Oregon board explains why it repeatedly released killer from psychiatric hospital

Three members of the five-person Oregon Psychiatric Security Review Board reviewed cases at the Oregon State Hospital during a public hearing earlier this month. (Bruce Ely / Special to the Malheur Enterprise)

The five members of the Oregon Psychiatric Security Review Board declined interview requests from the Malheur Enterprise and ProPublica. The members instead responded as a board to written questions about their practices and the case of Charles Longjaw. The board manages the custody and care of people such as Longjaw, who have been found guilty except for insanity in felony criminal cases.

How was the PSRB [Psychiatric Security Review Board], OSH [Oregon State Hospital] and state law different from today when Longjaw was found GEI [guilty except for insanity] in 1986? 

There are a few differences in the law between 1986 and today. First, in 1986, there was no requirement that an evaluation be performed by a certified forensic evaluator in order to successfully plead GEI. Also, 1986 predates statutory and case law expressly removing personality disorders, sexual conduct disorders and voluntary substance-related intoxication from the definition of mental illnesses that would qualify for the purposes of a GEI plea.

After reviewing your documents about Longjaw’s conditional releases, do you agree with those prior decisions? In hindsight, are there red flags that today’s board might have weighed differently?

The Board grants conditional releases to patients properly under its jurisdiction whom the evidence shows can be adequately controlled within the community. The Board applies this standard on a case-by-case basis based on the facts as they were at the time of the hearing. Knowledge of subsequent facts cannot change the facts as they were at the time of the decision.

When did you first learn about the 1999 rape by Longjaw?

Individual Board members find out about other offenses (or alleged offenses) at different times, but most likely, the Board members would find out about something like this by the time they were preparing for the next hearing involving the patient, if they didn’t know before. According to records, it appears that PSRB staff were notified of the patient’s arrest on February 22, 1999, via a memo from Parole Officer Duane Terry (who had discovered the charge that day) to Mary Claire Buckley, executive director.

Did the board do any internal review at that time? Why or not?

The Board has found no documents that would allow it to answer this question.

What could have been done differently to prevent the [1999] attack? (by the PSRB or others).

It would be inappropriate for the Board to speculate on this with respect to other parties. The Board itself would have looked at the evidence before it and decided whether the patient’s case met the statutory requirements for conditional release at the time of the hearing, but must make the same decision if the evidence indicates that the patient is qualified for conditional release.

If everyone did everything right, is this an expected and accepted outcome in some cases? Explain.

Bad—and sometimes serious—outcomes occur in many arenas, even when everything is done appropriately under applicable law and other guidelines. In the PSRB’s case, conditional release decisions are based on the evidence at the time of the patient’s hearing. Most patients do not reoffend while on conditional release status. Some experience a decline in mental health status or violate the conditions of their release and have their conditional release revoked. When this happens, most of the time the patient does not reoffend prior to the revocation. Very occasionally, a patient on conditional release does commit another offense: even a serious one. Obviously, these results can be horrible. The Board is always cognizant of these possibilities when considering whether it thinks the patient can be maintained safely in the community, and as members of the community themselves, it affects the Board when there are bad outcomes.

Why was 2015 the first time Longjaw had a risk review?

According to available records, the 2015 hearing was this patient’s first since 1998 (as he had been incarcerated in Washington for most of the intervening time). The risk review panel was not part of the conditional release process in 1998.

Would a modern-style risk review have provided the board at the time with any more information than they received?

The risk review panel relies on a patient’s presentation at the time of the review. What the panel would have turned up at any point in the past is a matter of speculation.

When did the PSRB staff learn about the 2016 murder charges against Longjaw?

There is no requirement that law enforcement or the courts notify the PSRB when one of its former patients incurs new charges, so there would have been no uniform time that the Board found out about these new charges.

When did you first learn about Longjaw killing a man in 2016? What was your initial reaction, as a community member and as a board member?

As above, the Board finds out about the new charges of its former patients at different times because there is no requirement that law enforcement or the court notify the Board officially. Like any member of the community, however, the Board members are saddened by such deaths.

Did the board do any internal review at that time? Why or not?

The decision to discharge Mr. Longjaw was based on the evidence available to it at the time of his hearing and on Oregon Revised Statute 161.351(1), which requires the Board to discharge any patient who is shown to no longer be affected by a qualifying mental disorder or to no longer be dangerous. Both qualifying mental disorder and dangerousness must be shown in order for the Board to maintain jurisdiction. Any review in this type of case could only have focused on that determination.

What could have been done differently to prevent the attack? (by the PSRB or others)

It would be inappropriate for the Board to speculate on what other parties should have done. As with conditional release, the Board would have looked at the evidence before it and decided whether the patient’s case met the statutory requirements for it to maintain jurisdiction, and when it does, it must discharge the patient if the evidence indicates that the patient does not meet the jurisdictional requirements under statute.

What does his conviction this month mean to the board, as a body and as individuals?

Generally, the Board does not comment on the outcome of cases that don’t involve it, but as a body, it hopes that all court decisions are appropriate under the circumstances.

If everyone did everything right, is this an expected and accepted outcome in some cases? Explain.

Bad — and sometimes serious — outcomes occur in many arenas, even when everything is done appropriately under applicable law and other guidelines. In the PSRB’s case, sometimes a patient recovers from his/her qualifying mental disorder or it is discovered later that the cause of the behavior was not what it was thought to be when the patient was placed under the Board’s jurisdiction. Once the Board discovers this, it has a statutory duty to discharge the patient from its jurisdiction. Mental health issues are multi-faceted and as such, and it is difficult for everyone involved to make an exact diagnosis. Over the years, the law has changed in order to minimize the danger to the public from those found Guilty Except for Insanity and placed under the board, and from those convicted and placed in the corrections system. The Board is always on the lookout for ways to improve the system, such as the addition of the certified evaluator. These improvements will not prevent all bad outcomes, but they can reduce their frequency.

Under what circumstances should the PSRB review prior decisions or its procedures?

The Board consistently reviews its procedures in order to find improvements. In hearings, the Board carefully considers all the evidence and applies the law to the facts. Once reviewed, it would be rare that one of the Board’s decisions would change based on subsequent events because the facts as they were at the time of the decision would have remained the same.

Why did the PSRB discharge Longjaw in 2015 despite abundant evidence that he was dangerous?

According to ORS 161.351(1), the Board must discharge any patient who either does not have a qualifying mental disorder, or does not present a substantial danger to others when that qualifying mental disorder is active. If even one is not present, the Board has no choice under the law but to discharge the patient.

Is that a sign the law is flawed? Explain.

If the law allowed for the Board to maintain under its jurisdiction those who are dangerous but who do not have a qualifying mental disorder, the potential would exist that it could find itself in a position to maintain jurisdiction over anyone who was considered dangerous, even if they didn’t have a mental illness. Criminal insanity under the law requires both, and removing part of the law could lead to violations of the rights of some in the community who should not be under the Board’s jurisdiction.

Is the board discussing any changes to procedures or recommended changes to law after the Longjaw and Montwheeler [Anthony W. Montwheeler] cases? Explain. (These could be recommendations related to the PSRB or other parts of the system.)

The Board is always considering how to improve its processes and procedures. Any changes would have to comply with all applicable laws and be reasonably likely to improve the service the Board provides for the public’s benefit. If the Board developed (or discovered) such options, it would certainly consider them.

Did Carter [Longjaw’s case worker] promptly notify the board director about moving to a new home, which violated conditions, after learning about it Aug. 4, 1994?

According to the document you’ve cited, she appears to have notified PSRB staff on August 8, 1994, following the August 4, 1994, meeting.

Currently, when a case manager finds out about a patient’s violation via a voluntary statement from the patient during a scheduled appointment, the case worker might check with the patient and/or others (a drug and alcohol counselor, instructor, employer, etc.) who might have further information regarding the situation, including whether what the patient said is true. Once the case manager has this information, she will tell the PSRB right away if she believes the violation will put the public at risk and/or if the patient’s mental health status has changed significantly. In less acute situations, the case manager might call the PSRB a few days after the incident, or include it in her monthly report on the patient.

What was the director’s response?

That information usually isn’t in the exhibit file, since the file’s purpose is to help the Board determine the propriety of its jurisdiction over the patient and other conditions. Rarely would the executive director’s response to a particular incident report help the Board decide the answer to either of those questions.

Regarding revocations, I should cover a couple of pieces of general information. First, revocation is only one tool at the PSRB’s disposal when patients experience a change in mental health status or violate the terms of their conditional release. Second, these tools—including revocation—are designed to keep the public safe and to aid in recovery, not as punishment. Typically, revocation orders only outline conditional release violations that formed the cause of the revocation. According to the affidavit accompanying the revocation order, it appears that the patient’s conditional release wasn’t revoked because he moved without telling his case manager.

Reporter Jayme Fraser: [email protected], 541-473-3377, twitter @JaymeKFraser. As part of ProPublica’s Local Reporting Network, Fraser spending the year examining the way states manage people with mental illnesses who commit violent crimes.

Oregon failed to keep public safe: The story of Charles Longjaw.

EDITOR’S NOTE: The Malheur Enterprise continues to investigate the state system that freed Anthony Montwheeler. He is facing trial in Vale for murder, assault and kidnapping for a January 2017 string of crimes. He might once again assert an insanity defense to criminal charges. The Enterprise received funds from ProPublica, the New York-based nonprofit investigative newsroom, to hire Fraser to advance the project, focusing on the Oregon Psychiatric Security Review Board. – Les Zaitz