Consultants provide update on Montana State Hospital assessment

Montana State Hospital
Posted at 9:47 PM, Jun 27, 2022

HELENA — On Monday, a state legislative committee heard from the consultants who’ve been brought in to help address the ongoing issues at facilities like the Montana State Hospital.

Diane Rafferty and Chris Baglio, of the firm Alvarez and Marsal, spoke in front of the Children, Families, Health and Human Services Interim Committee.

The Montana Department of Public Health and Human Services hired Alvarez and Marsal to do a comprehensive assessment on seven state-run health care facilities.

“The goal is to create sustainable improvement at each facility,” Baglio said.

Much of the attention has focused on MSH, which has faced ongoing concerns about staffing and patient safety. The Centers for Medicare and Medicaid Services terminated its provider agreement with the Warm Springs facility earlier this year, citing a report that identified numerous deficiencies – including some that led to patient deaths. DPHHS has since replaced the hospital’s administrator and brought in contractors to address the issues.

“These are issues that have been long-standing and building over time,” said Baglio. “So as we’re working toward that lasting change, which is going to take time, we’re also looking for short-term wins – opportunities where we can show some improvement now.”

The consultants acknowledged the continuing challenge of recruiting staff – particularly nurses – which has required MSH to use contracted employees. They also said there’s been a lack of needed staff training.

Rafferty said one of the biggest issues has been a lack of the data they’d need to track quality improvement. She said MSH doesn’t have electronic health records.

“When we try and understand the use of restraints, the use of medication, we have to go through 100 paper charts,” she said.

Rafferty said DPHHS is looking at switching to an electronic records system, but it’s likely several years away. In the meantime, she said they’ve asked administrators at MSH and the other state facilities to identify two data points they can start monitoring to get a better understanding of quality of care.

“Those metrics have never been measured, so it’s hard to say what success looks like if you’ve never measured it,” said Rafferty. “That’s why we’re starting from scratch.”

Rafferty said she believes fewer of the serious incidents that had been seen at MSH have occurred in the past few months. She credited the change in leadership, working with the staff and support from DPHHS.

“Small steps, but we’re making the right moves,” she said.

She also identified one key positive: the commitment of MSH staff.

“The people that are still there really care about their patients and are proud to come to work every day, and when they see things in the press and they see the bad things, it’s been hard on their morale,” she said. “Many of those staff will stay, so it’s our job to get them trained, get them competent, look at the care delivery model, look at our patient outcomes and make sure that the patients are in the right place, at the right time, with the staff to deliver their care.”

The consultants said they have completed a “culture and climate survey.” Baglio says the goal was to hear concerns from staff at the facilities they’re evaluating and to identify ways to encourage retention. The full results are set to be released next week.

Their overall assessment should be completed around October.

Also at Monday’s hearing, the committee moved forward with a bill draft that will go before lawmakers during next year’s legislative session. By 2025, it would prevent people from being committed to the Montana State Hospital if they have a primary diagnosis of Alzheimer’s disease, dementia or traumatic brain injury – unless they have harmed or are at an immediate risk of harming themselves or others.