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As judge considers holding state in contempt, Md. health secretary defends psychiatric care

Maryland's top health official spent more than 90 minutes in court Tuesday morning defending the pace at which the state is moving mentally ill criminal defendants out of jail and into treatment.

A Baltimore judge is weighing whether to hold the state in contempt for failing to follow court orders to immediately move those individuals into treatment. At times, they have languished in jail for months waiting for space to open in one of the state-run psychiatric hospitals.


Acting Health Secretary Dennis Schrader testified that he's making some administrative changes and directing his staff to shuffle resources to open up room for more patients.

"It's not going fast enough for me," Schrader said.


But under questioning from Sharon Bogins Eberhart of the Office of the Public Defender and Judge Gale Rasin, Schrader acknowledged that he only tracks how many people are in jail waiting for beds, not how long they are waiting. And he often answered questions by saying that he doesn't know all of the details of the mental health system because he delegates responsibility to his subordinates.

He also declined to answer questions about whether he has asked Gov. Larry Hogan for more money to add beds or employees to the hospitals, saying that's information he's not allowed to share.

"That would be privileged," he told Bogins Eberhart, an assistant public defender who handles mental health cases.

He gave the same answer to Rasin when she asked. Schrader said he didn't discuss with Hogan whether or not he could testify about the budget.

"It's understood we don't discuss these matters in public," Schrader said.

Rasin seemed unconvinced by Schrader's attorney's explanation that the development of the state budget is a deliberative process covered by what's known as "executive privilege."

Rasin asked Schrader's attorney, Kathleen A. Ellis from the state Attorney General's office, to submit a written legal argument explaining why Schrader can't discuss his budget requests.

Rasin said it's "highly relevant" to know whether Schrader and his staff have asked for more money as she weighs her decision.


Doug Mayer, a spokesman for Hogan, said in an interview that "many budget options will be considered" next year for dealing with the backlog of mental health patients waiting in jail for space in hospitals.

"The budget process is just beginning and will continue through the fall," Mayer said, adding that the issue is important to the Republican governor.

One year ago, then-Secretary Van T. Mitchell testified before the same judge that he should have asked for more money to alleviate the backups in the state hospital system.

For more than a year, the state has fought being held in contempt for failing to follow court orders to send criminal defendants to psychiatric hospitals because they need evaluations, are incompetent to stand trial or have been found not criminally responsible for their actions.

The state's psychiatric hospital system has been whittled down over the years, as modern medicine has moved away from institutionalizing people for mental illness. But an increasing number of defendants in the court system have mental health issues, and 80 percent of people in the state psychiatric hospitals are sent there from the courts.

Schrader, who took over as acting health secretary last December, said he hopes to get the state hospitals to a point where they are under capacity most of the year, and can handle the surge of patients that tends to come in the spring and summer.


Despite balancing multiple obligations as health secretary — including dealing with possible changes to the Affordable Care Act — Schrader said he's impatient to see progress and he constantly asks his staff for updates.

"All I want to know is: 'Are we making progress?' " he said.

Schrader said he plans to announce a new administrator soon to oversee all state psychiatric hospitals, so they operate better as a hospital system. He's also moving a doctor who works in administration into a clinical role where he will visit hospitals to help improve their care of patients, including more efficiently discharging them from the hospital when appropriate.

Schrader also said the state reached an agreement with Bon Secours Hospital in Baltimore to open five beds that could handle non-criminal patients from state hospitals, and is in talks to open more beds there.

He said a few beds have been opened at Clifton T. Perkins Hospital in Jessup, which treats the most dangerous mentally ill people charged with crimes.

Schrader, meanwhile, is working without pay as a dispute continues over his position. Schrader has not been confirmed by the state Senate, as Hogan withdrew his nomination and then re-appointed him after the General Assembly session ended in April. The General Assembly put language in this year's budget saying unconfirmed nominees could not be paid. Schrader is challenging that in court.


Del. Erek L. Barron, a Prince George's County Democrat, traveled to Baltimore to observe part of Tuesday's hearing. A member of the House of Delegates committee that oversees hospitals, Barron said he's frustrated that mentally ill people continue to be stuck in jail.

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"The longer they go without treatment, it exacerbates their problems," Barron said.

He said if people are held in jail when they should be in the hospital, that could amount to a violation of their constitutional right to due process.

Barron said he's researching whether the Assembly could pass a law to deal with the issue. And he said he thought lawmakers would be willing to give more money to the state hospitals.

But he noted that the request for more money has to come from the governor: "We have to be asked," he said.

An earlier version of this article misspelled the name of Sharon Bogins Eberhart. The Baltimore Sun regrets the error.