Five takeaways from our reporting on Montana State Hospital 

As Montana Free Press recently reported, medical practitioners and other staff at the state psychiatric hospital in Warm Springs are raising alarms about new leadership and policy changes at the public facility — with one employee describing current working conditions as “like being stuck in a recurring bad dream.”

The complaints come nearly two years after federal regulators pulled certification from the Montana State Hospital as a result of patient deaths and safety concerns. The administration of Gov. Greg Gianforte has pledged to regain that certification from the Centers for Medicare and Medicaid Services, calling the current reforms at the hospital part of a “significant cultural, clinical, and operational transformation” in a Wednesday statement to MTFP.

Here are five key takeaways from our reporting.

#1 The state has parted ways with the hospital’s longtime chief medical officer

The same day MTFP published its article about staff turnover and other issues at the hospital, the state health department confirmed that Dr. Thomas Gray, a forensic psychiatrist and the facility’s longtime chief medical officer, is no longer a hospital employee. 

Gray, whom many clinicians regarded as a cornerstone of the institution, was placed on paid administrative leave in December, according to multiple current and former staff who said they were never given a reason for his departure. The state on Wednesday declined to provide further information about the end of Gray’s employment by the state, citing the confidentiality of personnel matters. 

Gray could not be reached for comment Thursday.

#2 Montana State Hospital’s current top doctor lives in Wyoming and works other jobs

In December, the state health department contracted with Traditions Behavioral Health, a California-based staffing company, to hire Dr. Micah Hoffman as its new chief medical officer. Hoffman lives in Wyoming and concurrently works other jobs in addition to being the top doctor for Montana’s roughly 260-bed campus in Warm Springs. 

The health department on Wednesday clarified that Hoffman, unlike other recent administrators at the facility, is not considered an interim contractor. Rather, the state said, Traditions Behavioral Health is providing “permanent physician leadership” for the hospital. 

In response to a question about Hoffman working from Wyoming, the department said the new chief medical officer “is onsite every other week, and when not onsite is directly engaged with the day-to-day operations at MSH remotely. This model is not uncommon and [is] used by other states.”

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#3 Advanced Practice Registered Nurses at the hospital are unionizing

In emails obtained by MTFP, labor leaders with the Montana Nurses Association in March congratulated a group of advanced practice registered nurses (APRNs) on the recent filing of a petition to pursue unionization. 

The hospital administration in Warm Springs had been notified, organizers said, but still had time to file a response to the petition through the Board of Personnel Appeals within the state labor department. Additional hearings on the unionization effort could take place in April.

The state health department did not respond to a specific question from MTFP this week about the nurses’ decision to unionize. 

#4 Medical staff are pushing back against new rules they say undermine patient care

In two April staff meetings with hospital medical practitioners and administrators, recordings of which were obtained by MTFP, doctors and APRNs raised multiple concerns about new rules handed down by state health department leaders and consultants.

Providers said they were being strongly dissuaded from ordering direct supervision of patients,  a protocol known as 1:1 staffing. If a patient is on 1:1 staffing, clinicians have to justify continuing that arrangement to hospital administrators for longer than a day. 

Medical staff said 1:1 staffing is an essential tool to help protect patients who pose a risk to themselves or others, forecasting that patients could die as a result of the new deterrence. Administrators countered that the new rules are designed to reduce staffing costs and help find better long-term alternatives for patient care.

Medical practitioners also raised concerns about having to submit daily and weekly documentation of patient treatment, often without the assistance of dictation or transcription services, and a new restriction on reviewing security video footage after safety incidents involving patients. 

#5 State health department is mum on concerns about privatization or closure

Current and former hospital staff told MTFP they fear that policy changes are meant to drive out long-time health care providers and destabilize the institution enough to justify its closure or privatization. 

“The only way people can make sense of the actions of these quote-unquote leaders is to say that the whole purpose is to scuttle the place. Is to destroy it,” said one medical provider who requested anonymity out of fear of professional retaliation. “I don’t buy that, but that’s what people are saying.” 

In its responses to MTFP’s questions, the state health department did not directly comment on that fear. MTFP’s question referenced policy changes, such as those regarding 1:1 staffing, that employees described as creating instability that could lead to closure or privatization. The state’s response justified the changes as being “based on state and federal rules and regulations,” but did not reference employee speculation about the prospect of privatization. 

Questions, comments or feedback about MTFP’s reporting on the Montana State Hospital? Reach out to [email protected].