn’t associate with anyone who had a felony conviction.

Gonzalez was sexually assaulted during her time in the Army and endured years of depression, anxiety, post-traumatic stress disorder and struggles with substance use, said Derek Franseen, an attorney for Gonzalez’ family who is suing the county on her behalf. The court listed Gonzalez as homeless. Between 2016 and 2018, she was charged with possession three times, obstructing an officer and breaking and entering a stranger’s house in Midwest City to ask if she could use the bathroom. 

The mental health court agreement was difficult for her to manage. Without permanent housing, transportation or a cell phone, court officials say the requirements can be challenging for people with serious mental illness. If they miss appointments or don’t maintain sobriety, they can fail the program and end up in prison. 

A judge issued warrants for her arrest when Gonzalez missed court dates. She was booked into the Oklahoma County Detention Center in October 2018 and held without bond while the county searched for a bed at an inpatient mental health treatment facility. She was still waiting in January 2019 when she died by suicide alone in her cell at age 29. 

Oklahoma County officials launched a new program this spring to pull people with mental health conditions and eligible offenses out of the jail entirely and send them to community-based treatment. The goal is to divert people from jail entirely, but the program has no funding yet.

The Court-Ordered Outpatient Treatment Program — CO-OP for short — has less supervision for participants than mental health court. Participants don’t have to come back to court every week, and their criminal charges are typically dropped up front. When a person isn’t complying with program requirements, law enforcement takes them to a treatment provider for a new assessment instead of back to jail. 

“(Gonzalez is) the type of individual who probably would have been approved,” said Oklahoma County Public Defender Bob Ravitz. “She probably would have gotten out of jail and been alive, in my opinion.” 

CO-OP already has about 130 active participants since it began at the start of April. 

In recent years, officials have recognized people with mental illness are often held in jails or prisons but don’t receive effective treatment there. Public pressure has pushed state and local governments to create new programs and expand access to care. But a workforce shortage, stigma around treatment and years of financial neglect keeps people across the state from reaching treatment. 

Without funding and dedicated staff, the county employees who run CO-OP are fighting to keep up with their other responsibilities and what they describe as exponential growth in the program. Some of the mental health providers that treat CO-OP participants aren’t fully staffed either.

“Once we started, the floodgates just opened with referrals,” said Madison Mélon, an attorney with the Oklahoma County Public Defender’s Office who supervises diversion programs. “We just keep going because getting connected to services in the community in whatever capacity we’re able to facilitate is better than them languishing in the jail.” 

Keeping people with mental illness out of jail 

Gonzalez’ death sparked the Oklahoma Disability Law Center to investigate mental health care access at the Oklahoma County jail. Last year, the U.S. Department of Justice announced it was investigating whether Oklahoma fails to provide community-based mental health treatment and how the Oklahoma City Police Department responds to mental health calls after the Law Center and the ACLU of Oklahoma filed a joint complaint.

Nick Southerland, an attorney with the Law Center, helped Oklahoma County officials create the CO-OP program. 

“While we believe that the CO-OP program is a step in the right direction when it comes to keeping people with mental illness out of jail, we are still working to ensure that people who are in jail receive the care that they need,” Southerland said.

Every county in Oklahoma is experiencing a shortage of mental health professionals, according to 2023 data from the Rural Health Information Hub. Oklahoma has underfunded mental health programs for years. State mental health funding declined 11% over the past decade when adjusted for inflation, a state oversight report found in 2022. 

Many Oklahomans don’t access care until a crisis happens. If that crisis lands them in a county jail, they are 13 times more likely to die from suicide than the general population, said Elizabeth Hancq, director of research with the Treatment Advocacy Center, a national nonprofit that pushes for better access to mental health treatment. 

Oklahoma County has one of the deadliest jails in the nation. Forty-three people have died in the jail since August 2020, according to jail records and medical examiner data. Nine deaths were suicides. Another six had a documented mental health issue but died because of other health problems, according to court documents, medical examiner reports and family statements reviewed by The Frontier. 

The jail typically has around 150 people on mental health observation at any given time, jail administrator Brandi Garner told the facility’s oversight body in August. Nearly half of the 2,200 people with low-level offenses screened at the detention center between October 2022 and June 2023 reported current or past mental health needs, according to numbers provided by a jail diversion program. 

The longer someone is at the jail, the more their mental health deteriorates, said Donna Hanson, the jail’s health services coordinator. People with a severe mental illness typically return to incarceration more frequently than those without a mental illness, according to a 2018 study by the U.S. Government Accountability Office.

People with mental health conditions can sit in the jail for months because they can’t post bond or are waiting for a mental health evaluation. Most people in the jail are being held pre-trial.

The facility has struggled for decades with overcrowding, leaks, mold and bed bugs. In 2021, inmates took a correction officer hostage and said they weren’t allowed to shower and toilets were backed up. Staffing shortages have made it difficult for inmates to access what little mental health care is available. 

Faster access to treatment

The new CO-OP program relies on the Labor Commissioner Mark Costello Act, an Oklahoma law that allows a person to be court-ordered into mental health treatment if they are a danger to themselves or others and may not pursue treatment on their own. Lawmakers approved the act in 2016 after Oklahoma Labor Commissioner Mark Costello was killed by his son who had a history of severe mental illness. 

CO-OP is designed to be a one-year program in civil court where a person agrees to attend mental health treatment in exchange for being quickly released from the county jail and having their charges dropped up front. This means the process can move quickly. Officials say their goal is to identify and accept a person into the program within 48 hours. 

Jail staff send a list of people who they’ve identified as having a serious mental health condition to Mélon in the Public Defender’s Office. She looks over their charges and treatment history, and sends the names of potentially eligible people to the District Attorney’s Office for final consideration. Other lawyers or judges can also refer people to the program.

People with low-level misdemeanors or felony charges can be accepted into the program, as long as they don’t have a history of sexual misconduct or serious violence. Jeff Massey, an assistant district attorney in Oklahoma County, said he talks with any crime victims, looks over possible damages a person might have to pay back and whether the person has charges from another county before admitting them into the program. Roughly 30% to 50% of applicants sent to Massey get approved for the program, he said. 

People in the program have charges like trespassing, disorderly conduct or assault and battery on a police officer or health care worker, said District Judge Sara Bondurant, who presides over the CO-OP program. When people are in a crisis or dealing with a chronic mental illness, these are the types of charges that can keep them in jail, Bondurant said.

So far, the program has about a 50% to 60% compliance rate, Massey said. 

Program officials expect many CO-OP participants to also be experiencing homelessness. About a quarter of unhoused people in Oklahoma City self-reported having a severe mental illness, the city’s most recent count of people experiencing homelessness shows. And in January, at least 11% of individuals in the county jail were homeless, according to a report by the Oklahoma County Criminal Justice Advisory Council. 

“It’s important that people do understand that these are individuals who are not hardened criminals,” said Michael Hanes, associate clinical director at Hope Community Services, one of CO-OP’s mental health providers. “I hope we can get the community to understand and have compassion for this population, and that incarceration is not the answer.”

People experiencing homelessness face additional barriers to care, providers said. Even if they’re in a program like CO-OP where they have access to a mental health provider, without a safe place to live, managing mental health long-term will be difficult. 

Many providers that work with CO-OP try to provide wrap-around services, so participants aren’t just getting mental health treatment but are also being connected to housing services or collecting important personal documents. 

Yet that level of staffing requires money, which many providers and court programs are missing, and time to work with people until they are ready to engage fully in recovery. 

The Oklahoma County Crisis Intervention Center has a “no wrong door” policy, providing services or resources to anyone who comes to the facility as many times as they show up, said Lauren Stover, director of the center. The crisis center works with CO-OP to provide services and assessments.

“You never know what you say differently or provide differently that could finally be the thing that clicks for them,” Stover said. 

Lack of funding

A collection of sticky notes and pieces of paper with names and dates help Mélon, the public defender who runs diversion programs, keep track of the growing number of CO-OP participants. 

 Mélon and one other public defender take on the brunt of managing CO-OP referrals and patient appointments. She gets to work early to meet with potential participants at the jail. Anywhere from 50 to 100 CO-OP emails ping her inbox every day. She bounces between tasks for CO-OP and seven other diversion programs. 

“Thinking that ‘I’m not going to be thrown in jail, and I’ll get another opportunity’ is really meaningful to people,”  Mélon said. 

One CO-OP participant had charges stemming from a public suicide attempt on “the worst day” of their life,  Mélon said, but is now receiving treatment with minimal court contact. That success makes the work meaningful, she said. 

CO-OP was inspired by a similar program in Tulsa that has diverted over 600 people from the local jail since 2020, according to the Tulsa County District Attorney’s Office. 

The Tulsa program has nearly $1 million in grant funding to spend on full-time staff, data management and treatment. It’s considered an effective program with around 90% of participants engaging in their treatment plans consistently, said Stan Lane, the program coordinator. 

As Oklahoma County’s program continues to grow, officials say they’ll struggle to manage without additional funding or staff. The intake process can take a few days to more than a week, with people waiting in jail in the meantime. The State Department of Mental Health covers treatment costs for most participants through Medicaid.

“Only time will tell if we have the appropriate provider network to handle all of these people,” Mélon said. “It goes back to the money issue.”

Outpatient treatment programs are growing in popularity across the country, and many begin without funding like CO-OP, Hancq said. That can make it difficult for programs to keep up with demand, especially if treatment providers are spread thin, she said. 

Oklahoma County could apply for federal grants to fund the program or might be able to tap into money that voters approved through State Question 781, a citizen-led ballot measure in 2016, said Timothy Tardibono, director of the Oklahoma County Criminal Justice Advisory Council. 

The ballot measure called for state money saved by reducing penalties for some drug and property crimes to be divided between counties statewide for mental health treatment. Lawmakers have dragged their feet on putting money into the fund but have finally agreed on spending more than $12.5 million over the next year. 

With future funding, the CO-OP program hopes to help people in a mental health crisis to avoid jail altogether. Police would instead take people in crisis to a local mental health center, where they would immediately be connected to an attorney and approved for treatment without ever being booked into jail. 

Until then, people in crisis at the jail are relying on a small team to find them and connect them to resources. Officials say the program won’t turn away eligible applicants despite capacity concerns.

“If we have 1,000 participants, I’ll spend my time doing this,” Bondurant said. “That would be absolutely fine. Because this is so important and so critical in our community.” 

The post People with mental illness are more likely to die in jail. A new Oklahoma County program puts them in treatment instead appeared first on The Frontier.

During the final days of the 2023 legislative session, the anti-abortion group Oklahomans For Life sent its members an early-morning email marked “URGENT.”  

Tony Lauinger, chairman of the group, urged support for Senate Bill 368, which would have made it easier for survivors of rape and incest to obtain legal abortions in Oklahoma. 

“Those thinking SB 368 is not pro-life ‘enough’ are thinking short-term rather than recognizing the reality of pro-abortion momentum since Roe V. Wade was overturned last June,” Lauinger wrote. He did not respond to requests for comment.

Voters in six other states have defeated abortion-ban proposals or have enshrined abortion access into state constitutions through statewide votes last year. An Amber Integrated poll conducted in August 2022 found that 62% of likely Oklahoma GOP runoff voters said they supported access to abortion in cases of rape, incest or medical emergencies. In his email, Lauinger also mentioned an internal poll where 71% of Oklahoma voters supported exceptions for rape and incest of a minor reported to law enforcement. 

Currently, state law bans all abortions except to save the life of the mother. 

Anti-abortion lawmakers say they are in a dilemma: Support legislation that could make it easier for some women to get abortions, or risk successful legal challenges and backlash from voters.

To reduce momentum behind a potential state question restoring abortion access in Oklahoma and avoid future legal challenges, some conservative lawmakers want to narrow the state’s abortion ban. Sen. Julie Daniels, R-Bartlesville, said efforts failed this year after Gov. Kevin Stitt wouldn’t commit to supporting Senate Bill 368, which Stitt’s office disputes. Several lawmakers also said they wouldn’t support any exceptions beyond saving the life of the mother, Daniels said.

“What happened was a difference of opinion among pro-life legislators,” said Daniels, who has written many of the state’s abortion laws and tried to run Senate Bill 368. “But short of those exceptions, the pro-life movement is losing those wars in other states. We didn’t want that to happen to us.”

Abortion rights advocates say even if lawmakers add exceptions to state law, local groups will continue to push for access to abortion. 

“We are clear in our position that Oklahomans need and deserve abortion access,” said Tamya Cox-Touré, director of the ACLU of Oklahoma. Cox-Touré said it’s surprising lawmakers think that adding exceptions for rape and incest of a minor reported to law enforcement would stop a potential state question. “We know that an overwhelming number of attacks and sexual assaults go unreported. These exceptions are unworkable.” 

States with rape and incest exceptions typically require a woman to prove that an assault occurred by filing a police report. But most sexual assaults nationwide go unreported, according to the Rape, Abuse and Incest National Network.

Requiring someone who has been sexually assaulted to report to law enforcement can be traumatizing and difficult, especially if they were abused by an intimate partner or family member, said Priya Desai, a board member with Oklahoma Call for Reproductive Justice

And despite the existing exception for saving the life of the mother, women have had to travel out of state to receive emergency health care because Oklahoma doctors said they didn’t think they had the legal coverage to perform the abortion procedure, according to The Oklahoman. 

“They think that these exemptions are going to pacify people, but in reality, the truth is that these exemptions don’t really help that many people,” Desai said.

In February, when Daniels first presented a version of the bill to clearly state exceptions in state law, she told other lawmakers that she didn’t expect rape and incest exceptions to be used frequently. Since last spring when Oklahoma’s most recent abortion bans were approved, no abortions have been reported to the State Department of Health, but it’s unclear how the new laws have affected reporting requirements.

Oklahoma lawmakers enacted several, sometimes conflicting, abortion bans last year in anticipation of Roe V. Wade being overturned. Only one of those bills contained exceptions for rape and incest. 

The Oklahoma Supreme Court overturned those bans in recent weeks after abortion rights groups sued and the court ruled that the Oklahoma constitution protects a woman’s right to have an abortion to save her own life. Now, the state’s abortion ban is only propped up by a 1910 law that bans abortions except to save the life of the mother. 

The state Supreme Court’s actions have made lawmakers feel more urgency to make state laws on abortion consistent and include some exceptions, said Sen. Jessica Garvin, R-Duncan. But some legislators have concerns about backlash from anti-abortion voters if they include exceptions throughout state abortion laws. 

“To take a stance on exclusions is difficult for some because maybe they are worried about the next election,” Garvin said. “Unfortunately, there are a lot of people who are not willing to publicly talk about their stance on abortion. But these are conversations that have to be had.” 

Senate Pro Tem Greg Treat, R-Oklahoma City, told reporters this spring he would support clarifying exceptions to the abortion ban. By the end of the session, Treat said the idea was “controversial” and wouldn’t advance this year.

“Although it’s not something that I would be extremely excited about, I would know that it would protect our ability to protect unborn life to a much greater level if a state question were to come forward,” Treat said in March. 

Stitt said during his 2022 gubernatorial campaign that he would sign a bill that clearly defined exceptions for rape and incest. A representative for Stitt’s office said it was “absolutely not true” that he wouldn’t commit to supporting Senate Bill 368 this session.

“The governor wasn’t noncommittal, rather he hadn’t yet expressed one way or another before it was too late for the bill to advance,” spokeswoman Kate Vesper said. 

Republican lawmakers nationwide are considering exceptions to abortion bans as a way to ward off state questions. Legislatures in other states and in Oklahoma have looked to make the initiative petition process more difficult, as well.

In recent years, Oklahoma lawmakers have tried to pass bills that would increase the number of signatures needed to file an initiative petition, raise the percentage of voters that have to approve a state question and lengthen the time to challenge petitions. Since 2016, Oklahoma voters have approved sweeping criminal justice reforms, expanded Medicaid and legalized medical marijuana — all policy areas the Legislature drug its feet on.

As the state’s Republican majority tries to figure out what approach it will take to clarify laws in the future, local abortion rights groups are preparing to launch an education campaign with an eye on an eventual statewide vote on reproductive rights. 

Advocacy groups say a state question is one way to restore abortion access in the state. The groups could also bring additional lawsuits to the state Supreme Court in hopes of a ruling that people have the right to elective abortions in the state, something the court hasn’t done in past court cases. 

Local abortion rights organizations are also working with groups in other states that have had successful state questions. One initiative petition was filed in Oklahoma last year to restore abortion access, but it was quickly withdrawn.

“We know that when these measures are put to the people through strategic, comprehensive, community-led efforts, abortion wins,” Cox-Touré said. “We know that this is going to be a multi-million dollar effort, and we have to get it right.” 

Voters in other conservative states have pushed back against abortion bans in statewide votes, including a landslide victory in Kansas for abortion rights. Advocates say that gave them hope a state question on abortion access could eventually succeed in Oklahoma. 

The post Despite support from some pro-lifers, efforts to soften Oklahoma’s strict abortion ban failed this year at the Legislature appeared first on The Frontier.

The state will spend $4.6 million to create the Family Representation and Advocacy Program, housed under the Administrative Office of the Courts, to pay and train attorneys to work with parents and kids, manage caseloads and provide support during court cases. The program will also coordinate with social workers and other staff to help families. 

“It’s very exciting,” said Rep. Mark Lawson, R-Sapulpa, who worked to get the bill approved.

Oklahoma’s Department of Human Services and advocacy groups for lawyers, parents and kids have spent years trying to minimize the time children spend in state custody. Parents who lose custody through the child welfare system have a right to an attorney, but the state doesn’t currently have the funding or systems in place to ensure families get well-trained lawyers in a timely manner.

Low pay, high caseloads and a lack of funding for support staff like investigators or expert witnesses make it difficult to find attorneys willing to take on these cases.

Preliminary data from a parent representation program in Tulsa County shows that parents who receive high-quality legal representation are more likely to be reunited with their kids, who spend less time in state custody. Lawmakers pointed to that early success to make a case for statewide funding.

The Administrative Office of the Courts will seek a nonprofit to manage the program through a central state office. 

Lawmakers initially asked for roughly $20 million to roll the program out statewide, but Lawson said the $4.6 million should be enough to set up the central office and begin hiring staff. 

Most counties have existing contracts with attorneys to provide parents and kids legal representation, said former Tulsa County Judge Doris Fransein. Those contracts are paid for with local dollars. District court systems, which have struggled to keep up with costs in recent years, will benefit from the new state program, Fransein said.

The number of counties that can be included in the program will depend on funding. The program will focus initially on counties that have a hard time finding attorneys or that pay the lowest rates. 

Lawmakers will decide how much, if any, additional funding to give the program during the next legislative session. 

“Someone will have to lobby heavily next session for more money,” Fransein said.

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The post Lawmakers fund parent representation program appeared first on The Frontier.

Machines whir outside his door. A wheelchair sits next to Teddy’s bed, the only piece of furniture besides a dresser. He leaves the room for meals and comes back to watch a compact TV that sits at the foot of the bed. Teddy rarely gets visitors. The Frontier and Curbside Chronicle are only using Teddy’s first name to protect his privacy. 

His former case manager, Sherry Helsel, said the nursing facility is a best-case scenario for Teddy, who suffered a traumatic brain injury years before, leaving him with severe memory loss and unable to walk without assistance. After his last family caregiver died, he bounced between shelters and health care facilities. 

When he was discharged from an Oklahoma City hospital in July 2021 after a roughly two-week stay, hospital staff had him dropped off at a local homeless shelter with adult diapers and a walker, Helsel said. Lying in his nursing home bed in April, Teddy said he didn’t remember his time experiencing homelessness. 

“He didn’t ask for any of this,” Helsel said after visiting Teddy, pausing to dab at tears in her eyes. “Life happened to him, like it does to all of us. But a lot of us are fortunate, and we have resources to help us when we’re in this situation.”

In Oklahoma City, there are few good options for people experiencing homelessness who are discharged after a hospital stay but still too sick for the city’s already strained shelters. 

Providers agree a medical-level respite facility would expand care options to more people, but no medical respite program exists in Oklahoma. 

Hospitals mostly provide short-term care for severe illness or injury. The state’s only non-medical respite center for people experiencing homelessness, the Cardinal Community House in Oklahoma City, doesn’t provide care for people with intensive needs like Teddy, who can’t do basic tasks on their own such as going to the bathroom or bathing. 

Oklahoma County’s Social Services Department has a seven-bed contract with Cardinal Community House to give case management and respite services to people experiencing homelessness after they are discharged from area hospitals. More than half of the applications the county has denied are because a person had higher care needs than the respite center could provide, according to county data. 

Meanwhile, the need is growing. Statewide, discharges to homelessness from hospital emergency rooms increased nearly 45% between 2020 and 2022. Emergency rooms discharged about 13,000 people to shelters or the streets during that time, according to provisional data from the Oklahoma State Department of Health. 

A state task force had been studying the problem and looking at ways to use Medicaid funding to expand care options in the state, but efforts stalled after Gov. Kevin Stitt disbanded the Governor’s Interagency Council on Homelessness in April. The governor’s office did not respond to requests for comment. 

The state is also facing a nursing home staffing shortage, making bed space limited at long-term care facilities. People who rely on government benefits to cover care costs have an even harder time getting a bed since state reimbursement rates are often lower than the cost of care.

Cindy Maggart, Mercy hospital’s director of post-acute care services, said her team faces an up to 90% denial rate when trying to get patients who need long-term care into nursing homes. Hospital administrators said it is part of their job to find facilities where patients can get the care they need. But financial barriers, criminal background checks, delays in gathering important documents and fears about losing personal freedom can keep people from some placements.

Without access to additional care options, individuals end up discharged to the street or to local shelters that aren’t equipped to care for them.

“People are being discharged to the street or to the shelters because we’re in this really hard spot of what do we do with this individual, especially those who can’t perform their activities of daily living,” said Racheal Singley, director of Catholic Charities’ case management team serving respite center clients. “There’s nowhere for them to go, and it’s very difficult sometimes to see that.” 

A little more care

Helsel was in her office at the Homeless Alliance, a nonprofit that runs a day shelter in Oklahoma City, in July 2021 when she got a call from a social worker at SSM Health St. Anthony who was looking for someone to take Teddy after the hospital discharged him, she told The Frontier. 

SSM Health said it couldn’t comment because of patient privacy laws, but agreed that the community needs a place for individuals who are too sick for shelters but don’t require hospital care. SSM Health was the first local health system to contract with the respite center in early 2022.

The first question Helsel had for the hospital staffer was whether Teddy could do basic daily living tasks on his own like dressing, eating and going to the bathroom. The hospital worker said yes, Helsel remembered. 

After the hospital dropped Teddy off at the Homeless Alliance, Helsel took him to the City Care night shelter and planned to pick him up on her way to work the next morning. Teddy wouldn’t be able to navigate the mile walk back to the Homeless Alliance day shelter on his own. 

Every night, City Care fits as many people as possible into its 140-bed facility, sometimes going over capacity. On a daily basis, the night shelter sees people who have open wounds, are incontinent or have serious mobility issues, said director Shawn Loyd. 

In the two years since the shelter opened in April 2021, there have been roughly 1,100 ambulance transports from the facility to a local emergency room, according to data provided by EMSA, Oklahoma City’s ambulance operator. 

Staff frequently have to act like nurses aides, Loyd said, showering people or changing adult diapers. But they aren’t trained to do those jobs. Nursing homes and assisted living facilities, which provide those services, have to follow strict guidelines and regulations that the shelter isn’t equipped to handle.  

“We have multiple people that have unmet health care needs, and we still have quite a large number of folks that are walking in the door that are just discharged from a hospital and could use a little more care,” Loyd said.

City Care tries to accommodate those it can, but some people are transported back to the hospital while others can’t stay because of safety concerns. 

When Helsel returned the next day to pick up Teddy, shelter staff told her he couldn’t come back because he wasn’t able to safely perform basic self-care tasks. Case workers arranged for Teddy to stay at a different area shelter, but he was discharged again because the shelter couldn’t care for him either. 

Helsel said she tried to get Teddy into Cardinal Community House, but he didn’t qualify because his care needs were so high.

Cardinal Community House offers a place to recover and receive case management for people who were recently discharged from a health care facility who no longer need hospital-level care but still have ongoing medical needs that would be made worse without somewhere safe to stay. Clients must be able to manage their own personal care and the center does not have its own medical staff to provide care to clients directly. People are usually limited to 30-day stays at the center, unless the contractor paying for their bed — typically a hospital — approves an extension. 

When Cardinal Community House opened in March 2021, it filled a hole in Oklahoma City’s health care discharge system, providers said. People that receive care there are less likely to wind up back in the hospital, and collaboration between hospitals and shelters has increased. But the center has limited funding and is still trying to find new health care groups to partner with.  

“The respite center fills a need, but I think that it has illuminated that there’s still a gap,” said Meghan Mueller, associate director of the Homeless Alliance. 

The Homeless Alliance paid to put Teddy into a hotel while Helsel applied for federal and state benefits and searched for a facility that would accept him. 

Helsel and two other staffers visited Teddy multiple times a day. He couldn’t prepare food for himself or manage his medications. Helsel called other shelters, adult protective services and nursing homes. But Teddy’s applications for benefits hadn’t been processed so he had no way to pay, and he wasn’t approved. After several weeks, Teddy was back in the hospital because of issues with managing his medications. 

The hospital, along with Helsel and Loving Care Management, an organization that helps place individuals in nursing care, eventually found a facility that would accept Teddy in August 2021. He’s still there today.

Helsel brings him bags of Reese’s peanut butter cups and cases of Dr. Pepper when she can. Teddy’s life is small, she said, but a nursing home is safer than living on the streets.

Looking for relief

So far, more than 250 individuals have received services from Cardinal Community House. 

Local hospitals and Oklahoma County’s Social Services Department pay the center to provide a private room, daily meals and case management services for patients that have been accepted into the program. Case workers help clients find permanent housing, apply for benefits and gather personal documents. 

But unlike a medical-level respite program, Cardinal Community House staff can’t provide much direct health care to clients. The center and hospitals can coordinate follow-up appointments with doctors, bring in some home health aides for certain clients, store medications and provide transportation.

Mercy hospital, which pays $135 per day for each of its five contracted beds, has kept its beds full with 20 patients since the contract went into effect in November 2022. 

“It’s that really great pivot point for patients that have really just been through the trenches, and they just need somebody to help them navigate that,” said Cindy Maggart, who directs post-acute care for the hospital. “And instead of bouncing around from shelter to shelter, this provides great continuity for them.”

But the hospital still sees a large number of patients who don’t qualify for the respite center.

In Oklahoma City, the number of people experiencing chronic homelessness — people with disabling conditions that have been homeless for a long period of time — has nearly doubled since 2017, according to counts done by social service providers. These groups tend to have high medical needs and frequently visit emergency rooms. 

Medical respite would increase the range of clients that can be accepted into care programs because health care staff would be employed by or partnered with programs directly, available to do multiple check-ins a day for all clients and help people do care tasks like going to the bathroom or getting dressed. 

“It’s in everybody’s benefit for respite shelters to exist,” said Kelli Ude, director of Cardinal Community House. “How the most vulnerable of our citizens are doing deeply impacts every one of us. With resources like this, we prevent poor outcomes, and we have a healthier community.” 

Cardinal Community House and City Care are both working on plans to develop medical respite facilities in Oklahoma City, but are still searching for funders. Costs have stopped the groups from creating medical respite programs so far. 

Lindsay Cates, a homelessness initiatives coordinator for Oklahoma City, said while there are no plans to use city dollars to help fund respite now, officials may decide to get involved later on. 

Oklahoma’s Medicaid program can cover some high-needs care, said Bobbi Six, the congregate settings project coordinator with the State Department of Health, but it requires a doctor’s order and a permanent place of residence. Getting approval takes about four months, she said. But since the respite center doesn’t directly provide its own health care to clients, it can’t currently receive any insurance payments. 

The state could get a waiver from the federal government to provide some funding to medical respite organizations, but efforts to do so are less coordinated after the statewide homelessness council was dissolved. The federal Centers for Medicare and Medicaid Services approved the first state waiver for funding medical respite in California this year and called respite programs “cost-effective and medically appropriate alternatives” in a January 2023 letter. 

Some hospitals have said they may be interested in participating in a medical respite program, which would likely be a financial benefit to them as individuals stop needing to rely on expensive emergency room visits, administrators said. Hospitals could provide funding or staffing.

“We would fill it up and keep it full,” Maggart said. 

By the end of April, Helsel was preparing for her last day as a case manager. The grant that funded her position was related to the pandemic and expired. She spent her last day visiting clients.

During her two years at the Homeless Alliance, many of Helsel’s clients tried to get care at hospitals and were discharged without adequate resources. Expanded respite programs would have helped, she said. 

As Oklahoma’s population ages, Helsel said she’s not sure the state is prepared. A lack of affordable housing options, low access to mental health care and staffing shortages at care facilities are all serious barriers that have not been addressed.

“There’s not enough funding for care for people with high-level needs,” Helsel said. 

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