HELENA — On Friday, state lawmakers pressed administrators for more details on how they’re addressing ongoing safety and staffing concerns at the Montana State Hospital.
“I appreciate all the efforts, the studies and the long-term approach – that’s needed,” said Rep. Ed Stafman, D – Bozeman, chair of the Children, Families, Health and Human Services Interim Committee. “But I’m also concerned about patient safety today and tomorrow.”
Adam Meier, director of the Montana Department of Public Health and Human Services, testified before the committee Friday. The update came a month after the Centers for Medicare and Medicaid Services terminated its provider agreement with the hospital, citing significant deficiencies. A federal report said some of those issues led to patients’ deaths.
After the termination, DPHHS replaced the hospital’s administrator and brought in contractors to identify ways to improve their policies to address the issues raised in the CMS report.
In one example, the report said the hospital hadn’t done enough to protect patients from serious falls. Meier said they’ve begun having people at risk of falling wear colored bands so they can be identified. However, he said the contractors told them they needed to do more to make sure everyone at the facility understands what those bands mean.
“They’re really helping us color in the lines, so to speak, in a lot of areas where they’re seeing gaps,” said Meier.
However, lawmakers continued to ask for more immediate action.
Rep. Danny Tenenbaum, D-Missoula, was part of a bipartisan group of four lawmakers that toured the Warm Springs facility earlier this week. He said he was shocked by the conditions.
“It was disturbing and disgusting, and it’s unacceptable,” he said.
In one exchange with Meier, Tenenbaum said employees showed him some patients with dementia were being housed four to a room.
“If we return for a tour of the State Hospital – say, before our next meeting, which is June 27 – are we going to see that same four people in a room?” he asked.
Meier responded that there aren’t enough alternate placements available for these patients.
“I can’t make any commitment to whether we can get people out by a certain deadline, because we have to create places for them to go – absent putting them on the street,” he said. “I share your concern, and again it’s one of the reasons that I felt things were problematic.”
But Tenenbaum said there was other space available at the hospital itself, in wings that aren’t currently being used.
“I know the space is there, we saw the space,” he said.
Meier said it’s a multifaceted issue and there’s not a simple solution. He said, to use those wings, they’d have to find staffing for them and make sure they’re adequately licensed.
He pointed to what he called an “acute workforce shortage.” While he said the hospital isn’t technically understaffed, he admitted it is reliant on contracted employees who tend to rotate in and out more often. That means there’s less consistency in care and a need for more frequent training.
Also during the hearing, the committee supported moving forward with a bill draft, to be presented to the next legislative session, that would require the state to begin transferring patients out of the State Hospital if their primary diagnosis is Alzheimer’s disease, dementia or traumatic brain injury. Under the current proposed text, DPHHS would need to find new community placements for those patients by 2025.
DPHHS leaders said they appreciated the intention of the bill, but they were concerned about the timeline. They said more community capacity needed to be developed so that these patients can be moved. However, lawmakers said they didn’t want to continue putting the issue off.
“Although it’s not the five years that some suggested, it is a good three years from now,” said Rep. Jennifer Carlson, R-Manhattan. “I think that, in my opinion, we need the impetus to do it.”
Tanenbaum said, after talking to DPHHS leaders and other stakeholders, he was confident they could make some revisions to the bill draft to address most of the concerns that have been raised.
“We think that we can get to a common bill that everyone will be pretty satisfied with,” he said.
Tanenbaum told MTN that, according to MSH leaders, the hospital has worked with more than 400 patients in the last year, and only about 20 of those had a primary diagnosis of dementia or traumatic brain injury.
The committee also endorsed another bill draft, which would require the state to share reports about allegations of abuse and neglect at the State Hospital with Disability Rights Montana.
“It gives another set of eyes,” said Bernadette Franks-Ongoy, Disability Rights Montana’s executive director.
When CMS terminated its agreement with MSH, the hospital lost access to about $7 million in annual federal funding. Meier said Friday that federal authorities have said it will be some time before they’re willing to consider renewing an agreement with the hospital. He also said DPHHS wants to wait to reapply to CMS until they make other decisions about the facility’s future. For example, if the state decides to keep only correctional patients there, it wouldn’t be eligible for CMS funding.