Lawmakers hear testimony on Montana State Hospital staff ‘exodus’

HELENA — Lawmakers heard hours of testimony Friday about critically low staffing levels at Montana State Hospital, the state’s only public psychiatric facility, in a tense hearing with state health officials, workforce representatives and patient advocates.

A federal investigation in late September by inspectors from the Centers for Medicare and Medicaid, first reported by Lee Newspapers State News Bureau, found that low staffing at the hospital in Warm Springs had resulted in insufficient monitoring of high-needs patients. At least one employee told inspectors that an elderly patient’s death in August may have been associated with staffing shortages.

“The turnover is my greatest concern. That directly results to poor patient care,” said Sen. Mark Sweeney, D-Philipsburg, who testified to the Legislature’s Children, Families, Health and Human Services interim committee about what he called an “exodus” of qualified staffers.

The hospital currently serves about 230 patients and could employ 524 workers, though approximately 40% of those positions are currently vacant, according to a December description of the facility by the Department of Public Health and Human Services. The hospital has increasingly relied on expensive contracts with traveling nurses, who are often paid at higher rates than long-term employees.

Union representatives from the Montana Nurses Association and the Montana Federation of Public Employees, as well as current and former hospital staffers, said working conditions, morale and patient care are suffering profoundly. Many people who testified pointed to the hospital’s current administration as a driver of staff discontent and the hospital’s struggling operations. 

The health department has advertised a $2.2 million contract for temporary management of the hospital and other state-run facilities with a Jan. 26 deadline for applications. The contract is slated to begin in February and expire in June 2023. 

DPHHS director Adam Meier said finding a new executive facilities director would be an essential part of stabilizing management and objectively assessing the facility’s operations.

“I think there’s a number of things that we can do. But what I’m not going to do is be rash. I’m going to be objective, I’m going to look at the data,” Meier said. New management, he said, will help the department “really get an understanding of what’s really happening on the ground.”

Some current hospital employees who testified Friday took issue with that use of funds, suggesting that the department instead invest in better staffing and care for patients. 

“Instead of spending $2.2 million, let’s look at getting psychologists. Therapists. Offer our patients therapy,” said Debbie Mehring, a hospital social worker.

Montana State Hospital treated approximately 850 patients in fiscal year 2019, according to DPHHS, through a combination of civil and involuntary commitments, emergency detentions, and placements ordered by a judge. Over the last two years, the department estimated, more than 60% of patients at the hospital had a co-occuring mental illness and substance use disorder.

Behavioral health care providers in Montana have for months identified the strain on industry staffing as a growing emergency that has intensified during the pandemic. A January survey of providers conducted by the Behavioral Health Alliance of Montana pointed to low Medicaid reimbursement rates, which are set by the state, and a dearth of eligible applicants as the greatest obstacles to hiring for open positions. 

BHAM said that burden is being acutely felt across the industry, pointing to the recent closure of group homes and a 25% statewide reduction of available beds for children and adults.

Lawmakers and officials on Friday struggled to agree on immediate solutions to stabilize the workforce, both at the state hospital and for other providers. Rep. Mary Caferro, D-Helena, asked Meier whether money set aside during the last legislative session could be spent on short-term wage enhancements for providers. Meier said the department is instead studying provider rates to inform calculated decisions about rate changes during the next legislative session in 2023.

“What you’re talking about is building a barrier around the house when the house is on fire,” Caferro responded. “The house is on fire. We don’t have time to study.”

Later in the hearing, Meier agreed that “there are fires burning,” but said he’s hesitant to make a decision that is not informed by comprehensive data and analysis.

After the application window for a new facilities contractor closes, Meier estimated, it might take a month to review bids and award contracts.

Regarding the study of provider rates, the director said he aims to have more data to analyze and digest by the end of the summer.