A State Hospital’s Troubles: Typical for the Country
Western State Hospital in Lakeland WA is undergoing troubles again. In an article published on the local tv news outlet KOMO-tv, entitled, “Western State Hospital warned again about the loss of federal funding,” by Keith Eldrige on Friday, July 7th, 2017 the details and some of the history leading up to this sad state of affairs is enumerated in straight forward and informative fashion.
A little background is in order to be fair and honest to the reader as taking thins out of context can almost always lead to a quick and wrong impression. As state hospital go, Western was doing fairly well under very trying circumstances that have been in NO way unique to it alone. It has been besieged in recent years like all state hospitals by the new wave of “ITP” or incompetent to proceed patients that have emerged in nothing short of droves of thousands across the country. These patients are one of the most obvious results of the “trans institutionalization” of patients from the ‘under-bedded’ state and local public psychiatric hospital systems nationwide through the misguided efforts to cut inpatient psychiatric beds drastically to save monies in state budgets, in turn, themselves slammed around economically by the huge impact of the Great Housing Bubble burst [read runaway Wall Street greedy foolhardy faulty and dishonest mortgage packaging of the 2000’s]. States had to cut budgets drastically and almost universally their mental health segments had to be cut and beds cut and the hospital closed out of hand in many states. So we had the well-known issue of the chronically mentally ill appearing out in the public without almost any housing and inadequate outpatient services in almost every state. And to survive they did things that put them in jail in droves. It was perhaps a little ironic or surprising that one very conservative [I do not mean that politically at all] group nationally, the associations of country sheriffs and other such law enforcement policy groups became some of the EARLIEST non-clinical groups yelling to the rooftops along with mental health advocacy groups such as NAMI, the Judge Bazelon Center, and Dr. E. Fuller Torrey’s national advocacy group, The Treatment Advocacy Center.
Dr. E. Fuller Torrey, national psychiatric advocate for the severely mentally ill
For the last two years or so, Western State Hospital had severe staffing and staff recruitment problems in additional to the influx of the mentally ill legal ITP patients. Staff, CNA;s (certified nursing attendants [called ‘ward techs’ when I worked my way through medical school as on]) and nurses left the hospital in certain predictable numbers as occurs in all places of work, be they hospitals or not. But the difference was, the pay scales for Western were not high enough to attract new staff to work there. The hospital is in the situation as unfortunately are so many state hospitals (including mine) is country non-urban [read big city with lots of people to recruit from]. And not too far away are the more affluent private hospital in larger regional population centers in that part of the state and a VA Hospital which pays federal level salaries, always higher for every job classification in such hospital systems. So many employees, including psychiatrists, left the hospital. Approximately two years ago, so many psychiatrists, perhaps a dozen or so if my swiss cheese memory serves me even approximately. That immediately left wards with little or no psychiatrist coverage and very quickly approximately 100 beds, several wards, had to be closed. That made the news nationally big time as the kids would say. And that did not sit well with the powers that be in Washington state. Bottlenecks of patients waiting in hospital ERs quickly developed. There was a case in the last year of a demented man who could not be accommodated into the hospital because there was no bed. That hit the media flames and was a mini-scandal. And the influx of the legal patients, the ITPs had to be taken first since they were court ordered as is the case around the country. As the legal patient continued to be referred and admitted at their usual and unending rate, the number of beds for ‘regular’ psychiatric patients diminished and that created the expectable hue and cry from heads of ERs in area hospital and family members of those patients who had to wait days and weeks for a bed to open up. The expectable happened, the hospital administer was chopped and then in the latter part of last year, a lady administrator was tapped to take on the gargantuan task of trying to make it all work better. By all accounts, she has been unflinchingly honest in public testimony before the hospital legislature and an unstinting advocate for her hospital and its deserving resident clients. Gradually Western has clawed it was to better functioning.
But it is not out of the wood yet. Part of what a hospital in Western’s plight, is that of continuing inspections and reviews by the “Feds,” often in the person of CMS, which is the Centers for Medicare and Medicaid Services. Since state hospitals typically serve the poor with such insurances, CMS makes sure that such hospitals meet certain quality of treatment and safety standards. And these standards are no piddling thing, the manuals of standards are as big as the annual federal budget and more specifically detailed.
Western still had budgetary gaps and big ones. It had deficiencies in safety, inadequate fire control measures, areas of the structure that drastically need renovation, and still staff issues. Staff have been required to work overtime on a regular basis for many months to make up for the migrating losses of staff to other facilities as detailed about. This resulted in frank and known and identified burn out and work fatigue identified by the hospital and more staff quitting. So Western has been in a vicious cycle of I suppose almost barely keeping its head above water with respect to staff and still not being able to get back up to full capacity.
The Governor of the State is Mr. Jay Inslee, a Democrat. He has a Republican-controlled state legislature. He has worked openly and tirelessly with the legislature to craft compromise funding bills to help the state hospital system and it has been hard and slow. And, in effect, not fast enough to remedy the long-standing and recent acute problems of Western State Hospital over the last two years or so.
The importance of all this is of course money. Money to support the hospital, part of which obviously comes from the state’s legislature and the rest from usually not very large patient collections, but the rest coming from the Federal agency, the CMS. If a hospital loses accreditation, it loses CMS funding. And then the state has to make up the difference immediately often to the tune of a million dollars a month or more in most states I have followed over the past decade or so that have gone through this painful process. Often the Feds, such as CMS, give extra time, in this case, another 60 days for Washington to put in place beginning remedies, in order to give the whole process time to hold off on the “death sentence” of cutting off federal funding altogether as it usually takes a long time, like well over a year or so if not more, to make big and expensive repairs in the physical plant and recruiting psychiatrists and psychologists to the tarnished hospital.
Western State Hospital and Washington are one of several state hospital systems in the same position and there are no easy answers for any of these bodies that are ‘under the gun.’ But one answer is clear and has been in plain sight for decades and is THE root cause for all this, large and continuing sums of monies must be spent by state legislatures to correct the neglect of decades of the mental health delivery systems.
I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.
View all posts by Frank
The Mental Health Reform Blog 